What Shoes Are Best for People With PAD?

For individuals managing Peripheral Artery Disease (PAD), daily choices can have a significant impact on comfort and long-term health. While much attention is given to diet, exercise, and medical treatments, one of the most overlooked yet crucial elements of a comprehensive care plan is footwear. The right pair of shoes is far more than a fashion statement; it’s a vital tool for protecting your feet, improving mobility, and preventing serious complications.

PAD restricts blood flow to the extremities, making the feet particularly vulnerable. This poor blood flow in legs and feet can lead to a range of issues, from chronic foot pain and numbness to a decreased ability to heal from minor injuries. A simple blister or scrape that would be trivial for a healthy person can escalate into a non-healing foot ulcer for someone with PAD. These ulcers create a dangerous entry point for infection, which can lead to severe consequences.

Choosing the right shoes is a proactive step in your Peripheral Artery Disease treatment. Proper footwear can enhance comfort during walking, reduce the risk of injury, accommodate swelling, and provide the stable support needed to stay active. This guide will walk you through the essential features to look for in a shoe, recommend specific types of footwear beneficial for PAD, and provide tips for getting the perfect fit to safeguard your foot health.

Why Footwear is a Critical Component of PAD Care

The feet of a person with PAD are in a delicate state. Reduced circulation means less oxygen and fewer nutrients are reaching the skin, nerves, and tissues. This leads to several challenges that the right shoes can help mitigate.

1. Reduced Sensation (Peripheral Neuropathy):
   Many people with advanced PAD also suffer from peripheral neuropathy, a condition causing numbness, tingling, or a complete loss of feeling in the feet. This is especially common in patients who also have diabetes. When you can’t feel your feet properly, you may not notice if your shoes are rubbing, causing a blister, or if you’ve stepped on a sharp object. A well-fitting, protective shoe acts as a shield for feet that can’t fully protect themselves.
2. Increased Risk of Ulcers and Wounds:
   The combination of poor circulation and reduced sensation is a dangerous recipe for developing foot ulcers or toe ulcers. Ill-fitting shoes that are too tight, too loose, or have rough internal seams can create pressure points and friction. Over time, this constant rubbing can break down the skin, forming a sore. Because of the poor blood flow, this sore may not heal, creating a chronic wound. This is particularly concerning for those at risk of a diabetic foot ulcer or a neuropathic foot ulcer.
3. Alleviating Foot Pain and Discomfort:
   PAD can cause a variety of uncomfortable sensations, including foot pain, cramping, and a feeling of coldness or numbness. Shoes with excellent cushioning and support can help absorb the impact of walking, reducing stress on sensitive feet and joints. The right footwear can make walking programs—a key therapy for PAD—more comfortable and sustainable.
4. Accommodating Swelling:
   Circulation issues can sometimes lead to edema, or swelling, in the feet and ankles. This swelling can fluctuate throughout the day. Shoes that are too restrictive can become painfully tight, further impeding blood flow. Footwear with adjustable closures and flexible materials can better accommodate these changes in foot size, ensuring consistent comfort and safety.
5. Providing Stability and Preventing Falls:
   Leg pain and muscle fatigue associated with PAD can affect balance and gait. Sturdy shoes with non-slip soles provide a stable base of support, helping to prevent stumbles and falls that could lead to injury.

Investing in proper footwear is a direct investment in your mobility and a crucial strategy for preventing the complications that arise from having blocked leg arteries. It’s a simple yet powerful way to protect your most vulnerable assets.

The Anatomy of a PAD-Friendly Shoe: Key Features to Look For

When shopping for shoes, PAD patients need to look beyond style and focus on specific functional features. Think of your shoe as a piece of medical equipment designed for protection and comfort. Here are the non-negotiable characteristics of a good shoe for someone with PAD.

1. A Wide and Deep Toe Box

This is arguably the most important feature. The “toe box” is the front part of the shoe that houses your toes.

• Why it’s important: A narrow, pointed toe box squeezes the toes together, creating friction and pressure points that can lead to blisters, corns, and ulcers. A wide toe box allows the toes to spread out naturally, reducing rubbing and pressure. A deep toe box provides extra vertical space, which is crucial if you have deformities like hammertoes or bunions.
• How to check: You should be able to wiggle your toes freely inside the shoe. There should be about half an inch of space (a thumb’s width) between your longest toe and the end of the shoe.

2. Superior Cushioning and Shock Absorption

Every step you take sends a shockwave up through your foot and leg. Good cushioning can absorb a significant amount of this impact.

• Why it’s important: Cushioning protects the delicate tissues and bones in your feet from repetitive stress, reducing foot pain and fatigue. This is especially important for the heel and the ball of the foot.
• What to look for: Look for shoes with thick, responsive midsoles made from materials like EVA foam or gel. Removable insoles (or “sock liners”) are a major plus, as they allow you to add your own custom orthotics for even better cushioning and support.

3. Excellent Arch Support

The arch of the foot acts as a natural shock absorber. Proper support helps it function correctly and prevents a range of foot problems.

• Why it’s important: Good arch support helps distribute pressure evenly across the foot, preventing pain in the arch, heel (plantar fasciitis), and ball of the foot. It also promotes proper body alignment, which can help alleviate knee, hip, and back pain.
• What to look for: The shoe should have a firm, supportive structure in the midfoot area. When you try to bend the shoe, it should bend at the ball of the foot, not in the middle of the arch.

4. Breathable Materials

Healthy air circulation around the foot is essential for preventing moisture buildup.

• Why it’s important: Feet that are constantly damp are a breeding ground for fungus (like athlete’s foot) and bacteria. Moisture also softens the skin, making it more prone to blisters and breakdown.
• What to look for: Choose shoes made from materials like mesh, soft leather, or canvas that allow air to circulate. Avoid non-breathable materials like plastic or patent leather for everyday wear.

5. Seamless and Smooth Interior

The inside of the shoe should be a friction-free zone.

• Why it’s important: Rough seams, stitches, or tags can rub against the skin, causing irritation and sores, especially if you have neuropathy and can’t feel the rubbing.
• How to check: Run your hand along the inside of the shoe. It should feel smooth and free of any lumps, bumps, or rough edges that could chafe your foot.

6. Adjustable Closures

The ability to customize the fit of your shoe throughout the day is a significant advantage.

• Why it’s important: Feet can swell, and an adjustable closure system allows you to loosen or tighten the shoe as needed for a secure but non-constricting fit.
• What to look for: Laces are excellent for providing a highly customized fit. Velcro straps are also a great option, especially for individuals who have arthritis or difficulty with fine motor skills. Avoid slip-on shoes, as they often provide a less secure fit and can cause your foot to slide around.

Recommended Shoe Types for PAD Patients

With the key features in mind, you can start to look at specific categories of shoes that are generally well-suited for people with PAD.

1. High-Quality Walking Shoes

A good walking shoe is often the best all-around choice for daily wear. Brands that focus on athletic and comfort footwear design their shoes with many of the features listed above.

• Benefits: They are engineered for shock absorption, support, and stability. They typically have a cushioned midsole, a supportive heel counter (the firm part that cups your heel), a flexible forefoot to allow for a natural walking motion, and are made from breathable materials.
• What to look for: Seek out “neutral” or “stability” walking shoes from reputable athletic brands. It’s highly recommended to go to a specialty running or walking shoe store where staff can analyze your gait and help you find the perfect model for your foot type.

2. Orthopedic Shoes

Orthopedic shoes are specifically designed to accommodate and support feet with medical conditions. While they once had a reputation for being clunky and unattractive, modern designs are often stylish and indistinguishable from regular comfort shoes.

• Benefits: Orthopedic shoes are built with extra depth to accommodate custom orthotics or foot deformities. They feature premium protective interiors, excellent support structures, wide toe boxes, and are often available in multiple width options (narrow, medium, wide, extra-wide) for a truly customized fit.
• Where to find them: These are typically found at specialty shoe stores, medical supply stores, or online retailers that focus on therapeutic footwear.

3. Diabetic-Friendly Footwear

Even if you don’t have diabetes, shoes designed for diabetic patients are an excellent choice for anyone with PAD. This is because both conditions require maximum foot protection due to neuropathy and poor circulation.

• Benefits: Diabetic shoes are built with the highest standards of protection in mind. They feature a soft, seamless interior lining, a non-binding upper that won’t constrict the foot, extra depth, and a wide toe box. They are designed from top to bottom to prevent any rubbing or pressure points that could lead to a foot ulcer. Many are also covered by Medicare Part B if prescribed by a doctor for a qualifying condition.
• Important Note: The term “diabetic shoe” signifies a specific set of protective features. A PAD specialist can advise if this level of footwear is right for you.

The Perfect Fit: How to Try and Test Your Shoes

Finding the right shoe is only half the battle; ensuring it fits correctly is just as important. An improperly fitted shoe, no matter how well-designed, can cause harm.

1. Shop in the Afternoon: Your feet naturally swell throughout the day. Shopping for shoes in the late afternoon or evening ensures you get a fit that will be comfortable even when your feet are at their largest.
2. Measure Both Feet: Most people have one foot that is slightly larger than the other. Always have both feet measured and fit your shoes to the larger foot.
3. Wear Your Usual Socks: Bring the type of socks you typically wear (e.g., cushioned athletic socks or compression stockings) to ensure the shoe fits correctly with them on.
4. The Rule of Thumb: As mentioned, there should be about a half-inch of space between your longest toe and the tip of the shoe. The shoe should be wide enough that the sides of your foot don’t feel squeezed.
5. Perform a Walk Test: Don’t just sit and stand. Walk around the store for several minutes. Pay attention to how the shoe feels. Is there any slipping in the heel? Is there any pinching or rubbing? Does the arch feel supported?
6. Check the Interior: Before you even put the shoe on, run your hand inside to check for any rough seams or tags that could cause irritation.
7. Break Them in Slowly: Even the most comfortable new shoes need a breaking-in period. Wear them for just an hour or two at a time at home for the first few days. After each wear, take them off and inspect your feet carefully for any red spots or areas of irritation. This allows you to identify potential problems before they lead to a blister or sore.

When to Seek Professional Help: Custom Orthotics and Specialist Consultations

While off-the-shelf shoes can work well for many, some individuals may need a higher level of customization. If you have significant foot deformities (like severe bunions or hammertoes), an abnormal gait, or persistent foot pain despite wearing good shoes, it’s time to consult a specialist.

Custom Orthotics:
A custom orthotic is a prescription shoe insert molded specifically to the contours of your feet. Unlike over-the-counter insoles that provide generic cushioning, custom orthotics are designed to correct biomechanical issues.

• How they help: They can provide targeted arch support, redistribute pressure away from sensitive areas, correct foot alignment, and provide superior shock absorption. For someone with PAD, this can be invaluable in preventing pressure sores and reducing pain. A podiatrist or a vascular specialist can evaluate if you are a candidate for custom orthotics.

Consulting a Specialist:
Your footwear is part of your overall PAD management plan. It’s important to discuss your footwear choices with your healthcare team. A podiatrist can provide expert advice on shoe selection and fitting and can prescribe custom orthotics. Your PAD specialist can assess how your footwear integrates with your complete Peripheral Artery Disease treatment plan, including exercise and other therapies.

Protect Your Foundation: A Final Word on Foot Health

For people living with PAD, foot health is not a luxury—it is fundamental to maintaining mobility and preventing devastating complications like leg ulcers and amputation. The shoes you wear every day are your first line of defense. By choosing footwear with a wide toe box, excellent cushioning, strong support, and a smooth interior, you create a safe and comfortable environment for your vulnerable feet.

Taking the time to find the right shoes and ensure a proper fit is one of the most effective and empowering steps you can take in managing your PAD symptoms. It enables you to participate more comfortably in essential activities like walking, which in turn improves your circulation and overall health.

If you are struggling with foot pain, numbness, or other PAD symptoms, don’t ignore them. A comprehensive evaluation by a vascular expert is essential. At Fox Vein and Vascular, Dr. David Fox provides expert PAD diagnosis and state-of-the-art care for patients from Manhattan, the 5 Boroughs, and the entire tri-state region. We can help you develop a holistic treatment plan that includes guidance on lifestyle, exercise, and the protective measures, like proper footwear, needed to preserve your health and quality of life.

For more information, visit foxvein.com or call (212) 362-3470.