Let us start with a number that usually surprises patients. A large research review from 2018 found that between 63 and 72 percent of people wear shoes that do not fit their foot length or width. It is not about whether the shoe was cheap or expensive. It simply did not fit that foot. And it is precisely that mismatch that is most strongly associated with pain and toe deformities — not the brand or the advertised technology.
That is good news, because most of this is something you can influence right in the shop. Below we have gathered what really matters and what is better to avoid.
Fit first, everything else second
Before you look at the material, colour or "space-age cushioning", check four things.
Length. There should be about a thumb's width in front of the longest toe — roughly 1–1.5 cm. The foot slides forward with every step and needs that margin.
Width. The shoe must be wide enough across the ball, where the toes spread. A common mistake: people go up a size to get more width. Then the heel slips and the toes are still squeezed. Better to look for the right width fitting.
Heel. It should hold firmly and not slip when walking.
Comfort from the first moment. "Breaking in" shoes is a myth. A good shoe is comfortable straight away.
A practical tip when shopping
Buy shoes in the afternoon or evening. Feet swell by up to half a size during the day, so a perfect morning shoe can pinch by five o'clock. Try both shoes and fit to the larger foot, because almost no one has perfectly equal feet. Walk around the shop for a few minutes — do not just stand up and sit down.
You can measure your foot at home. Stand on a piece of paper in socks, trace the foot with a pencil held vertically and measure the length from heel to longest toe and the width at the widest point. Then compare with the manufacturer's size chart, as sizing can vary between brands.
What a good shoe is made of
Wide, rounded toe box. The toes have room to lie flat. Pressure studies show that in a shoe with a round toe box, the pressure around the big toe is lower than in a square or pointed shoe.
A sole that bends in the right place. Take the shoe in your hand and try to bend it. It should fold under the toes — where the foot bends — not in the middle of the length. A shoe that bends in the middle or is completely rigid disrupts the natural roll of the foot.
A firm heel counter. The back part of the shoe, the part that cups the heel, should be stable. It holds the heel and gives control over movement.
A material that breathes. Leather, canvas or mesh let the foot breathe. Synthetic materials like vinyl or rubber trap heat and moisture — the perfect conditions for athlete's foot.
What to avoid in everyday wear
High heels. The higher the heel, the worse for the forefoot. Wearing them is associated with bunions, pain and a higher risk of injury. If you must, a safer limit is a heel of about 2 cm, worn occasionally, not for twelve hours a day.
Ballet flats and flip-flops. They look innocent but are flat, thin and unstable. The foot "grips" them with the toes to stay on, pressure increases under the forefoot, and that is a route to plantar fasciitis and pain that can radiate to the knees and back.
Too narrow a toe box. Squeezed toes gradually take on the shape the shoe allows — crooked. Hence hammer toes and worsening bunions.
Second-hand shoes. A worn shoe has moulded to someone else's foot, loses its stability and grip, and there is also a risk of transferring athlete's foot.
Shoes for what you actually do
A running shoe is designed for forward motion. It is not suitable for sports with lateral movements, like volleyball or indoor tennis, because it does not support the foot sideways. If you play a given sport regularly, buy a shoe for that specific discipline.
Slippers. Backless house slippers are one of the best-documented risk factors for falls in older adults. If you are buying slippers for yourself or your parents, choose ones with a full heel counter and a non-slip sole.
Children. Before a toddler walks outdoors, shoes are not needed. First shoes should have a soft, flexible sole, the right length and width, and a fastening over the instep. Children's feet grow fast — measure every two to three months.
Who should pay extra attention
Diabetes. The rules are stricter here. The inside of the shoe should be 1–2 cm longer than the foot, and the width should match the foot's width. Do not walk barefoot, in socks only or in thin slippers. Check the inside of the shoe by hand every day.
Pregnancy. Hormones relax ligaments and the growing weight flattens the arch. The foot lengthens — sometimes by a centimetre, permanently — and widens. Often you need to go up a size and choose a wider, well-cushioned shoe.
Older adults. Stable heel counter, non-slip sole, no backless slippers or heels. With age the foot lengthens and widens, so measure at every purchase.
Three myths we hear most often
"Shoes with arch support are always better." No. With a healthy, neutral foot, aggressive arch support can simply be uncomfortable. Arch support makes sense mainly with a high arch or symptomatic flat feet.
"Barefoot or minimalist shoes prevent injuries." There is no strong evidence for this. The type of load shifts — less on the knee and hip, more on the Achilles tendon, calf and metatarsals — but not the overall injury rate. If you want to switch, do so gradually over weeks, not overnight.
"More expensive means healthier." Price has little to do with it. What matters is fit, toe box shape, where the sole bends and what the shoe is designed for.
When insoles, and how it works in the Netherlands
For most people with a neutral foot, a good off-the-shelf insole works similarly to a custom one. Custom insoles really win with a high arch and in certain conditions. If you have persistent pain, recurring calluses or a progressing bunion, that is the moment to see a specialist.
In the Netherlands, feet are treated by a podotherapeut — the only legally protected paramedical profession in this area — and you can make an appointment without a referral.
What about reimbursement?
Insoles are not covered by basic insurance (basisverzekering) — with one exception: diabetics with elevated risk are entitled to reimbursement. Others can claim them under supplementary insurance (aanvullende verzekering), usually up to an annual limit of around €100–200. As rates and rules change every year, check your policy before purchasing.
Quick checklist before you shop
- ✅ Shop in the evening, try both shoes, fit to the larger foot
- ✅ Leave about 1–1.5 cm in front of the longest toe
- ✅ Look for the right width, do not compensate with a larger size
- ✅ Wide, rounded toe box — toes lie flat
- ✅ Sole bends under the toes, heel holds firmly
- ✅ Breathable material, especially in our climate
- ✅ Walk around for a few minutes — it should be comfortable immediately
- ✅ Replace running shoes every 500–800 km; rotating two pairs daily helps both last longer
If despite well-chosen shoes something hurts, goes numb or changes shape, book an appointment. It is easier to act early than to repair the consequences years later.
