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Footwear and Lower Back Pain

Support and Cushioning

How much support and how much cushioning required in a shoe depends upon the shape of an individual's feet and the amount one pronates.

Pronation is the normal, natural inward roll of the foot as the arch collapses (much like a spring) when walking, between the time the heel contacts the ground and toe-off.

Pronation is necessary for the foot to absorb shock. But not all the shock is absorbed. Some of the shock caused by the feet striking the ground is transmitted up the legs, through the pelvis, to the lower back.

What is Underpronation?
Some people underpronate. The foot does not roll inward enough to adequately absorb shock. These people usually (not always) have a high, inflexible arch. This leads to pain in the feet and/or knees and/or lower back. Underpronators need flexible shoes with extra cushioning.

What is Overpronation?
Some people overpronate. The foot rolls inwards excessively, which causes excessive internal rotation of the lower leg and knee and places strain on the entire lower body, including the lower back. Overpronators usually (not always) have low arches and straight feet. Overpronators need shoes with built in support features.

Adequate Cushioning:

Shoes with adequate cushioning in the soles help to absorb the shock of the feet hitting the ground. Cushioning is especially important when walking on hard surfaces such as pavement or tile (sidewalks and shopping malls) or when walking a great distance.

Cushioning is especially important to underpronators. Overly cushioned shoes can, however, reduce the stability of the shoe and make overpronation worse. Shoes that combine both support with lots of cushioning tend to be heavy.

Support: Overpronators need shoes with adequate support. Adequate medial (arch) support helps prevent the feet from rolling in excessively while walking. Adequate heel support is also necessary to control overpronation.

Shoes that incorporate these features are called stability shoes or motion control shoes. Stability shoes are for those who overpronate mildly or have a normal gait. Motion control shoes are for those who overpronate severely. Extra support may also required if one has gained extra weight. Motion control shoes tend to be are more rigid than stability shoes and tend to be heavier. There is no point in getting a shoe with more support than is required.

Shape of the Shoe:

The shape of the shoe should generally conform to the shape of the foot. The soles of shoes can be straight, curved, or semi-curved. For people who underpronate severely, a straight shaped shoe is best. For people who overpronate mildly or have 'normal' feet, a semi-curved shoe is best. For those who overpronate, a curved shoe is best.

*It is best to go to a retailer that has employees who specialize in fitting shoes. There they can look at the shape of your feet, observe your gait to see if you underpronate or overpronate or have a 'normal gait,' and recommend the best shoe for you.

The Perils of High Heels: Wearing high heels cause the pelvis to arch forward (causing sway back), placing extra stress on the lower back pain. Time spent wearing heels over 1 or 2 inches high increasing the likelihood of lower back pain - not to mention foot pain.


Arch supports can help but many people find them uncomfortable. Some people find more relief with custom made inserts (orthotics) than over-the-counter inserts but they are more expensive. They may be soft, rigid, or semi-rigid.

*Often, the footwear is not the main cause of the back pain, but it certainly can aggravate it.