A significant number of people wear shoes that don't fit well, perhaps because the shoes were on sale or they're hand-me-downs, or various other reasons. Regardless, always wear shoes that properly fit your feet, not just in terms of length, but also in terms of width. Wearing shoes that don't fit not only cause blisters, bunions and calluses, but they can reduce the stability and compromise the biomechanics of your feet and subsequently trigger back pain and other joint issues.  Get fitted for shoes later in the day because that's when your feet are a little larger, usually due to swelling and slight compression of your arches. Most off-the-shelf shoes are regular (medium) width, so you may have to order shoes from the manufacturer if your feet are really narrow or wide. Some footwear may fit well, such as flip-flops, but they can still cause foot and other musculoskeletal problems due to the lack of arch and heel support. Regardless if you have flat feet or not, wearing shoes with strong arch support is going to benefit your feet and improve your gait during walking / running at the very least. Wearing more supportive shoes may also significantly reduce your back pain or relieve the symptoms entirely, depending on its cause. As such, when buying new shoes, look for a comfortable walking or athletic shoe with substantial arch support, roomy toe box, firm heel counter and a flexible sole. Buy quality and avoid trendy styles that look flimsy.  Wearing flat sandals, flip flops and other slip-ons on the beach or around the pool is likely okay, but they shouldn't be used for extensive walking or any kind of exercise.  Avoid shoes with heels higher than two inches because it changes the center of gravity and causes strain on the lower back. However, wearing completely level shoes may put too much pressure on your heels, so consider buying shoes that are elevated in the heel by about 1/4 or 1/2 inch. If you are a regular jogger and think that your feet, shoes or running style may be causing your back pain, then get an evaluation done at a reputable running store. High-end running stores often employ people who are qualified to assess your gait, examine your feet and check the wear patterns on your shoes. These employees are not doctors, but they are usually experienced runners who can give you sound advice on what types of running shoes to buy, which can make a positive impact on your back pain. If you're a serious runner, you should be replacing your shoes every 350 to 500 miles or 3 months, whichever comes first.  You may be asked to run over a force plate that's hooked up to a computer, or get video-taped jogging on a treadmill as part of your assessment. If you're an over-pronator, shoes with lots of medial support in the arch will likely be recommended to prevent ankle collapse. If you're an over-supinator, then more lateral (outside) support is needed to force your foot into a neutral position. Make sure the rigidity of the heel counter (back of the shoe) is vertical and not tilting to one side or the other. Shock absorption is also important for running shoes, which is why many brands have air pockets within the soles. If you have flat feet and over-pronate, then you may be better off with custom shoe orthotics instead of new shoes. Orthotics are semi-rigid shoe inserts that support the arch of your foot and promote better biomechanics while standing, walking and running. By providing cushioning and some shock absorption, orthotics will also reduce the likelihood of problems developing in other joints such as your ankles, knees, hips and spine. Health professionals who make custom orthotics include podiatrists, as well as some osteopaths, chiropractors, physicians and physical therapists.  You should realize that orthotics don't reverse any structural deformities of the foot nor can they reconstruct an arch by wearing them over time. When wearing orthotics, you'll likely need to take the factory insoles out of your shoes first. Custom orthotics can be expensive without medical coverage, but off-the-shelf insoles may provide relief for back pain also.
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