Physical therapy (PT) is a movement-based treatment focused on restoring function, improving mobility, and reducing pain through exercise and manual techniques. Since all movement begins with the feet, the choice of footwear directly impacts the success of a therapy session. Wearing appropriate shoes is a safety measure that provides necessary stability to maximize treatment results and prevent secondary injuries. The correct shoe influences gait mechanics, balance, and overall body alignment.
Essential Characteristics of Physical Therapy Footwear
The ideal shoe for physical therapy must offer support, stability, and traction for various exercises. Footwear generally categorized as running shoes or cross-trainers usually possess the necessary structural features for controlled movement. A high-traction rubber outsole is required to ensure a reliable grip on clinic surfaces, which is important during gait training and balance work.
The shoe’s upper portion needs a firm heel counter—the stiff material cupping the heel—to minimize excessive rear-foot motion and maintain proper foot alignment. This structural control helps prevent compensatory movement patterns that could strain the knees, hips, or lower back. Sufficient arch support is also necessary to distribute weight evenly across the foot.
A wide toe box allows the toes to splay naturally during weight-bearing exercises, contributing significantly to balance and stability. Shoes must be secured with laces or strong straps, not slip-ons, to ensure the foot remains seated correctly during dynamic movements. A secure fit combined with a stable sole provides a reliable platform for performing exercises.
Footwear Categories to Avoid During Therapy
Certain types of footwear compromise safety and interfere with therapeutic goals. Slip-on shoes, mules, or backless styles should be avoided because they require the wearer to grip the shoe with their toes to keep it on. This toe-clenching alters natural gait mechanics and reduces the foot’s ability to stabilize the body during balance activities.
Open-toed shoes, sandals, and flip-flops offer no protection and leave feet vulnerable to injury from dropped equipment. These styles also lack the structure and secure fit needed for dynamic exercises or quick changes in direction. Dress shoes and high heels are unsuitable because their rigid soles and elevated heels change the body’s center of gravity and force the foot into an unnatural position.
A common mistake is wearing athletic shoes past their functional lifespan, often indicated by flattened midsoles or uneven tread wear. Over time, the foam and cushioning degrade, reducing the shoe’s ability to absorb shock and stabilize the foot. This loss of support can exacerbate pre-existing biomechanical issues, potentially leading to new pain. Experts suggest retiring athletic shoes after 300 to 500 miles of use.
Specific Adjustments for Specialized Therapy and Orthotics
Patients using custom-molded orthotics or inserts should always wear them inside their physical therapy shoes to maintain prescribed foot alignment. The footwear must be deep enough to accommodate the orthotic device without causing the heel to slip or the foot to feel cramped. This ensures the shoes work synergistically with the insert to support the foot’s structure.
In specialized treatments, such as aquatic therapy, standard athletic shoes are replaced with specific water shoes. These aquatic shoes feature rubber outsoles for traction on wet pool surfaces and are constructed from quick-drying materials like neoprene. Some specialized aquatic shoes also incorporate resistance elements to increase the intensity of underwater exercises.
Occasionally, a physical therapist will instruct a patient to remove their shoes and socks to perform specific exercises barefoot. This is typically done for activities designed to improve proprioception—the body’s awareness of its position in space—or to strengthen the intrinsic muscles of the foot. Exercising barefoot also helps assess the natural mobility of the ankle joint. The therapist’s instruction regarding footwear should always take precedence over general recommendations.