Everyday footwear: An overview of what we know and what we should know on ill-fitting footwear and associated pain and pathology.

Footwear has been used to protect feet for millennia with socially exclusive population adopting stylish and fashionable shoes with expensive materials. In terms of historic timeline, only more recently footwear has been worn by all classes in the western world as an integral part of their apparel. Traditionally, footwear has been constructed from natural materials, mainly leather, but has recently benefitted from the flexibility that technology has provided with a plethora materials and new design innovations. Although it has expanded the availability for a variety of consumers, the choice and fit continue to be problematic with many individuals wearing shoes that are ill-fitting. Provision of specific footwear advice for problem feet is poorly evidenced and is heavily practitioner dependant limiting its efficacy. There is limited understanding as to the changes that can occur from regularly wearing footwear that is unsuitable in shape, style and construction which is referred to as ill-fitting. Current research on the effect that everyday footwear has on foot function and pain focuses mainly on women’s shoes, particularly high heels. Defining what is a good fitting shoe, that does not damage the foot or mechanics of walking, may need to be individualised, but best fit is based on loose historical parameters rather than research evidence. The aim of this overview is to highlight aspects of current research, establishing what we know about the effect’s shoes have on the feet as well as exploring the mythology around footwear fit and advice that is often historical in nature

The impact of footwear choice on foot biomechanics in young adults with considerations to the potential risk of developing foot pathology

Foot pain and pathology can be disabling leading to more complex orthopaedic complaints over time. Footwear is often attributed as a significant factor in the development and persistence of foot pain, yet little is known about the impact everyday footwear choice has on the development of these pathologies and foot biomechanics. The aim of this collection of work is to assess the impact footwear choice has on foot biomechanics. A mixed methods approach has been employed across various publications to investigate the following; choices made when purchasing footwear, the impact footwear structure and styling has on foot mechanics and comfort and the effect of unstable shoes on muscle function. The publications employed literature reviews, qualitative questionnaires, repeated measures and quasi-experimental designs to address the research questions. There is a paucity of research regarding the effects that everyday footwear have on the feet of healthy individuals. A flat ballet pump was found to be the primary shoe of choice for young females with the colour of trainers being selected by sport science students. Altered physical characteristics of the shoe caused elevated dorsal and plantar foot pressure, impaired comfort and altered function. Fashionable exercise shoes were shown to demonstrate a varied effect on muscle activity. The availability of suitably fashionable and functional footwear appears to be severely limited leading to consumers purchasing inappropriate and ill-fitting footwear that may contribute to foot pathology. An extensive review of design, properties and manufacture with specific consideration to pathology in the footwear industry is recommended to improve footwear choice. The publications presented add new knowledge when evaluating consumer choice of footwear and the potentially adverse impact popular female fashion shoes have on foot biomechanics. The results also contribute to a wider understanding of the impact everyday footwear has on foot pathology and help in the application of footwear related treatment and rehabilitation plans

Footwear choices for painful feet – An observational study exploring footwear and foot problems in women

A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision. Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase. Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis. This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes

Medical-grade footwear: : the impact of fit and comfort

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License CC BY 4.0, (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: Pressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant's own preferred shoe. METHODS: Thirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time. RESULTS: Participants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint. CONCLUSION: The test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure.Peer reviewedFinal Published versio

Prevalence of musculoskeletal injury and pain of UK-based podiatrists and the impact of enforced altered working practices

Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence

Evaluation and Optimisation of a footwear assessment tool for use within a clinical enviroment

Footwear has been documented as a significant factor in the aetiology of foot pain in the general population. Assessing footwear in a clinical setting continues to be practitioner specific and there is limited guidance to direct advice. Health professionals must have access to clinically appropriate and reliable footwear assessment tools to educate patients on healthier footwear choices. The primary aim of this study was to critique what elements should be in a footwear assessment tool with a secondary aim of testing the agreed tool for validity

Do Barefoot Science™ insoles alter foot function?

Background: Barefoot Science™ insoles (BSI) are marketed as “reforming gait and reducing injuries”. The manufacturers claim that a graded metatarsal dome is novel and it is said to promote intrinsic foot muscle activity, improve balance and alter the shape of the arch. However, as such there is no evidence to support such claims

Surface Electromyography of the foot: a protocol for sensor placement

Background The use of surface EMG (sEMG) to record muscle activity is common place yet due to restrictions in technology studies on the intrinsic foot muscles have been limited or only fine wire instruments have been used. Aim This paper looks at the potential reliability of a sEMG protocol for assessing the intrinsic foot muscles. Methods Six intrinsic muscles were defined using ultrasound and muscle function testing. A protocol for sensor placement was created with repeatability and reliability testing of the protocol conducted by three separate testers on three subjects over two different time frames. Inter tester and Inter session repeatability and reliability was measured with ICC and percentage standard error of measurement. Results Although there was good correlation between Extensor Digitorum Brevis, Dorsal Interossei, Abductor Digiti Minimi and Flexor Digitorum Brevis there was increased variability and poor correlation for Flexor hallucis Brevis and Abductor Hallucis. The percentage standard error of measurement did not support the high ICC values indicating a lower precision of measurement. Significance Variability between testers and sessions shows an inconsistent reliability of sEMG and further work is required with protocols focussing on grouping muscles to improve the understanding of the intrinsic foot muscles

Medical-grade footwear: the impact of fit and comfort

Background Pressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant’s own preferred shoe. Methods Thirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time. Results Participants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint. Conclusion The test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure

Small Foot Orthoses.

Accurate assessment and correct diagnosis of digital deformities aids clinicians to develop a specific conservative management plan. Evaluation of the progression toe pathologies make over time, provides the clinician with adequate information to decide whether to improve muscle function during gait or offload and deflect pressure when required. Improved muscle function can be achieved with intrinsic foot exercise specifically for the flexor muscles, which can change the dynamics of the toes. Simple insoles with metatarsal pads have a similar effect on muscle function and can alleviate digital pain. Off-loading digits with specific splinting can be used to provide patients with comfort and support when hyperkeratotic skin lesions become irritable. Splinting can also be used to prevent ulcers from forming. When conservative measures no longer pacify patients symptoms a surgical alternative should be considered