Footwear choices for painful feet - an observational study exploring footwear and foot problems in women

Australian secondary school principals', parents', and students' attitudes to prescribed school footwear guidelines

BACKGROUND

Adolescents are often required to wear footwear that adheres to uniform guidelines at secondary school. There is a paucity of literature on factors influencing school footwear choice and what drives the development of school footwear guidelines. The aims of this study were to describe (i) current school footwear guidelines in secondary schools across Australia, (ii) factors that influence footwear choice in secondary school students and their parents, and (iii) principals, parents, and students' beliefs on factors which contribute to school footwear guidelines.

METHODS

An online survey was distributed to principals, secondary school students (aged 14-19 years) and their parents across Australia. The survey included questions on current school footwear guidelines, factors influencing footwear choice (for students and parents), participants beliefs on the effect footwear has on musculoskeletal health, current and previous lower limb pain, and beliefs on factors that contribute to school footwear guidelines. Parent and student responses to factors that influence their footwear choice were compared using proportional odds logistic regression. Students and parents' responses to factors influencing footwear guidelines were compared to principal responses using proportional odds logistic regression. Significance was set at an alpha of < 0.05.

RESULTS

Eighty principals, 153 parents and 120 secondary school students responded to the survey. 96% (77/80) of principals reported that their schools have set guidelines for school footwear. 88% of principals considered comfort to be important when developing school footwear guidelines. Proportional odds logistics regression showed that parents and students were 3.4 and 4.9 times more likely, respectively, than principals to rate comfort as being important when schools develop footwear guidelines. More than 40% of students reported experiencing musculoskeletal pain, and 70% of these students reported the pain to be exacerbated when in their school shoes. Less than a third of participants considered healthcare recommendations important to the development of footwear guidelines.

CONCLUSIONS

Nearly all principals that participated in this survey had set guidelines for school footwear. There is a discord between parents, students, and principals on the importance that factors such as comfort, play in the development of school footwear guidelines.

Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width

Background: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. Methods: A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery’s effect on foot width. Measurements were made preoperatively and 3–6 months following surgery. Results: The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). Conclusions: This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.

Foot Muscle Strength, Muscle Shortness, Balance, and Shoe Preferences in Different Foot Postures

Objective: The aim of this study was to investigate the foot muscle strength, muscle shortness, tibialis posterior endurance, balance, and the shoe preference differences between the neutral and pronated foot posture. Methods: Forty-nine participants consisting of 23 women and 26 men, and age of between 18 and 45 years were participated in the study. Foot posture, medial longitudinal arch height, height, gastrocnemius and hamstring muscle shortness, foot and ankle muscle strength, tibialis posterior muscle endurance, static balance, and shoe preferences of the participants were evaluated. Subjects were recruited into two groups according to their foot posture evaluated with Foot Posture Index: as those with neutral and pronated foot posture. Results: Navicular drop, gastrocnemius, and hamstring muscle shortness were significantly higher in participants with pronated foot posture compared to those with neutral foot (p0.05). Conclusion: Flexibility of gastrocnemius and hamstring muscles were reduced, but foot muscle strength, tibialis posterior muscle endurance, and balance remained unaffected in young individuals with excessive foot pronation. Moreover, shoe preferences may not affect the foot posture in young people. Although all age-related biomechanical effects of foot pronation are not well known yet, muscle shortness seems to arise earlier than muscle weakness and reduced balance in pronated foot posture

Analysis of hallux valgus angles automatically extracted from 3D foot scans taken in North America, Europe, and Asia

The forefoot is the foot part most affected by ill-fitting shoes. Footwear fitting considers the measurements of length, width, and arch length. Toe shape has not yet been used in sizing feet and fitting shoes. This study aims to investigate the variation in toe shape, as measured by the hallux valgus angle. An automatic and reproducible hallux valgus angle measuring method using 3D foot scans with no palpation markers is proposed and applied to about half a million samples collected across North America, Europe, and Asia. The measuring method is robust and can detect the medial contour along the proximal phalanx even in extreme cases. The hallux valgus angle has a normal distribution with long tails on both sides in the general population. Large dispersions of HVA values were observed for both genders and in all three geographical regions. Practitioner summary: The hallux valgus angle has a broad distribution in the general population. Females have larger hallux valgus angles than males, and people from Asia have larger hallux valgus angles than people from North America and Europe. Shoe toe boxes should be designed to fit the actual shapes of shoppers' toes. The proposed method for measuring HVA opens a new opportunity to study the causal relationship between shoe wearing habits and HVA on a large scale.

The Management of Complex Regional Pain Syndrome-associated Foot Pain using a Poron Insole, a Sponge Upper Padding, and a Post-operative Shoe: A Case Report

Background:

Pain from complex regional pain syndrome (CRPS) is frequently refractory to various treatment methods. Here, we present a case wherein foot pain from CRPS I was managed by applying an insole made from poron (a soft polyurethane foam and highly absorbent material for shock reduction), a sponge upper padding, and a post-operative shoe.

Case Presentation:

A 47-year-old female patient with CRPS I on her left foot complained of pain for a few months, which was aggravated while standing and walking [numeric rating scale (NRS): 8]. She had a history of a linear fracture in the distal portion of the left 1st metatarsal bone 5 months ago, and the pain from CRPS started 2 months after the fracture. We believed that the aggravated pain during standing and walking was allodynia. We utilized a poron insole, a sponge upper padding, and a post-operative shoe to reduce the pressure and friction loading on her left foot. 1 month after this intervention, the patients’ pain during standing and walking was found to have reduced from NRS 8 to NRS 3. At her 3- and 6-month follow-ups, the degree of pain was sustained at NRS 3.

Conclusion:

We believe that the reduction of allodynia using materials, which can absorb mechanical pressure and friction of the foot, can help manage pain from CRPS.

Evaluation and optimisation of a footwear assessment tool for use within a clinical environment

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.

A combined Nominal Group Technique and then a Delphi technique from purposively sampled experts of foot health professions were employed to critique elements of footwear assessment. The agreed tool was then tested by practising podiatrists on 5 different shoes to assess the validity and reliability of the measures.

Twelve test evaluation criteria were identified receiving significant ratings to form the final footwear assessment tool consisting of five footwear themes. Application of the tool in a clinical setting validated the themes of footwear characteristics, footwear structure, motion control and wear patterns. However, the assessment of footwear fit was not reliable.

The footwear tool was refined based on the collective consensus achieved from the rounds creating a more clinically appropriate tool. The validity of this tool was assessed as high in some of the themes but for those that were lower, a training need was identified.

Impact of foot health behavior among ethnic minority populations: A cross-sectional population-based study

OBJECTIVE

To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups.

DESIGN AND MEASURES

A cross-sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self-reported type of outdoor footwear and clinical characteristics by sex were collected in 2019-2020.

SAMPLE

A total of 78 Roma participants self-identified as members of this ethnic minority and 72 participants non-Roma were assessed (n = 150).

RESULTS

The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non-Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p < .05).

CONCLUSION

Roma people wear flip flops and slippers and non-Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity.

The Impact of Kinesiology Taping on a Greek Foot with a Hammertoe-A Case Report

Background and Objectives: Hammertoe, one of the most common toe deformities, causes pain due to overloading of the periarticular tissues and skin lesions. Additionally, it results in problems with footwear choice, an unattractive foot appearance and a deterioration in quality of life. The most common treatment for rigid and advanced deformities is surgery, and these procedures are widely described in literature. If the changes in the interphalangeal and metatarsophalangeal joints are flexible (that mean they undergo correction without causing pain) or surgery is not possible, conservative treatment should be considered. No research, however, has been found detailing this treatment method. Conservative treatment includes the Kinesiology Taping (KT) method, which involves applying taping to correct deformities. This report describes the effect of KT treatment in a female patient with hammertoes. Materials and Methods: Anthropometric foot measurements (3D scanner) and foot loadings (baropodometric platform) are presented before KT applying, immediately after tapes application and after tapes removal following one month of use. Results: After using KT application parameters such as: foot length, maximum foot load, load under the area of the metatarsals II-III changed. Conclusion: Kinesiology Taping seems to be a symptomatic form of treatment of the effects of lesser toes deformity, therefore it is a good alternative for patients who do not want or cannot undergo surgery.

Toe gaps and their assessment in footwear for people with diabetes: a narrative review

BACKGROUND

Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions.

METHODS

The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes.

RESULTS

A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0-1.6 cm and a maximum of 1.5-2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices.

CONCLUSIONS

Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments.

Effect of the Modified Lapidus Procedure for Hallux Valgus on Foot Width

BACKGROUND

Despite the importance of shoe wear to patients with hallux valgus (HV), few studies have investigated changes in foot width following surgery in this population. The purpose of our study was to determine if the modified Lapidus procedure would effectively decrease foot width in patients with HV.

METHODS

Thirty-one feet (19 left, 12 right) in 30 patients (29 females, 1 male) who underwent a modified Lapidus procedure in combination with a modified McBride and Akin osteotomy for treatment of HV were included in the study. All patients had preoperative and at least 5-month postoperative imaging, consisting of both weightbearing radiographs and computed tomography (WBCT) scans, which were used to measure bony and soft tissue foot widths pre- and postoperatively by 2 independent observers.

RESULTS

Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.90). Bony foot width decreased significantly, by a mean of 8.9 mm (9.1%) on radiographs and 7.9 mm (8.4%) on WBCT scans (P < .001). The soft tissue foot width also decreased significantly, by a mean of 6.9 mm (6.3%) on radiographs and 6.7 mm (6.4%) on WBCT scans (P < .001). Changes in the hallux valgus angle and intermetatarsal angle correlated with changes in bony foot width on WBCTs (both r > 0.4, P < .02).

CONCLUSIONS

The modified Lapidus procedure in combination with a modified McBride and Akin osteotomy resulted in statistically significant changes in both bony and soft tissue foot width. Patients should be counseled that foot width decreases, on average, by 0.5 to 1 cm.

LEVEL OF EVIDENCE

Level III, comparative series.

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear

Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.

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 is known 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.