FOOTWEAR CHOICES FOR PAINFUL FEET
BACKGROUND
Foot pathology and pain is reported in
approximately 24–30% of the adult population
with it being one of the top 20 reasons for
seeing a doctor when over the age of 65
[1–4]. Foot pain has been associated with
reduced mobility [5], decreased leg strength
[6] and an increase in falls risk [7]. Ill-fitting
footwear can increase foot pain, reduce
stability inhibit relevant rehabilitation and
in-crease hyperkeratotic lesions [8, 9]. Footwear
characteristics such as heel height, toe box
width, sole hardness and thickness have all been
identified as elements that contribute to foot
pain [10–12].
It is thought that habitual constriction caused
by foot-wear causes osteological deterioration
in feet over a long period of time [13], with
unshod populations having a lower frequency
of bony morphology [14]. However, in western
populations there is a need to wear footwear
to address environmental and functional
requirements as well its role in identity [15], with
young UK women pur-chasing on average 6
pairs of shoes a year [16].
The styling and fit of footwear worn can
accelerate the chances of foot pain and the
development of progressive foot deformity and
pathology. Narrow toe boxes have been found
to restrict the movement of the forefoot [17]
resulting in a stiffer foot prone to increased
stress from loading as well as significantly
increasing dorsal and plantar forefoot pressures
[18]. Fastening techniques used in shoe design
have been shown to influence the normal
width expansion of the shoes upper around
the metatarsal heads, which if compressed
increases internal stresses [19]. Similarly, the
presence of a dorsal fastening on footwear
improves ground clearance during gait and
reduces the risk of falling [8]. Correct fitting of
shoes also plays a role in pathology and pain
with two thirds of feet measuring broader than
"It has been proposed
that women have
an emotional
relationship
with their shoes
influenced initially
by fashion and the
need for personal
identity before any
considerations of pain
and pathology."
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Pedorthic Footcare Association | www.pedorthics.org