shoe toe box shape and volume
the persistence of symptoms that require clinical
intervention [27] . Changes in footwear from narrow
fitting shoes to a broader walker style have shown
to reduce the incidence of foot pain [28] . Education
on the ill-effects of tight fitting footwear is poor
and research indicates that footwear in the younger
population is influenced by fashion and color [29,30] .
Footwear choice in young females is determined by
the activity that is planned with high heels being
chosen for socializing, boots for warmth and flat
ballet pumps for school [11] .
This study aimed to investigate differences in toe box
volume and shape with a particular focus on peak
pressure, time to peak pressure, total contact time
and pressure time integral around the dorsal aspect
of the forefoot and defined plantar foot regions in a
healthy young female population with no known foot
pathology.
methods
Participants: 27 asymptomatic healthy females were
recruited from a convenience sample with an average
age of 22.5 (+/− 4.5) years, body mass of 63.3 (+/−
8.9) kg, height of 1.64 (+/− 0. 6.5) m, shoe size UK
5.5 (+/− 0.8). All recruited subjects gave full consent
to participate in the study. Ethical approval was
sought and granted from Staffordshire University
ethics committee. All subjects included in the study
were asymptomatic at the time of testing and were
excluded if any musculoskeletal foot pathologies
were present, particularly in the forefoot for example:
hallux valgus, lesser toe deformities and fifth
metatarsophalangeal joint deformities.
Foot sizing measurements for foot length were taken
using a Brannock device® to match the foot tested
with the appropriate footwear size. A subjective
assessment for footwear fitting and comfort was
conducted for each subject prior to testing in that
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shoe. Three types of footwear were used within
this study. The key difference in the 3 footwear
styles tested was the shape and dimensions of the
toe box: square, round and pointed toe (Figure 1).
Color and design were controlled by including
black ballet pumps with an accessory feature on the
toe box. Subjects were blinded to the brand of the
footwear by removing all labelling. Sole thickness
and material were assessed and closely matched,
however differences in sole material were present.
The volume of each shoe’s toe box was measured
by calculating the average quantity of fine sand that
filled the shoe to a level where the toe box upper
finished (Figure 1).
data collection
Plantar foot pressure was measured for each shoe
condition as well as a barefoot condition using a 1m
pressure plate (Footscan®, RsScan Olen, Belgium).
The plate was built into the walkway and placed
4m along a total length of 10 m. This enabled the
subjects to attain a normalized walking speed prior
to data capture and prevent stepping onto the plate
[31]
. The plate was calibrated to each individual
participant’s body weight prior to data collection.
Each condition was tested in a randomized order
determined prior to data collection with subjects
choosing a folded card identifying the order of the
test condition. There were two successful walking
trials collected for barefoot, square shoe, round shoe
and pointed shoes.
Interdigital and dorsal pressure was collected
separately using Walkinsense® (Tomorrow Options
Microelectronics, Portugal). See Figures 2 and
3. This new system allows for individual sensors
to be located anywhere on the foot and has been
previously validated [32] . Eight piezoresistive force
100Hz sensors were individually secured with