shoe toe box shape and volume
other sensors and plantar foot regions showed
no differences between shoe shape and barefoot
conditions. The square shaped shoe and pointed
shoe was where the significance fell with a pointed
shoe being in contact with the foot for longer periods
of time on the dorsal aspect of the foot and the
square shoe being in contact with the toes two – five
in the plantar aspect of the foot.
pressure time integral
Sensors 2, 3, 4 and 8 showed variable significant
differences between the pointed shoe having a
higher-pressure time integral at 2, 3 and 4 and the
round shoe being significantly lower at sensor 8. The
midfoot region, first toe and toes −2-5 were areas
that also showed a significant difference between
conditions, with variance lying between the pointed
shoe at the midfoot (having a significant lower
pressure time integral than the other conditions) and
the square shoe conditions. The barefoot condition
had a higher-pressure time integral around the
plantar region of the toes 2–5.
discussion
The results of this study clearly indicate that the
shape of a shoe’s toe box has a significant impact
on dorsal and plantar pressures of the foot. Round
toe shoes were shown to produce less peak pressure
around the medial aspect of the foot, and the
pressure time integral is also lower in this region.
Conversely, the pointed style of shoe distributed
the least amount of pressure in the lateral toe area.
These observations can be related directly to the
dimension and shaping of each the round and
pointed shoe styles which correlate to the natural
anatomical contours of the foot. However, the
volume of the shoe was not correlated to forefoot
pressure, with the round shoe having the least
volume in the toe box across all shoe sizes tested
and this condition demonstrated the lowest pressure
values. This lack of correlation might be due to the
stylized point of the shoe. This pointed shoe has an
extended length to the normal foot contour, which
increases the measured volume but does not alter
the toe pressure due to lack of direct contact. The
shape of the toe box therefore should be considered
as a cause of increased forefoot pressure and not just
the width of the shoe as previously mentioned as a
problematic design of ill-fitting footwear [12,25,26] .
The dorsal digital area showed higher peak pressure
on the medial side of the foot whilst wearing a
square and pointed shoe shape, with the design of
the shoes encroaching on the natural shape of the
first digit. Similarly, this correlation of shoe shape
and foot shape was also seen in the square toed shoe
which exerted the highest amount of peak pressure
over the fifth digit. The gradient of the lateral border
of the toe box was similar both in the square shaped
and the pointed shoe. There was greater variability
regarding regional significance of peak plantar
pressure in the masked areas of the plantar pressure
with each shoe condition showing significance at
different regions of the foot. The sole material of
each shoe was not controlled within the study design
and will have altered plantar pressure distribution
and results. Although care was taken to choose three
designs that only differed by toe box shape it was
difficult to replicate the same sole characteristics.
However, the round shoe shape did consistently
result in higher peak plantar pressure within the
forefoot region accompanied by lower dorsal peak
pressures around the medial forefoot. This could be
due to a lower recorded volume of the toe box and
possible cramping of the normal toe profile altering
toe function and plantar pressure during toe off.
It is also worth highlighting that the pointed shoe
condition produced a significantly higher peak
Current Pedorthics | March/April 2019
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