Make an Appointment 866-623-7600

Fleet of Foot

Kenneth G. Venos, M.D.

Shoes in our culture perform three major functions.  The first is to protect the foot.  The second is to enhance performance and function of the foot in athletics and day to day activities.  The third function serves a cosmetic function for dress and design.

The style of the shoes refers to the essential design character and architecture of the shoe.  There are seven basic footwear styles.  These include the pump, the oxford, the sandal, the mule, the boot, the clog and the moccasin.  Fashion is the variation of a particular style and is dependent on the imagination of designers and buying habits of consumers.

The basic anatomy of men’s and women’s shoes are very similar.  The proportions, however, tend to be different.  These differences lead to an increased incidence of foot problems in women.  The toebox is the front portion of the shoe’s upper.  The space between the floor and the plantar aspect or bottom of the toes is the “toe spring”.  This gives a rocker bottom effect to the shoe and helps progress weight during the gait cycle.  A narrow or pointed toebox gives the illusion of a small foot although often compresses the toes and leads to foot problems.

Just behind the toebox is the vamp or the upper part of the shoe that covers the instep.  In women’s fashionable shoes, there is a very small vamp and no tongue in an attempt to make the foot look smaller.  The perfect vamp is one that is large enough to cover the instep while being snug enough to secure the foot in the shoe.

Behind the vamp, the upper portion comprising the back of the shoe’s upper, is called the quarter.  This extends to the counter or the area at the back of the shoe that encases the heel.  The counter controls the heel and heel fit.  Many people who purchase a wide width shoe to accommodate a wide forefoot, find that they have problems slipping out of the counter because of poor fit.  This is because shoe manufacturers tend to “scale up” all parts of the shoe to the same proportion.  Unfortunately, foot width which can increase from spreading between the forefoot bones, tends to enlarge more than the heel width which is a single bone.

Inside the shoe is the insole or the cushioning on which the foot is supported.  This area comes in contact with the bottom of the foot and provides cushioning.  Unfortunately, fashionable shoes often dictate a small-appearing foot and insoles are as thin as possible and provide no cushioning effect.  Many sport-specific shoes have special outsoles to provide traction, shock absorption and to control pivoting for optimal performance.

Another feature of a shoe is its heel height.  This is generally dictated by current fashion.  Heel height is measured from the bottom of the outsole, where the heel begins, to the bottom of the heel.  The pitch of the heel is the angle or inclination of the back surface of the heel and generally the higher the heel, the greater the pitch.  The advantages of high heels are purely cosmetic.  The give the optical illusion of shortening of the foot, slenderizing the ankle and calf and giving a long-legged look.

The construction of the shoe is based upon the last.  The last is a plastic or wooden model that approximates the size and shape of the weightbearing foot.  Most shoes are produced to a standard or medium width.

Fit as well as current fashion and design have an impact on the problems caused by shoes.  Sizing of shoes dates back to the 14th  Century.  At that time, barley corns were used to define length with three barley corns equaling one inch.  King Edward decreed that 39 barley corns placed end to end would equal the size of the largest foot.  This came out to 13 inches and was designated a size 13, with each smaller size, one barley corn or one-third inch less.  Our current system of shoe sizing is still based on this.

The most complete measuring device for shoe sizing is the Brannoc measuring device generally seen in shoe stores.  Proper measurement of the shoe size includes the overall foot length heel to toe, arch length, heel to arch and width.  A properly sized shoe will have the ball of the great toe at the level of the widest part of the shoe which is why the arch length is important in shoe fitting rather than the overall length through the tips of the toes.  Historically, shoes in a pair were identical and it wasn’t until the 18th Century that the left and right were different.  This symmetry allowed people to get more wear out of their shoes by changing them from one foot to another.

A shoe with laces will always provide a more secure fit by being tightened after the shoe is put on the foot.  If the shoe is the correct shape for the foot, the correct size will allow for 3/8” between the end of the shoe and the longest toe (not necessarily the great toe).  In general, as the shoe gets longer, the manufacturers enlarge all key internal dimensions in fixed proportions.  This is called scaling.  Recent studies have shown that as a foot length increases, the foot width does increase somewhat but the heel width does not.  This leads to the common problem of having a heel counter that is too loose in the shoe that accommodates the length and forefoot width.  Rather than have their feet slip in and out of the heels, many people buy shoes that are too tight in the forefoot.

Athletic shoes are usually based on cushioning and control.  The accelerated rate of improvement in running and jogging activities has made for a greater demand in specific shoe types to help accommodate for overuse syndromes in the athlete.  Cushioning determines how well a shoe absorbs impact during activity.  Footwear with a cushion rating of 50 points or greater is ideal for exercising three days a week or more.  A higher cushion rating equates to less breakdown of the shoes shock absorption during long duration activities.

The control rating indicates how a shoe can alter one’s foot floor contact.  Some feet need a greater amount of alteration while others need none.  Supinators usually require a 0-20 control rating or a neutral shoe.  A neutral pronator requires a 0-40 rating or a neutral support shoe.  A mild over-pronator requires a 20-50 rating support shoe.  A moderate over-pronator requires a 30-60 rating and may want to consider a motion control shoe.  A moderate to excessive over-pronator will require a rating of 50-80 or a motion control shoe and an excessive over pronator will require a rating of 60-99 or a motion control shoe.

Trail style shoes offer traction, stability and durability.  These shoes are better equipped to handle uneven surfaces and unpredictable grades more effectively than road shoes.  They are often made of water-resistant or quick drying uppers and are usually quite durable.

Neutral style shoes are designed for running on predictable surfaces such as tartan tracks, decomposed granite pathways or warm asphalt.  These are best worn for supinators or neutral pronators and provide protection and comfort.

Support shoes are designed to help guide the foot back into a neutral foot floor contact position.  Structural devices aid in minimizing the risk for over-pronation and these shoes are represented by the greatest variety of styles by the individual brand manufacturers.  They are perfect for mild to moderate over-pronators and have a wide range of cushioning and control.

Motion control styles are best for the over pronator, especially the excessively over pronated foot.  They provide a good deal of control and help return to the foot to a neutral position in the stance phase of gait.  They usually include duel density foam and  thermal plastic units and will accommodate orthotics.

Although women represent a major portion of the athletic shoe market, many female athletes find it difficult to find comfortable running or athletic shoes.  When making a woman’s shoe, manufacturers proportionally scale down all key internal dimensions by means of a process called scaling or grading.  Unfortunately, this is usually not very effective.  Women have different shapes to their feet than men especially in the heel.  Female runners generally complete the heel-toe gait faster and typically pronate more than their male counterparts.  They need shoes that include control features such as increased firmness in the medial aspect of the arch and medial internal heel wedge.  They also need a straight last and a stronger medial heel counter.

Children shoes also present a point of confusion for most consumers.  Most children learn to walk about the time of their first birthday.  As the child begins to walk, there are often many questions about what he or she should wear.  When selecting children’s shoes, three questions need to be answered:  How does the shoe fit?; how is the shoe made?; and, is the type of shoe appropriate for the child’s age?

The fit demands that shoes should be comfortable from the start.  If new shoes need to be broken in, it either means that they were not properly designed or not properly fitted for the child’s foot.  Seventy percent of children wear shoes with D and E widths and most boys wear E widths and most girls wear D widths.  A tie fashion shoe can accommodate more widths and it should be remembered that young feet grow at different rates.  Most early toddlers under 16 months of age grow more than one-half a shoe size every two months.  Toddlers from age 16 to 24 months grow an average of one-half shoe size every three months.  The young child, 24 to 36 months old, grows approximately one-half foot size every four months and children over age 3 experience increases of one-half shoe size every four to six months.

Shoe construction needs to consider that children’s feet perspire greatly and the upper part of their shoes should be made of breathable materials such as leather or canvas to allow the shoe to breath.  Plastic and other man-made materials should be avoided.  The insole should also be made of an absorbant material  and remember most shoes do not need a special arch support.

All toddlers younger than 16 months have flat feet and usually and arch does not develop fully until age 6 to 8 years.  The outer sole of the shoe should not be sticky.  These outer soles can cause the young child to be clumsy and cause falls.  Toddlers do not need heels on their shoes.  Flat outer soles make it easier to begin walking and higher heeled shoes can cause the foot to slide forward cramping the toes against the shoe.  Pre-walking shoes should be flexible rather than providing rigid support and the fit should mimic the young child’s foot shape.  Toddlers’ shoes for ages 9 months to 3 years should allow the foot to breathe and a high-top shoe will stay on the foot better than an oxford or a low top tennis shoe.  A leather or canvas tie shoe is more secure and will stay on the foot and the sole of the shoe should be smooth like the palm of your hand causing less friction so the shoe doesn’t grab the floor and cause the child to fall.

School-age children shoes are more dependent on style and shoe fit.  Options include athletic shoes, sandals and hiking shoes.  Reasonably priced, flexible, well-ventilated shoes allowing plenty of room for growth are important to avoid the development of calluses or bunions.

Remember shoes should be comfortable from the start.  Careful evaluation of the foot and appropriate shoe fitting can avoid a number of problems in the short and long term and improve performance and function.

X