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Department
of Podiatry
Footwear
Fitting
Outline
Introduction
Footwear assessment
History taking
Assessment of shoe fit
Wear marks/Interpretation of foot function
Suitability
References
McPoil TG. (1988). Footwear. Physical Therapy; 68(12): 1857-1865.
Janisse DJ. (1992). The art and science of fitting shoes. Foot &
Ankle; 13(5): 257-62.
Rossi WA, Tennant R. Professional Shoe Fitting: Chapter 8, pp.90-105.
Merriman LM, Tollafield, DR.Assessment of the Lower Limb: Chapter
10, pp.227-47.
Why assess footwear?
Unsuitable footwear or shoes that do not fit correctly may affect
the efficacy of treatment or be the cause of the problem
Shoes provide information of how the foot functions during gait
Footwear Assessment
Part of an overall global assessment
‘New patients’ should be advised to bring shoes they wear
‘everyday’ or that are associated with symptoms
Stages at which parts of footwear assessment can be completed
History
Background information about general footwear and purchasing habits
is essential
Financial circumstances
Wardrobe
Habits
Acquisition of footwear
Independence
Assessment of shoe fit
Late 1940’s - early 1950’s: Shoe fitting x-ray units were
extensively used by shoe stores (USA)
Image of feet within shoes obtained
Banned ~1970
Assessment of shoe fit
A well fitting shoe should fit snugly around the heel and the arch
and allow free movement of toes
Style of shoe is likely to dictate fit
Weightbearing assessment is crucial
length - overall and heel-to-ball
width
depth
Factors affecting fit
Static fit
Weightbearing fit
Thermal fit
Functional/Dynamic fit
Dynamic Fit Concept
Length
A gap (~12 mm) between the longest toe and front of shoe to allow
for foot elongation
Must consider particular circumstance
shoe style (toe shape and depth, heel height)
mobility of foot type (mobile?)
Length Assessment
Observe uppers for bulging, skin of foot
Patient standing, palpate the end of the longest toe through the toe
puff
Sprinkle talcum powder inside shoe, patients walks, assess gap at
shoe
Insert strip of card the length of foot into shoes
Assess both feet
Heel to Ball Length
Hinge of shoe needs to be aligned with ball of foot
Widest part of foot should be in widest part of shoeHeel to Ball Length
Assessment
Patient standing in shoes, feel for the first and fifth MPJs. Bulge
of joints should be level with bulge of shoes
Flex shoe sole and compare to foot
Dynamic test: observe patient walking unshod vs shod: stiff or ill-fitting
footwear may alter propulsion
Width
Correct width will allow toes to rest flat on the insole without being
compressed
Shoes too narrow will cause pressure lesions
Width Assessment
Patients standing in shoes, grasp upper at level of MPJs, pinch upper
between finger and thumb. Tense = too small, wrinkles = too wide
Fit tip of pencil under throat line?
Consider
Static vs Dynamic vs Thermal Fit
Depth/Volume
Style of shoe/design of last influences depth/volume
Shallow shoes may affect nails or cause pressure lesions
Consider orthoses, deformities
Patients standing in double-support stance, palpate upper of shoes
above 4th & 5th toes, toes should not be cramped
Other factors affecting fit
Shoe flare
May not match foot
Outline of foot (bisect heel & 2nd toe) versus outline of shoe
(bisect prox & distal heel)
Measure maximum width of the medial and lateral sections of both outlines
Widest part usually medial, and should be ~ equal
Shoe Flare Assessment
Other Factors affecting fit cont..
Inside Border Shape
Shape of front of foot and its impact on inside border of shoe
Patient stands on outline of shoes with heels aligned
Overlap of toes over the edge of shoe indicates shoe is inappropriately
shapedInside Border Shape Assessment
Make up Picture showing template of shoe against foot
Other factors Affecting Fit cont...
Fixation
How is foot secured within shoe?
Shoe should be not too tight or loose, and allow some adjustment
laceup - requires gap between rows of eyelets, ~3-4 eyelets
Patient stands one foot in front of other, and leans forward on front
foot. Grasp upper.
If inadequate fixation - will detect forward motion of foot in shoe
Dynamic test: May see movement of foot within shoe
Wear marks/Interpretation of foot function
Assessment of wear patterns of shoes (inside of shoe, upper and soles)
may help confirm a diagnosis, highlight deformity elsewhere, or reveal
information about foot function
Wear = pattern & excessive/insufficient
Need to know normal vs abnormal wear
Wear
on the sole
Pressure under sole of shoe should be even, so no one part wears out
excessively
Normal wear may occur at lateral heel and medial central forefoot
May also be slight curvature on undersurface of the sole - toe-spring
accentuated by walking
Variation from above represents abnormal
Examples
Sole curvature absent/assymmetrical/excessive - Abnormal toe function
(R/A)
Tip of sole - Excessive = last design toe spring insufficient. Absent
= lack of push-off
Excessive forefoot wear - AJ equinus
Circular forefoot wear - MPJs used as transverse pivot
Excessive heel wear - inner = everted STJ, outer = inverted STJ
Wear on the upper
Crease marks in the upper
normally runs slightly obliquely following line of MPJs
Excessivley oblique - failure of 1st MPJ d/f
Absent - Propulsion absent (short stride and flat footed gait)
Deformation
caused by shoe conforming to foot deformities
Hallux valgus,tailor’s bunion, claw toes
everted STJ vs inverted STJWear on Inside of Shoe
Wear patterns inside shoe likely to mirror those found on heel and
sole
Insock will often display a print of the sole of the foot from which
areas of high pressures can be assessed
Suitability
A number of factors affect the suitability of a shoe
age/deterioration of shoe
alterations of foot shape
conditions/situation in which worn
Suitable shoe styles
Two important parts of an ideal shoe
band around instep prevents foot sliding forward
pressure behind heel to prevent foot sliding back
?Support
may not be essential for an ideal functioning foot
Points to look for in a suitable shoe
Conclusion
Footwear Assessment
part of an overall global assessment
History taking
Assessment of shoe fit
factors to consider, length, heel-ball, width, depth, other factors
Wear marks
upper, sole, inside
Suitability
Dynamic Fit Concept
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