Feet and Footwear

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Feet and Footwear

• A match made in Heaven?
• Or
• The Odd Couple?

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Why is Footwear so important?

• When an wound occurs we tend to concentrate on
  healing the wound.
• We should start by trying to find and eliminate
  the cause
• Footwear examination and History are vital.

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Why do we wear any Footwear?

• Protection
• Weather, environment.
• Comfort
• Warmth, ventilation
• Functional for Activity
• Walking, Running, Sports, Dancing
• Cultural Aesthetic
• Matches outfit, Fashionable,

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What are our Feet for?

• Locomotion
• Stability
• Cultural Aesthetic?
• Foot Size Male Large Feet attractive
• Female Small Feet attractive
• Controlling Foot Shape
• Chinese Foot Binding and Cosmetic Surgery

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Chinese Foot Binding or the Golden Lotus
Started in 900AD and finished completely in about
1949. Started at the age of 2-3 the ideal foot
length was 3-4 inches
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The Lotus shoe for the bound foot
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What foot look is achieved by foot binding?

• The forefoot is moved closer to the rearfoot
• The Arch is made higher
• The overall foot length is much shorter
• The 2,3,4 and 5th toes are clawed under the foot

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Are modern societies any less obsessed with
changing foot shapes for aesthetic reasons?
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What foot look is achieved by a high heeled
shoe?

• The forefoot is moved closer to the rearfoot
• The Arch is made higher
• (looked at from the side including shoe)
• The foot length on the ground is much shorter
• The 2,3,4 and 5th toes are clawed due to
  narrowing of the shoe

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Modern societies also use surgery to alter the
foot shape

• Surgeons in the USA debate the ethics of cosmetic
  foot surgery
• How far would you go to wear a fashionable pair
  of shoes
• Bunion surgery or Amputation perhaps?

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If Shoe Won't Fit, Fix the Foot? Popular Surgery
Raises Concern

• ''I think it's reprehensible for a physician to
  correct someone's feet so they can get into Jimmy
  Choo shoes,'' said Dr. Sharon Dreeben, an
  orthopaedic surgeon in La Jolla, California., who
  is chairwoman of the foot and ankle society's
  public education committee. (New York Times
  7-12-03)

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If Shoe Won't Fit, Fix the Foot? Popular Surgery
Raises Concern

• But advocates for the procedures say that
  critics simply do not understand the importance
  of high heels.
• ''Some of these women invest more in their shoes
  than they do in the stock market,'' said Dr.
  Suzanne M. Levine. (New York Times 7-12-03)

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Shoe Fit in Context

• Shoe fitting and suitability
• This can only be decided when the foot that is
  going to wear the shoe is present for you to
  compare the shoe with the foot
• The shoes that seem good may be awful for the
  patients foot

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Lets be Interactive

• Take off one shoe and place it on the table in
  front of you
• If you had to be honest would you think it was a
  good well fitting shoe or a poor fitting one?

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Template testing of shoe fit

• Take a cereal packet or any card large enough for
  your foot and place it on the floor and put your
  bare foot onto them
• Draw around the outline of your foot
• Use scissors to cut the template out

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Template testing of shoe fit

• Place the template you made into your shoe
• Now look inside is the fit okay?
• Has the card buckled at the edges?
• This represents the deformity that may occur to
  get your foot into that shoe

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Template testing of shoe fit

• Did the fit of the template match your original
  thoughts as to whether the shoe was likely to be
  a good fit?
• This is a relatively quick test as even a good
  looking sensible shoe is dangerous if it is too
  short for the foot.

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Footwear Advice

• Good Shoe?
• Good Fit
• Length
• Width (Ball Toes)
• Depth
• Stable
• Supportive?
• Smooth internal seams
• Fastenings

• Bad Shoe?
• Poor Fit
• Too long or short
• Too narrow
• Too shallow
• Unstable
• Not Supportive?
• Rough internal seams
• No Fastenings

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Why is it difficult to get pts to change footwear
styles?

• Social and cultural pressure is HUGE!!
• Fashion is more important than comfort to a lot
  of people.
• People want to fit in with their peer group.

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Why is there pressure to wear a certain type of
shoe?

• Throughout history shoes have been an adornment
  for the foot rather than for the pure function of
  warmth and comfort.
• For example for two hundred years in Europe the
  Chopine was the Queen of Platforms (1400-1600)
  especially with courtesans and high nobility.

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The Chopine
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The Chopine

• However Venetian prostitutes started to wear
  Chopines as the shoes elevated them, when
  lingering in dark doorways waiting for customers,
  to a height which would make them noticeable. The
  fashion for Chopines died out in the upper
  echelons when the lower orders started wearing
  them.

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The High Heel

• The British in the 17th century became very
  concerned for the morals of women if they used
  false devices to trick men into marrying them
• Especially by the use of high heeled shoes along
  with cosmetics, wigs and other fakeries.

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Act of Parliament 1670

• Be it resolved that all women, of whatever age,
  rank, profession, or degree whether virgin maids
  or widows that shall after the passing of this
  Act, impose upon and betray into matrimony any of
  His Majesty's male subjects, by scents, paints,
  cosmetics, washes, artificial teeth, false hair,
  Spanish wool, iron stays, hoops, high-heeled
  shoes, or bolstered hips, shall incur the penalty
  of the laws now in force against witchcraft,
  sorcery, and such like misdemeanours, and that
  the marriage, upon conviction, shall stand null
  and void.

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Is it just the women being vain?

• Men wore the modern heel high first in 17th
  century France as an adaptation of the riding
  footwear that required a heel for stirrups
• But the heel of the shoe became higher (3-4) and
  thinner until it was just a court fashion for
  men not suitable at all for riding.

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The Poulaine

• Through the 13th and 15th centuries the Poulaine
  or Krackowe was infamous as the footwear for
  aspiring men.
• A flat soled shoe with a very long narrow toe
  front made from a roll of leather extended out
  the front

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The Poulaine
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The Church bans the Poulaine

• The Church was appalled at the outrageous sexual
  overtones of the Poulaine and thought it might
  cause Pagan worship to return
• The shoe became infamous as an under the table
  flirtatious device to raise female garments and
  well just imagine the rest!

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So throughout history the shoe is also about
power and wealth

• Sexual power
• Change of body shape
• Very high heels (dominance) plus submission
  (inability to run away)
• Long toes (phallic symbol) Winklepicker or
  Poulaine
• Show of wealth
• Cant walk cant work
• Shoes too expensive to scuff or damage proves
  doesnt work for a living
• Designer shoes (mostly male designers)

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Can we learn from History?

• People will always want to be fashionable (both
  men and women)
• You dont have to wear fashionable shoes all day
  every day. You need a functional everyday shoe
• Remember Fashion is not comfortable and Comfort
  is not fashionable.

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Balance

• Patient compliance with footwear is a balancing
  act between what they perceive as their need for
  a certain style of shoe and what you as a
  clinician would like them to wear.
• Try for comfort for at least 80 of the day
• Especially for work or daywear.

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Buying retail shoes (leaflet)

• Buy in the afternoon
• Sizes vary widely between manufacturers and
  styles so dont have rigid preconceived ideas on
  size
• Everyday shoes should be right length width and
  depth with wide stable heel that is not too high.

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Patients are not the best judges
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Therapeutic Footwear

• When foot deformities make it impossible to find
  retail shoes that fit
• Needs consultant referral
• Requires Patient Compliance
• Needs to be worn 65 of time to be worthwhile

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Worn or Wardrobe?

• A lack of preplanning and patient consultation
  can lead to a waste of resources.
• Therapeutic shoes issued for good medical reasons
  will not be worn as the overriding social
  pressure of fashion stops the person from wearing
  them (become clinic shoes!)

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Pre planning

• If therapeutic footwear is deemed necessary long
  preliminary talks with the patient are vital
• They need to be convinced of the need and that
  the shoes issued need not be hideous granny
  shoes or Frankenstein Boots.

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Measuring
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Bespoke or Stock

• Bespoke are made to measure and more expensive
  but may be necessary if LLD or deformities are
  too gross even for stock shoes
• Stock shoes are made on lasts that are wider and
  deeper than ordinary retail shoe lasts

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Summary

• Check patients current footwear if there is an
  unexplained foot lesion
• Advise if retail shoes suitable
• Refer if therapeutic shoes are necessary
• Assess patients willingness to change

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Summary of everyday shoe fit

• Right Length and a close fit at heel without rubs
• No gaping at topline
• No local tight spots or rough internal seams
• Broad heel of suitable height
• Adequate width depth for 1st MP joint
• Functional fastening

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