what-when-how
In Depth Tutorials and Information
C h a p t e r
6
Chapter Contents
Footwear
assessment
Introduction 81
Assessment of the patient's
footwear - history of usage
and preferences 83
Patient assessment
checklist 83
Footwear as an aid to diagnosis
- wear marks 85
Influences on shoe wear 85
Normal wear 85
Abnormal wear 86
Variation in heel wear 88
Variation in tip wear 88
Variation in tread line wear -
rigid foot 89
Variation in tread line wear -
severe functionally hyper-
mobile pronated foot 89
Variation in tread line wear -
mild functionally hypermobile
foot 90
Distortion and wear of the
uppers 90
Heel counter wear and
distortion 92
Other factors influencing
wear 92
Assessing foot size 93
Measuring overall length 96
MTP joint to toe length 97
Ball width 97
Assessing footwear fit 98
Heel it and heel height 98
Throat 99
Design of patterns and
vamps 99
Summary 100
Review questions 100
Reflection 100
Self-assessed questions 100
References 102
Further reading 102
Introduction
Footwear plays an important role in the main-
tenance of foot health, in the structure and
function of the growing foot, and in the healthy
adult population. Additionally, it plays a vital
role for people with systemic diseases affecting
the health status of the lower limb. Patients
with diabetes, rheumatoid arthritis (RA), con-
nective tissue disorders, peripheral vascular
disease and other conditions associated with
compromised neurological status and poor
tissue viability benefit from appropriate foot-
wear. It is known that footwear can be a pre-
cipitating cause of trauma leading to lower
extremity ulceration and amputation in people
with diabetes (
Striesow 1998
,
Uccioli et al
1995
,
Chantelau et al 1990
). The benefits of
appropriate footwear in patients with RA are
reduction in pain and increased mobility
(
Williams et al 2007
,
Chalmers et al 2000
,
Fransen and Edmonds 1997
, Michelson 1994).
In the elderly population, it is recognized that
inadequate footwear such as badly worn shoes
or slippers contribute to the occurrence of falls
(
Koepsell et al 2004
,
Sherrington and Menz
2003
), demonstrating the complex interplay
between footwear, walking and balance;
because of the potential impact of footwear in
these specific patient groups, a separate
chapter is devoted to exploring the issues and
options for them (Chapter 9).
