what-when-how
In Depth Tutorials and Information
Footwear as an aid to diagnosis - wear marks
The footwear needs to be assessed with the patient walking and standing
to evaluate how the patient functions with the footwear. This can be fol-
lowed by an assessment of the unshod foot once the footwear has been
removed. This time can also be used to check the ability of the patient
to put on and take off their footwear, and the footwear can then be
inspected further because it can reveal clues to aid diagnosis. It is useful
to start with an evaluation of any wear marks or distortions.
Key
Concept
Footwear wear marks or distortions in the footwear may help confirm a
diagnosis.
Evaluation of footwear wear marks is an important aspect of overall
assessment, providing clues to the underlying problem in relation to foot
function, structure and gait. As the wear pattern can be unique to each
individual, it can provide vital information in the specialist field of forensic
science (Vernon and McCourt 1999). As shoe wear patterns may be a
record of the usual long-term activity of the foot, their assessment may
provide insight to foot function and influencing factors. There are a mul-
titude of influences on footwear wear patterns (
Figure 6.1
).
Influences on shoe wear
Assessment of the wear patterns of footwear involves observing the inside
of the shoe, the upper and the soles. This may help confirm a diagnosis
or reveal information about foot function (
Vernon et al 2004
).
Footwear of a traditional, all-leather construction provides the best
source of useful information. The reasons for this are that this type of
footwear is constructed to last for an extended period when compared
with mass-produced high street fashion footwear, and that the wear char-
acteristics of leather are such that the effects of dysfunction are recorded
in a way that is easy to read, with the intensity of wear being clear. Wear
on modern materials can be much more difficult to interpret.
Normal wear
Pressure under the sole of the shoe should be even, so no one part wears
out excessively. Normal wear should occur at the lateral heel and medial
central forefoot (
Figure 6.2
), following the normal pathway of the foot's
centre of pressure. Normal heel wear spreads across the postero-lateral
