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Excessive
creasing in
the upper
Medial bulge
associated with hallux
abducto-valgus
Distorted uppers
associated with
excessive pronation
Figureā€ƒ6.3 Distorted uppers owing to excessive pronation
shortening of the medial border of the foot. The vamp crease will shift
back on the medial side and will be nearly straight across the upper of
the shoe. Additionally, there is almost always an associated retraction of
the toes, which distorts the upper with bulges over most of the inter-
phalangeal joints.
In the case where a person has severe and excessive pronation, the
whole of the upper becomes distorted into a recognizable pattern. The
combination of the changes is shown in Figure 6.3 .
Distortion of uppers result in the life span of the shoe being shortened
significantly. The most obvious distortion is the alteration at the throat of
the shoe. This is caused by the adduction and plantarflexion of the talus
with the medial shift of the navicular. These are the two major components
of closed chain pronation. The medial heel bulge is caused by the third
component of pronation, that is, the tilting of the calcaneus. The middle
section of the shoe is markedly abducted in relation to the abnormal
rearfoot position, appearing as a lateral break at the level of the midtarsal
joint. The fore part of the shoe is broadened by the splaying of the fore-
foot, and the first and fifth metatarsal heads form prominent bulges. From
the medial side, the most noticeable feature is the bulging of the upper
caused by clawing of the toes.
Normally, adductus deformities are compensated for by subtalar pro-
nation and these result in the wear patterns identified previously as being
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