shoe toe box shape and volume
The fifth toe and interdigital fourth and fifth area
are common locations to develop focal chronic
callus lesions. The results from this study suggest
that the shape of the toe box may play a part in the
development of such lesions with the lateral border
of the forefoot resulting in higher peak pressure and
pressure time integrals in the square shoe. An increase
in pressure may be attributed to the graduation of
the toe box shape if does not follow the anatomy
of the foot. Changes to footwear style may help to
reduce the incidence of these common problems and
improve comfort for many females. Cases have been
reported where the fifth digit has been amputated to
accommodate the foot in a desired shoe [35] . Further
research into the impact of footwear styling at the toe
box on pathological feet is recommended.
Considering the results from this study, development
of shoe design needs to advance to encompass an
accepted toe box for fashion as well as foot health.
This may involve the medial border of the shoe
around the 1 st metarsalphalangeal joint and the first
toe being designed in a round shape and the lateral
border around the 5 th interphalangeal joint having
a pointed graduated shape. These style features
could minimize peak pressure, contact times and
consequently pressure time integral in the forefoot.
This style and shape of shoe is infrequently seen in
the market place with the majority of footwear styles
adopting a narrowed toe box with equal shaping to
the medial and lateral side of the shoe. By limiting
consumer choices on footwear shape people are
forced to choose footwear that has been shown to alter
pressure to the forefoot. Providing footwear choices
that do not impact on forefoot pressure could prevent
pathologies that are associated with ill-fitting shoes.
There are limited studies to investigate the impact
that footwear shape and style have on foot pathologies
however, there are strong links between foot pain and
ill-fitting footwear especially in the elderly population
[36]
. Footwear choices are led by fashion and image
rather than health [11,29,30] . Changes in footwear
design for younger adults, to accommodate natural
foot position and shape, may be a useful way to help
prevent painful foot pathologies and deformities
occurring prior to old age.
The style of footwear investigated in this study was
determined by fashion and the most popular choice
amongst young females [11] . Although, the fit of the
foot in the shoe around the toe box may alter with
increased heel height, fastening of the shoe, shoe
upper material and also last shape, the conclusions
outlined in this manuscript do not address these
factors. Further structured investigation into
quantifying the pressure under the upper is required.
Furthermore, there should be a detailed examination
of all shoe styles with varied toe box shapes. The
pointed shoe employed within this investigation was
longer in the toe box region than the square and
round shoe and therefore had an increased volume.
The styled extension of this toe box may have masked
the actual fit of the foot inside the shoe. This might
require further scientific study of the relationship
between design and function. In addition to this,
studying a population with foot pathology will help in
understanding the contribution footwear style makes
to development of foot disorders.
conclusion
The shape of the toe box can alter the pressure
applied to the forefoot around the digits and plantar
aspect of the foot in healthy young women with no
known foot pathology. Hence, footwear advice with
reference to the shape of the toe box is essential in
the management of pressure related lesions and when
preventative measures are being considered.
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Current Pedorthics | March/April 2019
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