Shoes & Shoegear

Bryan LevayMonday, May 13, 2013

Overview

• 7 shoe styles• Shoe anatomy• Sizing• Shoe life• Evaluation• Minimalist • Diabetic shoe

The 7 basic styles

#1 Sandal

• Oldest form• Basic open toe design• More robust for soldiers • New styles & variations• Poor support often

leads to discomforthttp://www.google.com/url?sa=i&rct=j&q=war+sandals&source=images&cd=&docid=kwryg94no_MdXM&tbnid=c6Ou9hHtfzWyjM:&ved=&url=http%3A%2F%2Fwww.kshs.org%2Fp%2Fcool-things-japanese-footwear%2F10365&ei=FdCPUeHGFIqiigek3YHAAw&bvm=bv.46340616,d.aGc&psig=AFQjCNFtYeStNqcvAnCpbOxb-xz8r8zvPA&ust=1368465813575772

http://www.google.com/imgres?q=sexy+sandals&um=1&safe=active&client=safari&sa=N&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=ikg3ehXBR67uXM:&imgrefurl=http://www.ebay.com/itm/Elegant-Rhinestone-Heels-Sexy-Sandal-Comfy-Medium-Heel-/280382960838&docid=iQ3SOwXYivjVFM&imgurl=http://i194.photobucket.com/albums/z142/HOO121/Pics%252520VIII/P1010116_01.jpg&w=1024&h=768&ei=ndCPUdH4Oc2aiAf26oGIAQ&zoom=1&ved=1t:3588,r:1,s:0,i:86&iact=rc&dur=557&page=1&tbnh=181&tbnw=250&start=0&ndsp=18&tx=130&ty=52

#2 Moccasin

• “Foot covering”• Popularized Native

American, but has Ancient Mongol roots

• Simple closed design

http://www.google.com/imgres?q=moccasin&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=rJI48cJzaXU-ZM:&imgrefurl=http://dowestboots.com/leather_laced_minnetonka_moccasi.htm&docid=_j1MNs05UIUutM&imgurl=http://dowestboots.com/brown_minnetonka_moccasin_7.jpg&w=640&h=480&ei=89GPUa2tAtCaiAf6uoHgDw&zoom=1&ved=1t:3588,r:50,s:0,i:238&iact=rc&dur=397&page=3&tbnh=179&tbnw=239&start=34&ndsp=20&tx=119&ty=72

#3 Clog

• Peasant shoes• Scandinavian countries• Wooden design• Resurgence in

popularity

http://www.google.com/url?sa=i&rct=j&q=clog+diagram&source=images&cd=&docid=sDtsm5nNf907sM&tbnid=b9cxa09njx6fxM:&ved=&url=http%3A%2F%2Fwww.shopping.com%2FDansko-Dansko-Professional-Cabrio-Clog-Women-s%2Fprices&ei=ZdSPUe70DaiViAfEsYBg&bvm=bv.46340616,d.aGc&psig=AFQjCNEDbHvZdhr5NQYEOEyGNhLxhBbfLw&ust=1368466917569052

http://www.google.com/imgres?q=crocs+clogs&um=1&safe=active&client=safari&sa=N&hl=en&rls=en&biw=1130&bih=713&tbm=isch&tbnid=QUAlBeDf0OdVfM:&imgrefurl=http://coachshoessummer2011.blogspot.com/2012/05/dansko-work-clog-professional-crocs.html&docid=S2YrFDXuN0Fj3M&imgurl=http://2.bp.blogspot.com/-O5ifP_2IIe4/T78Yntry3PI/AAAAAAAAYBI/qK1kyJkISdU/s1600/DANSKO-CROC-CLOGS-13.jpg&w=600&h=440&ei=h9aPUZ7VBoe4iQf7hIGoAw&zoom=1&ved=1t:3588,r:15,s:0,i:128&iact=rc&dur=284&page=2&tbnh=181&tbnw=247&start=13&ndsp=20&tx=54&ty=90

#4 Pump

• Prominent in late 16th century United Kingdom

• Thin constructed that acted as a “slip-on”

• Heel lift added • Many variations

http://www.google.com/imgres?q=open+toe+pump&start=303&um=1&safe=active&client=safari&hl=en&rls=en&biw=1130&bih=713&tbm=isch&tbnid=COlKH2tQnqm2DM:&imgrefurl=http://www.salamandershoes.com/ARA/889,5,6,ARA-St-Tropez-blue-nubuck-opentoe-pump.html&docid=I9mJ6r65m5OOGM&imgurl=http://salamandershoes.com/images/P/IMG_2267-lg.jpg&w=500&h=375&ei=8dqPUeX5MPCPiAeVkoCABQ&zoom=1&ved=1t:3588,r:21,s:300,i:67&iact=rc&dur=261&page=14&tbnh=175&tbnw=223&ndsp=24&tx=84&ty=68

http://www.google.com/url?sa=i&rct=j&q=ballet+en+pointe&source=images&cd=&docid=1vqbBnrBHFMqbM&tbnid=K3WtgvAmBlJxgM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.ebay.com%2Fitm%2FNew-GRISHKO-Maya-Ballet-Pointe-Shoes-Size-7-XXXX-M-%2F160969302902&ei=KNyPUavLKKboiAeYroGYAQ&bvm=bv.46340616,d.aGc&psig=AFQjCNGfd5Tw_IUrcYJwsNzj53yUNawdiw&ust=1368468860347355

#5 Mule

• Hybrid of a clog & pump• Closed toe, backless

shoe• The original slipper• May have heel

http://www.google.com/url?sa=i&rct=j&q=mule+shoe&source=images&cd=&docid=yZIrTm8S5tlqFM&tbnid=XBbqodRkHMh_GM:&ved=0CAUQjRw&url=http%3A%2F%2Flovetosparkleandshine.blogspot.com%2F2012%2F04%2Fdefinition-of-beauty-shoe-styles.html&ei=6N6PUdysDYWtiAeipoGYBQ&bvm=bv.46340616,d.aGc&psig=AFQjCNEJuJLWyzMduSUm4rCdGM2oVvX3JA&ust=1368469601893559

#6 Oxford

• First lace-up style shoes• Mid-17th century• Has been the mainstay

of shoegear since• A “monk” is a variation

with a buckle

http://www.google.com/imgres?q=oxford+shoes&start=149&um=1&safe=active&client=safari&sa=N&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=mNpXY8vISqZP1M:&imgrefurl=http://www.kmart.com/shc/s/t_10151_10104%3FtName%3Dlace-up-oxford-shoes.html&docid=hlPqHO-lExSR_M&imgurl=http://c.shld.net/rpx/i/s/i/spin/image/spin_prod_640857801&w=1900&h=1900&ei=99-PUZS_Ls3PiAfl5oDYCQ&zoom=1&ved=1t:3588,r:71,s:100,i:217&iact=rc&dur=1271&page=8&tbnh=191&tbnw=190&ndsp=24&tx=84&ty=61

http://www.google.com/imgres?q=monk+shoes&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=74MHj8ldIQwBXM:&imgrefurl=http://nm2u.wordpress.com/2013/01/06/official-fashion-a-z-dos-and-donts-for-2013-gents/&docid=DK7_sDGRZHin9M&imgurl=http://nm2u.files.wordpress.com/2013/01/harris-tan-double-monk-shoe-brown-product-1-230038-566698469_full.jpg&w=1020&h=732&ei=a-GPUdCfNejyiAeplICgBw&zoom=1&ved=1t:3588,r:6,s:0,i:98&iact=rc&dur=568&page=1&tbnh=182&tbnw=254&start=0&ndsp=15&tx=58&ty=51

#7 Boot

• Closed-toe • Extends above ankle• Lace-up or slip-on

http://www.google.com/imgres?q=boot&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=GYJqUG2eDEoTBM:&imgrefurl=http://rfclipart.com/boot-outline-1431-vector-clipart.html&docid=pUQvNSSDHBSz5M&imgurl=http://img.rfclipart.com/image/big/94-7c-14/boot-outline-Download-Royalty-free-Vector-File-EPS-2734.jpg%253Fv3&w=1200&h=1200&ei=A-KPUc2dF-aSiQfDmoCwDA&zoom=1&ved=1t:3588,r:48,s:0,i:232&iact=rc&dur=385&page=3&tbnh=183&tbnw=203&start=37&ndsp=20&tx=79&ty=115

http://www.google.com/imgres?q=boot&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=wSILxymByYQr4M:&imgrefurl=http://www.target.com/p/women-s-mossimo-supply-co-kaci-western-boot-assorted-colors/-/A-13971671&docid=LjIj8-Xv-nMTXM&imgurl=http://img1.targetimg1.com/wcsstore/TargetSAS//img/p/13/97/13971671.jpg&w=410&h=410&ei=A-KPUc2dF-aSiQfDmoCwDA&zoom=1&ved=1t:3588,r:39,s:0,i:205&iact=rc&dur=319&page=3&tbnh=185&tbnw=185&start=37&ndsp=20&tx=37&ty=108

http://www.google.com/imgres?q=boot&start=290&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=pX5ObHsweeroyM:&imgrefurl=http://buildaboot.com/&docid=ENXxN23p2n9XdM&imgurl=http://buildaboot.com/sites/default/files/temp/288860082.png%253F1362002519&w=500&h=500&ei=beKPUavdOKm5iQfUloGoBg&zoom=1&ved=1t:3588,r:95,s:200,i:289&iact=rc&dur=334&page=15&tbnh=184&tbnw=225&ndsp=20&tx=139&ty=119

SHOE ANATOMY

Upper

Lower (sole)

Uppers

vamp

tongue

padded collar

eyelets

counter

quarter

top line

Vamp

• Covers the top of the toe box• May have a toe cap• Different composition based on function

http://www.google.com/imgres?q=running+shoes&start=140&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=xY5ypTq10o5eEM:&imgrefurl=http://www.nikefree8.com/nike-free-5-0-v3/mens-nike-free-5-0-v3/nike-free-5-0-v3-mens-running-shoes-gray-green-1&docid=Sr-5m57LYbgNVM&imgurl=http://www.nikefree8.com/image/data/Nike%252520Free%2525205%2525200%252520V3/Mens%252520Nike%252520Free%2525205%2525200%252520V3/Nike%252520Free%2525205%2525200%252520V3%252520Mens%252520Running%252520Shoes%252520Gray%252520Green1-1.jpg&w=500&h=500&ei=0PqPUfb6O-2SiAeq-oHYAQ&zoom=1&ved=1t:3588,r:52,s:100,i:160&iact=rc&dur=616&page=9&tbnh=181&tbnw=225&ndsp=16&tx=102&ty=109

http://www.google.com/imgres?q=dress+shoes&start=454&um=1&safe=active&client=safari&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=_LyQRmnbrg6qLM:&imgrefurl=http://buy-work-shoes.web-mall.biz/product/1/257/Shoes-For-Crews-Statesman-Mens-Brown-No-Slip-Dress-Shoes.html&docid=q3iBs0ABSKUjbM&imgurl=http://buy-work-shoes.web-mall.biz/img/1/249.jpg&w=350&h=350&ei=hvuPUd7AB6qOiAfJ94DIDg&zoom=1&ved=1t:3588,r:60,s:400,i:184&iact=rc&dur=671&page=24&tbnh=188&tbnw=197&ndsp=20&tx=89&ty=61

Quarter

• Forms along the sides of the upper• Largest part of the upper

quarter

Heel Counter

• Maintains the shape of the shoe• Controls and stabilizes the heel

http://www.google.com/url?sa=i&rct=j&q=heel+counter&source=images&cd=&docid=7KV_9i2nFxCo5M&tbnid=dDiAmzUhOYb5BM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.theshoesnobblog.com%2F2012%2F07%2Fbreaking-in-shoes-your-first-30-days.html&ei=QgKQUZ_hHMmUiQeY0oDgAg&bvm=bv.46340616,d.aGc&psig=AFQjCNHwJA4eV3xm1merBpnK7zc_xg9aeA&ust=1368478208968784

http://www.google.com/imgres?q=heel+counter&um=1&safe=active&client=safari&sa=N&rls=en&hl=en&biw=1130&bih=713&tbm=isch&tbnid=foNnxRo5EXUTCM:&imgrefurl=http://themiddlemiles.blogspot.com/2011/04/gear-review-nike-free.html&docid=YNtsktrWulxtwM&imgurl=http://4.bp.blogspot.com/-Sk-ToRr4T_4/TaxsxfEKitI/AAAAAAAAARg/PApPxs4-DoE/s1600/nike%252Bfree%252Bheel%252Bcounter.JPG&w=506&h=367&ei=gACQUcb2G4adiAfOxIHQBg&zoom=1&ved=1t:3588,r:71,s:0,i:305&iact=rc&dur=385&page=5&tbnh=191&tbnw=264&start=71&ndsp=21&tx=184&ty=134

Tongue

• Prevents debris from entering• Protects against pressure of laces• Ensure it’s not too long to irritate leg

Padded collar

• Cushion• Achilles notch

Lower (sole) anatomy

• 3 components to the sole of a shoe– Inner sole– Middle sole– Outer sole

http://www.google.com/url?sa=i&rct=j&q=asics&source=images&cd=&docid=z06xqjP-ZYcpnM&tbnid=mcejDICpLGKXAM:&ved=0CAUQjRw&url=http%3A%2F%2Fhypebeast.com%2F2009%2F11%2Fasics-gtii-tweed-collection%3F_locale%3Den&ei=FyORUfW9DIS0iQf7wYHYDQ&bvm=bv.46340616,d.aGc&psig=AFQjCNEK5VoPanPLsFR_jt22pcfqHwf4KQ&ust=1368552560839283

Outer sole

• Portion of the sole that makes contact with the ground

• Provides traction, resists wear, and absorbs shock

• Treaded layer glued to midsole• Thinner than the midsole• Typically, either made from:– Blown rubber lighter, but less durable– Carbon rubber heavier, but more durable– Combination

http://www.google.com/url?sa=i&rct=j&q=bottom+of+skate+shoes&source=images&cd=&docid=vY1BJhH9NkbaEM&tbnid=Fs10TupHExOa1M:&ved=&url=http%3A%2F%2Fwww.tactics.com%2Fdc%2Fmikey-taylor-s-skate-shoes%2Fblack-gum&ei=9gmQUZWTOeaKiQfRnoFw&bvm=bv.46340616,d.aGc&psig=AFQjCNFk_ENrMMn4CiTraGnEsOu5tZW_Cw&ust=1368480631287728

http://www.google.com/url?sa=i&rct=j&q=bottom+of+running+shoes&source=images&cd=&docid=KVE04tR8kYZZSM&tbnid=VkCKw0Rw8xtq6M:&ved=&url=http%3A%2F%2Fwww.volleyballcentral.net%2Fmizuno-wave-nexus-g3-team-men-s-training-shoes.html&ei=EgqQUa2yHe6jiAeAjIHgAQ&bvm=bv.46340616,d.aGc&psig=AFQjCNHb8lfJApSNpdWdIHc1qZsTpEjQHA&ust=1368480658852654

Middle sole

• Thickest layer• Provides the majority of cushioning and shock

absorption• Modification layer• Typically made from EVA or PU– Ethylene vinyl acetate lighter, better cushioning,

deteriorates quicker– Polyurethane denser, heavier, more durable

Modification layer

• Mid sole cushioning devices• Medial post• Shank

Mid sole cushioning device

• Majority comes from EVA• Manufactures also insert their proprietary

cushioning systems (w/n midsole)• Most common cushioning systems use

encapsulated air, gel or other materials

Medial post

• Within the midsole (firmer) • EVA, thermoplastic

urethane, carbon fiber or other materials

• In stability and motion control shoes

• Not in cushioned or neutral shoes

• Size ,shape, & density determine amount of stability provided

Shank

• Stiffens the shoe under the arch

• Makes the middle portion of the shoe more resistant to torsion and flexion

• In most running shoes except the lightest and most flexible

• Assists shoe in bending at toes

• Adds weight

Inner sole

• Not visible on constructed shoe

• Junction attachment of the sole to the upper shoe

• Not an insert

Sizing

• Use a similar weight sock and orthotics• Leave at least ¼ inch (up to ½ inch) between

longest toe and end of shoe • Heel counter should be snug enough to

prevent heel from sliding• Fit shoe during the end of the day (swelling)• Shoes should never need breaking in• Always try on both shoes

Last

http://www.google.com/url?sa=i&rct=j&q=shoe+last&source=images&cd=&docid=q5Kd0s2ZGezjNM&tbnid=teUim7327_HEeM:&ved=&url=http%3A%2F%2Fwww.rei.com%2Flearn%2Fexpert-advice%2Frunning-shoes.html&ei=6ROQUf3PDo2diAej3oHIAg&bvm=bv.46340616,d.aGc&psig=AFQjCNGDBlmGh1m44AMHQwlZVPZJxMJsiw&ust=1368483177593564

Shoe life

• Less dependant on age of shoe• More dependant on amount of usage and

signs of wear• Athletes vs non-athletes• Work vs casual• Differences among body habitus• Presence deformities

Shoe breakdown

• Occurs most commonly at the outer sole• Has has outer sole worn through to the middle

sole?• Is there a 4mm difference from the other side

of the heel?

Shoe breakdown

• Lack of middle sole shock absorption• Uneven on flat surfaces • Noticeable creases• General rule of thumb: Replace 300-500 miles

Shoe breakdown

• Heel counter deviation

Guidelines for replacement

• Even without use shoes can wear out• Depending on environment • Best to replace athletic shoes that are over a

year old• Can be expensive in short term• Will prevent injuries and keep patients active

in long run

Picking shoes

• Right shoe for the right foot• Best shoe for the job• Comfort & Function > Appearance• Remove/Avoid if irritating

Evaluating

• Straight heel• Counter test• Stable sole bottom• Bend at the toes• Torsion test

http://www.google.com/url?sa=i&rct=j&q=heel+counter+test&source=images&cd=&docid=KfcuIwAVZZ5jXM&tbnid=opt2ihPlJqjgXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.therunnershigh.com%2Farticles%2Fdefrunningasa2.html&ei=uB2QUbODHq-ViQfX5YGIAg&bvm=bv.46340616,d.aGc&psig=AFQjCNHb0cKBVixwjuyMOQr7H3q6ATnLfQ&ust=1368485644751002

http://www.google.com/url?sa=i&rct=j&q=heel+counter+test&source=images&cd=&docid=SROGfnHg03Rs-M&tbnid=VLcW9nn0zKj2HM:&ved=&url=http%3A%2F%2Fwww.footankle.com%2Fshoes.htm&ei=jB2QUfPZGIePiAe3joHoBw&bvm=bv.46340616,d.aGc&psig=AFQjCNHb0cKBVixwjuyMOQr7H3q6ATnLfQ&ust=1368485644751002

Adapted for Arnold Ross, DPM

Evaluating

• Straight heel• Counter test• Stable sole bottom• Bend at the toes• Torsion test

http://www.google.com/url?sa=i&rct=j&q=shoe+torsion+test&source=images&cd=&docid=xrJFpRKw9lVm8M&tbnid=obo6Um9XO3fOyM:&ved=0CAUQjRw&url=http%3A%2F%2Fkenva.wordpress.com%2F2008%2F04%2F15%2Fthe-shoe-test-by-mark-t-reeves%2F&ei=BR-QUYvyGMjIkQXm9oHYDw&bvm=bv.46340616,d.aGc&psig=AFQjCNFspuHlJZXkeeYz95AhGWoJIKDvbw&ust=1368485940397604

Shoe recommendations

• APMA• AAPSM

• You don’t need to recommend a manufacturer, but give patients the knowledge to find their own shoes

Minimalist shoes

Minimalist shoes

• Became popular after an article in Time in 2007• Predominantly anecdotal • Concept:– Feet were not meant to wear shoes, therefore,

cannot function efficiently with use– Barefoot/minimalist shoes allow strengthening of

the pedal musculature

Minimalist shoes

• Conflicting research• Difficult to assess• Assumes no deformity

Diabetic shoes

• AKA extra-depth shoes• AKA therapeutic shoes• Prescribed

http://www.google.com/url?sa=i&rct=j&q=diabetic+shoes&source=images&cd=&docid=uJEbQucQ4S-k7M&tbnid=aC64w_qbQqhp3M:&ved=&url=http%3A%2F%2Fwww.wcbl.com%2Forthotics-2%2Fdiabetec-shoes%2F&ei=4ziQUfmGJqKbigfr84Eo&bvm=bv.46340616,d.aGc&psig=AFQjCNFL-1QBiFX9KRnO7EKvDUiWbwc-mA&ust=1368492643971323

Diabetic shoes

• Function– Protect residual foot– Maintain position inside the shoe & reduce shear– Contribute to restoring normal gait– Allow for accommodation of orthotic device– Allows for modification e.g. steel shank or

rockerbottom

Diabetic shoes

• Supplied by orthotist or sale in private office

• Medicare supply new pair & 3 inserts each year

• Exam shoes during patient encounter

http://www.google.com/url?sa=i&rct=j&q=diabetic+shoe+display&source=images&cd=&cad=rja&docid=G3f3-iK-Qg-NPM&tbnid=Y8ltNc5-6F4p3M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.freemandrug.com%2Fid64.html&ei=cCSRUfiWH82ViAeV3YGgBA&bvm=bv.46340616,d.aGc&psig=AFQjCNF_wkPftLE5ldCZiUBxAVm3rINALg&ust=1368552931325909

Conclusion

• Today’s shoes are variations of the 7 basic models

• Sole vs upper• Find the correct shoe for the correct foot for

the correct job• Diabetic shoes can help prevent ulcer

formation

References• Dr. Comfort. (n.d.). Basic shoe anatomy.• Janisse, D. J., & Janisse, E. J. (2006). Pedorthic and orthotic

management of the diabetic foot. Foot Ankle Clinics of North America, 11(4), 717-734. doi: 10.1016/j.fcl.2006.06.005

• Mustafa, I. (2012). Shoes presentation.• Rossi, W. (1985) The seven basic shoe styles. Footwear and the

Podiatrist 75(3), 169-171. • Vonhof, J. (2011). Fixing your feet: Injury prevention and treatments for

athletes (5th ed.). Birmingham, AL: Wilderness press.• Yan, A. F., Sinclair, P. J., Hiller, C., Wegener, C., & Smith, R. M. (2012).

Impact attenuation during weight bearing activities in barefoot vs. shod conditions: A systematic review. Gait & Posture (Advance Online). doi: 10.1016/j.gaitpost.2012.11.017

QUESTIONS?Thank you!