The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females

Abstract

BackgroundIll-fitting footwear can be detrimental to foot health with the forefoot being an area for most discomfort. Studies on footwear have primarily examined sports or orthopaedic prescription shoes and little is known about the effects that everyday flat shoes have on the forefoot. The aim of this study was to investigate the effect of toe box shape in a popular slip-on pump on dorsal and plantar pressures with particular interest around the forefoot in a healthy female population.MethodA convenience sample of 27 female participants with no known foot pathologies was recruited. After assessment of foot size, plantar foot pressure and interdigital pressures were recorded for each of the 3 different toe box styles; round, square and pointed. Participants walked at a self-selected speed over a 10 m walkway whilst wearing each of the 3 styles of shoe and also whilst barefoot. Processed and analysed data extracted included peak pressure, time to peak pressure, contact time and pressure time integral. ANOVA and Freidman analysis was used to test for statistical significance.ResultsShoes with a round toe showed least pressure around the medial aspect of the toes whilst the pointed shoe had least pressure on the lateral toes. Contact times for the plantar regions were not altered in any shoe condition yet contact around the medial aspect of the toes was highest in the pointed shoe.ConclusionThis study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot. Furthermore, the contours of the shoe also have an impact on the contact time and pressure time integral around the forefoot and also the peak plantar pressure in the toe region. The changes observed could be significant in the development of pathology in certain footwear toe box shapes. Consideration should be given to footwear design around the toe box to improve fit and reduce pressure. Further work is required to investigate the effect of toe box shape and volume on a pathological population with pressure related lesions.

Footwear Experiences of People With Chronic Musculoskeletal Diseases

“…Recent research has found that footwear‐related pain is highly prevalent among women in the general population and that there is a strong association between foot pain and ill‐fitting footwear . Moreover, footwear choices among younger women are driven predominantly by fashion and the self‐image they want to portray .…”

An investigation into the effects of, and interaction between, heel height and shoe upper stiffness on plantar pressure and comfort

“…Aspects related to the upper of the footwear would also be expected to affect reported comfort of wearers and biomechanical outcomes. In women's dress shoes, the toe-box shape has been demonstrated to alter plantar and inter-digital pressures (Branthwaite, Chockalingam, & Greenhalgh, 2013). The volume of a shoe upper has also been implicated as a risk factor for reduced foot health and pain when wearing medical-grade footwear (Hurst, Branthwaite, Greenhalgh and Chockalingham, 2017), which is a function of both upper shape and material.…”

Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus

“…Biomechanical studies have revealed that heel elevation increases the pressures under the metatarsal heads (8), limits motion of the first metatarsophalangeal joint (9), and increases the stiffness of the Achilles tendon (10), whereas shoes with a narrow toe box increase pressures on the medial side of the foot and between the toes (11). Over time, these changes may contribute to the development of foot pain and deformity.…”