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Dr. Afaf A.M ShaheenLecture 4RHS 422

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A suitable pair of shoes minimizes stress on all portions of the feet, provides support, and acts as a shock absorber of ground reaction forces.

The basic parts of a shoe are:

Sole

Upper

Heel

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Medial Heel FlareLateral Heel Flare

Internal Lift Heel

Heel Elevation

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Heel & Sole Elevation

Metatarsal Bar

Sole Lift

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Reinforced Toe Box

Forefoot Rocker bar

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• Foot stability is critical to minimizing ankle injury, excessive pronation, and slipping of the heel during gait cycle.

• A keystone of a good shoe is its ability to absorb shock.

• The construction of and materials used for the insole, midsole, and the outer sole determine the amount of shock absorption that the shoe will provide.

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A good shoe must be flexible and provide stability with each step.

The sole should provide adequate traction as it contacts the ground, especially in early stance as body weight is transferred onto the foot.

The heel height can create stress on the forefoot during gait.

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Heels of more than 1 ⅟₂ inches exponentially increase weight-bearing forces on metatarsal heads.

The upper should be soft and pliable.

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• Feet come in many shapes, sizes, and conditions of health.

• The biomechanical and functional characteristics of feet change over the individual’s lifetime.

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• The infant’s foot must adapt to weight bearing, especially as walking becomes functional.

• The foot of a child continues to adapt as normal growth changes alignment of pelvis, femur, and tibia.

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Many pediatric and lower extremity foot disorders require more aggressive management.

An understanding of the natural history of many of these disorders is important in establishing the appropriate footwear.

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Shoe prescription for these biomechanical problems of the foot, if a child’s foot is developing normally and doesn’t exhibit any signs of an abnormality, a soft-soled shoe is appropriate.

If some degree of abnormality exists, a more supportive, rigid shoe is indicated for toddlers.

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• During pregnancy, women may experience problems in lower extremities, including edema, leg cramps, restless legs syndrome, joint laxity, and low back pain.

• As a result, foot pain is a common problem in pregnant women.

• An important consideration is the provision of shoes with maximum shock absorption.

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1. Gel-cushiond running shoes are recommended, especially if women continue to jog or walk for exercise.

2. Athletic and walking shoes provide good support, excellent cushioning, and a solid heel counter.

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High heel shoes are inadvisable during pregnancy.

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• The hormonally induced tissue laxity of pregnancy leads to a broader forefoot as the metatarsal heads separate and the distal transverse arch flattens and to a longer foot as the longitudinal arch is less efficiently supported by soft tissue structures.

• For this reason, pregnant women are advised to wear a larger shoe size, with a square or deeper toe box, or both, especially if edema is also a problem.

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Foot function and footwear needs have a developmental aspect.

Understanding of how the foot changes over the life span and of the special needs

is essential. Knowledge of about the components of shoes and their variations, and the criteria for proper fitting is an important tool for

clinical practice.

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