ArticlePDF AvailableLiterature Review

Incorrectly fitted footwear, foot pain and foot disorders: A systematic search and narrative review of the literature

Wiley
Journal of Foot and Ankle Research
Authors:

Abstract and Figures

Background Correct footwear fitting is acknowledged as being vitally important, as incorrectly fitted footwear has been linked to foot pathology. The aim of this narrative review was to determine the prevalence of incorrectly fitted footwear and to examine the association between incorrectly fitted footwear, foot pain and foot disorders. Methods A database search of Ovid MEDLINE and CINAHL yielded 1,681 citations for title and abstract review. Eighteen articles were included. Findings were summarised under the categories of (i) children, (ii) adults, (ii) older people, (iii) people with diabetes and (iii) occupation- or activity-specific footwear. Differences in footwear fitting between sexes were also explored. Results Between 63 and 72% of participants were wearing shoes that did not accommodate either width or length dimensions of their feet. There was also evidence that incorrect footwear fitting was associated with foot pain and foot disorders such as lesser toe deformity, corns and calluses. Specific participant groups, such as children with Down syndrome and older people and people with diabetes were more likely to wear shoes that were too narrow (between 46 and 81%). Conclusion A large proportion of the population wear incorrectly sized footwear, which is associated with foot pain and foot disorders. Greater emphasis should be placed on both footwear fitting education and the provision of an appropriately large selection of shoes that can accommodate the variation in foot morphology among the population, particularly in relation to foot width.
Content may be subject to copyright.
R E V I E W Open Access
Incorrectly fitted footwear, foot pain and
foot disorders: a systematic search and
narrative review of the literature
Andrew K. Buldt
1,2*
and Hylton B. Menz
1,2
Abstract
Background: Correct footwear fitting is acknowledged as being vitally important, as incorrectly fitted footwear has
been linked to foot pathology. The aim of this narrative review was to determine the prevalence of incorrectly fitted
footwear and to examine the association between incorrectly fitted footwear, foot pain and foot disorders.
Methods: A database search of Ovid MEDLINE and CINAHL yielded 1,681 citations for title and abstract review.
Eighteen articles were included. Findings were summarised under the categories of (i) children, (ii) adults, (ii) older
people, (iii) people with diabetes and (iii) occupation- or activity-specific footwear. Differences in footwear fitting
between sexes were also explored.
Results: Between 63 and 72% of participants were wearing shoes that did not accommodate either width or length
dimensions of their feet. There was also evidence that incorrect footwear fitting was associated with foot pain and foot
disorders such as lesser toe deformity, corns and calluses. Specific participant groups, such as children with Down
syndrome and older people and people with diabetes were more likely to wear shoes that were too narrow (between
46 and 81%).
Conclusion: A large proportion of the population wear incorrectly sized footwear, which is associated with foot pain
and foot disorders. Greater emphasis should be placed on both footwear fitting education and the provision of an
appropriately large selection of shoes that can accommodate the variation in foot morphology among the population,
particularly in relation to foot width.
Background
Footwear has been used by humans for approximately
30,000 years [1]. Although originally worn as a protect-
ive covering for the foot, modern footwear is designed to
fulfil a range of purposes, the accomplishment of which
is judged by three criteria: form, function and fit [2].
Form relates to the aesthetic appeal of footwear, while
function relates to the ability of footwear to accomplish
its intended purpose, eg. to protect the feet of individ-
uals who undertake activities that may present a risk of
injury. Finally, fit pertains to how footwear can accom-
modate the morphology of the foot [3].
Footwear fitting is acknowledged as being vitally import-
ant as in most cases fit governs function [3]. This means
that footwear cannot fulfil its intended purpose if it does
not fit the foot correctly [2]. Furthermore, it has been sug-
gested that incorrectly fitted footwear is a major contribu-
tor to the development of structural foot disorders, such
as hallux valgus and lesser toe deformity [4,5], as well as
skin lesions, such as corns and calluses [6].
Correct footwear fitting is an inherently complex
undertaking for two main reasons. Firstly, the footwear
industry is currently unable to design and manufacture
footwear that can conform to the three-dimensional
morphology of all feet in the population [7,8]. This is
because foot morphology is highly variable between indi-
viduals, and there is limited variety in the shape of lasts
used to construct footwear [912]. Secondly, footwear
selection is not purely based on quantitative measure-
ments of footwear shape and size, but may be influenced
* Correspondence: a.buldt@latrobe.edu.au
1
La Trobe Sport and Exercise Medicine Research Centre, School of Allied
Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia
2
Discipline of Podiatry, School of Allied Health, La Trobe University,
Melbourne, VIC 3086, Australia
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43
https://doi.org/10.1186/s13047-018-0284-z
by qualitative factors [13,14]. It is therefore probable
that a substantial proportion of the population are wear-
ing incorrectly fitted footwear. With this in mind, the
aim of this review is to determine the prevalence of in-
correctly fitted footwear and to examine the association
between incorrectly fitted footwear, foot pain and foot
disorders.
Methods
An electronic database search was conducted in March
2018, using the online databases Ovid MEDLINE (1946-
#present) and CINAHL (1980-present). A set of search
terms were derived, and to broaden the search, some
terms were truncated with wildcard symbols. The follow-
ing keywords search terms were used: foot OR shoe* OR
footwear AND size* OR fit* OR length OR width OR
footwear fit*OR shoe fit*AND pain* OR disorder* OR
foot pain. Results were limited to human studies pub-
lished in peer-reviewed journals. The electronic database
search was supplemented by cross-checking citations and
reference lists from relevant published studies.
A single reviewer (AKB) assessed all studies that were
yielded from the search by title and abstract. Studies that
fulfilled one or both of the following two criteria were
included: (i) studies reported the prevalence of partici-
pants wearing incorrectly fitted footwear, and (ii) studies
reported the association between wearing incorrectly
sized footwear and foot pain or foot disorders.
Results
Search results
The search strategy yielded 1681 citations. Following
title and abstract review, 18 articles were included and a
narrative summary of the findings is provided. A sum-
mary of all included studies including participant charac-
teristics, method of analysis and main findings are
presented in Table 1.
For all included studies, sample sizes ranged from 50
to 440 participants, with the median number of partici-
pants being 138. Mean or average age was reported in
all but one study [15]. One study recruited only children
[16] and four studies recruited only older participants
[1720]. Three studies recruited only female participants
[2123], while two other studies recruited predominantly
male populations, including underground coal miners [24]
and war veterans [25]. Participants with specific medical
conditions were recruited in seven studies [15,16,2529],
including diabetes [25,28,29], diabetic peripheral neur-
opathy [15], Downssyndrome[16], Alzheimers disease
[27] and inflammatory arthritis [26]. Specific ethnic
groups were examined in three studies including partici-
pants of Japanese [21], Thai [19]orSingaporean[26]eth-
nicity. Finally, four studies recruited specific populations
[24,25,30,31], including war veterans [25], underground
coal miners [24], rock climbers [30] and three different
population groups from New York City (a foot specialist
private practice, an academic diabetic foot and ankle
clinic, and a charity centre serving homeless people) [31].
Study designs
The majority of included studies were cross-sectional in
design [1630] and three studies were case-control in
design [15,31,32]. All except one study reported the
method for measuring the foot [32]. The dimensions of
the foot were measured during relaxed bipedal stance in
all except two studies that measured the foot while the
participant was in a seated position [18,19]. It has been
suggested that feet should be measured during standing
to account for changes in dimensions due to splaying of
the foot after the acceptance of bodyweight [33]. The
studies that measured the foot while sitting did not pro-
vide a justification for doing so.
All except three studies measured the length of the foot,
with most using a manual device, including a measurement
stick [18,25,2931], Brannock® device [15,17,26,27]or
callipers [19,21,28]. Two other studies analysed the area of
a foot tracing [16,20], while another measured the dimen-
sions of a 3-dimensional scan taken from a foot mould [24].
Two studies only measured foot width [22,23]
while 10 studies measured foot width in addition to
foot length [1620,24,2629], using a variety of
manual devices such as a tape measure [19], Bran-
nock® device [17,26,27] or callipers [18,28,29].
Four studies measured foot width using measure-
ments from foot tracings [16,20,22,23] while one
analysed a 3-dimensional scan of a foot mould [24].
All except one study measured the shoes brought by
participants to the testing session. The only study that
did not measure the participantsshoes asked partici-
pants to report their usual shoe size [28]. For all studies,
footwear dimensions were measured using the same
method as the measurement of the foot. Most studies
used a manual device to measure footwear dimensions
[15,1719,2123,2531]; two used measurements
from a tracing of footwear [16,20], and one study ana-
lysed a 3-dimensional mould of the internal dimensions
of the shoe [24].
There were differences in the way that foot and shoe di-
mensions were compared and footwear fitting assessed.
Several studies used a pragmatic approach guided by shoe
sizing [15,18,19,2529,31,32]. For example, one study
considered a shoe to be incorrectly fitted if it was at least
half a British shoe size larger or smaller than the foot [31].
In contrast, other studies considered shoe fitting to be in-
correct if measurements such as overall area, length or
width differed between footwear and the foot [16,2024,
30]. In these cases, even though footwear and the foot
may be different dimensions, footwear size may be
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 2 of 11
Table 1 Summary of included studies
Authors Participants Method of analysis Main findings
Akhtar et al.
[32]
100 participants. 50 participants
in foot pathology group, 12 men,
38 women, mean age: 49
(range 1968) yrs. 50 participants
in control group, 19 men,
31 women, mean age: 41
(range 1965) yrs.
Foot length and width and
footwear length and width
was measured (method not
mentioned). Incorrect sized
footwear defined as difference
greater than half a shoe size
between foot and footwear.
In the foot pathology group, 21 (45%)
participants were wearing footwear at
least half a size too small
7 (14%) participants were wearing footwear
half a size longer than their foot
32 (64%) were wearing footwear narrower
than their foot, mean 6 (range 29 mm)
In the control group, 7 (14%) participants were
wearing footwear at least half a size too small
13 (26%) participants were wearing half a size
longer than their foot
15 (30%) were wearing footwear that were
narrower than their feet, mean 4 mm
(range: 27 mm)
Burns et al.
[18]
65 participants, 26 men
39 women, median age: 82
(range 6493) yrs. Participants
were consecutive admission
to hospital rehabilitation unit.
Foot length was measured with
the participant in a sitting position
using a standard Clarksmeasuring
stick. Foot width was measured with
calipers across the widest part of the
metatarsal heads Footwear was
measured according to shoe size and
dimensions measured with calipers.
Incorrect sized footwear defined as
difference between foot and footwear
greater than half a standard British shoe
(7 mm) for length or one size for width.
32 (49.2%) participants wore footwear that
was too long
3 (4.6%) were wearing footwear that
was too short
21 (32%) were wearing footwear that
was too wide
2 (3%) were wearing footwear that
was too narrow
47 (72%) of participants wore footwear
that was incorrectly fitting based on either
width or length
42 (65%) of participants wore footwear that
was too big (too long, too wide or both)
4 (6%) or participants wore footwear that was
too small (too short, too narrow or both)
Incorrect shoe length was significantly associated
with increased ulceration
Foot pain was significantly associated with
incorrect footwear length
Carter et al.
[26]
101 participants, 51 men,
51 women, mean age:
52 ± 14.5 yrs. All participants
diagnosed with inflammatory
arthritis.
Fit assessed using previously published
footwear assessment tool.
Appropriateness of shoe size determined
according to length, width and depth.
69 (68.3%) participants wore incorrectly
fitted shoes
62 (61.3%) participants wore shoes that
were too short
39 (38.6%) participants wore shoes that
were too narrow
31 (30.6%) participants wore shoes that
were too shallow
Chaiwanichsiri
et al. [19]
213 participants, 108 men,
105 women, mean age:
68.7 ± 5.4 yrs. Mean BMI:
24.7 ± 3.3. All of participants
were ethnically Thai.
Foot length, width, arch length, toe
depth and heel width were measured
with the participant in a sitting position
using the Chula foot calliper. Internal
footwear dimensions were measured
using Chula shoe calliper and tape
measure. Incorrect sized footwear
defined as at least 5 mm difference
between the foot and footwear for
length, width, toe box measurements.
50% of women and 34.3% of men were wearing
footwear that was narrower than their foot by
greater than 5 mm
22% of participants (35.5% of women) who were
wearing footwear that were smaller than their feet
reported foot pain compared to 9.5% of
participants who were wearing appropriately sized
footwear
De Castro
et al. [28]
399 participants, 172 men,
227 women, mean age:
69.6 ± 6.8 yrs. 34 women
and 38 men reported
having diabetes.
Foot length was measured during
relaxed standing with a calliper
(distance between the most
prominent point in the calcaneal
tuberosity region and the 2nd toe).
The participant reported footwear
size. Incorrect sized footwear defined
as foot length at least 2 mm difference
between foot length and reported
footwear size dimensions.
110 women (48.5%) and 119 men (69.2%) wore
incorrect size footwear (> 2 mm difference) based
on foot and shoe length
29 women (12.8%) and 57 men (31.1%) were
wearing footwear at least 1 cm longer than
their feet
1 (0.6%) man was wearing shoes shorter
than his feet
There was a significant association between men
and wearing incorrectly sized footwear
19 women or 55.9% of all women with diabetes
and 31 or 81.6% of all men with diabetes were
wearing incorrectly sized footwear
Incorrectly sized footwear was associated with ankle
pain in women
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 3 of 11
Table 1 Summary of included studies (Continued)
Authors Participants Method of analysis Main findings
Dobson et al.
[24]
270 participants, all men,
mean age 38.3 ± 9.8 yrs.,
height 178.9 ± 5.7 cm,
weight 93.2 ± 12.5 kg. All
participants were
underground coal miners.
Participants who wore sizes
9, 10, 11 or 12 were selected
for analysis.
Three-dimensional foot scans during
bipedal stance of participantsfeet were
taken. Dimensions of footwear worn by
participant (either lace up boots or gum
boots) were measured by scanning
footwear plaster moulds in the same
manner as participantsfeet. Moulds were
created by pouring plaster of Paris into
footwear. Foot and footwear dimensions
were compared.
There was a significant difference between
3-dimennsional foot dimensions and 3-dimensional
footwear dimensions
Participants were wearing footwear that were
substantially longer than their feet
Width of the forefoot and heel areas of footwear
were not wide enough for participantsfeet
Frey et al. [23] 356 women, average age
42 yrs. Participants had no
history of diabetes,
rheumatoid arthritis, previous
foot trauma or surgery. Any
foot deformity was recorded.
Foot tracings were taken during relaxed
weightbearing. Foot width was defined
as the widest line perpendicular to a
longitudinal bisection of the foot. The
shoe was traced and shoe width was
defined as the widest line perpendicular
to a longitudinal bisection. Foot width
and shoe width were compared.
88% of participants were wearing footwear that
was narrower than their foot (average 1.2 cm)
In participants who had no foot pain, the average
footfootwear width discrepancy was 0.56 cm
(20% of all participants)
For participants without deformity the average foot
lengthfootwear width discrepancy was 0.60 cm
(23% of all participants)
Of participants with a foot narrower than or equal to
footwear, 64% had foot pain and 57% had foot
deformity
Of participants with foot wider than footwear,
84% had foot pain and 79% had foot deformity
Frey et al. [22] 255 women, average age
41 yrs. Participants had no
history of diabetes,
rheumatoid arthritis, previous
foot trauma or surgery.
Foot tracings were taken during relaxed
weightbearing. Foot width was defined
as the widest line perpendicular to a
longitudinal bisection of the foot. The
shoe was traced and shoe width was
defined as the widest line perpendicular
to a longitudinal bisection. Foot width
and shoe width were compared.
86% of participants were wearing footwear that
were narrower than their feet (average 0.88 cm)
In participants who had no foot pain the average
foot width-footwear discrepancy was 0.58 cm
In participants without deformity, the average
forefoot width-footwear width discrepancy was
0.52 cm
Harrison et al.
[29]
100 participants, 52 men,
48 women, mean age
62.0 ± 14.9 yrs. All participant
were diagnosed with diabetes,
36% of participants were
administering insulin. The
median length of time that
participants had diabetes
was 5.0 years.
Foot length was measured during
standing with a Clarksmeasurement
device. Foot width was measured using
sliding calipers. Footwear length was
recorded using a measuring stick.
Footwear width was measured using
sliding calipers. Footwear length and
width was subtracted from foot length
and width. Incorrect sized footwear was
defined as greater or less than half a US
shoe size difference between footwear
and foot length or greater or less than
0.7 cm difference between footwear
and foot width.
For the right foot, 63 (63%) of participants were
wearing incorrectly sized footwear
23 (23%) participants were wearing footwear that
was too long
10 (10%) participants were wearing footwear that
was too short
43 (43%) participants were wearing footwear that
was too narrow
1 (1%) participant was wearing footwear that was
too wide
29 (29%) participants were wearing footwear that
was correct length but too narrow
For the left foot, 65 (65%) of participants were
wearing incorrectly sized footwear
24 (24%) participants were wearing footwear that
was too long
10 (10%) participants were wearing footwear that
was too short
46 (46%) participants were wearing footwear that
was too narrow
1 (1%) participant was wearing footwear that was
too wide
30 (30%) participants were wearing footwear that
was correct length but too narrow
There was no association between incorrectly fitted
footwear and neuropathy or absent pulses
Kusumoto
et al. [21]
51 women, average age
21.3 years. All participants
were Japanese students.
Foot length was measured during
relaxed bipedal stance with spreading
callipers from the centre of the
posterior heel to end of longest toe.
Sizes of leather footwear and sneakers
were recorded. Foot length and length
corresponding to footwear size compared.
For leather footwear, 8% (right feet) and 2%
(left feet) of participants wore same foot and
footwear length
73% (right), 75% (left) participants wore footwear
longer than the foot (maximum 14 mm)
20% (both left and right) wore footwear shorter
than the foot (maximum 4 mm)
For sneakers 8% (right), 6% (left) of participants
wore same foot and shoe length
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 4 of 11
Table 1 Summary of included studies (Continued)
Authors Participants Method of analysis Main findings
73% (right) 71% (left) of participants wore shoe
longer than the foot (maximum 14 mm)
18% (right) and 22% (left) of participants wore
footwear shorter than the foot (maximum 6 mm)
Lim et al. [16] 50 participants, 28 men,
22 women, 10.6 ± 3.9 yrs.,
height 131.9 ± 18.6 cm,
weight 39.6 ± 18.4 kg. All
genetic variants of Downs
syndrome was present
among participants.
Outline of each participantsfoot was
traced onto a footprint mat while
standing in relaxed bipedal stance.
Maximum length and width of the
participantsfoot and footwear was
documented in millimetres. The outline
of the sole of footwear was traced
onto graph paper. Percentage
difference between foot and footwear
dimensions was calculated for length
and width measurements.
29 (58%) participants wore footwear narrower
than their feet
5 (10%) participants wore footwear shorter
than their feet
There was no significant association between
foot structure and footwear fit
López-López
et al. [27]
73 participants, 25 men, 48
women, 81.4 ± 6.4 yrs., height
162.9 ± 9.8 cm, weight
66.2 ± 12.2 kg. All participants
were diagnosed with
Alzheimers disease.
Foot length (distance between the
posterior heel and the end of the
longest toe) and width was measured
during relaxed standing with a
Brannock® device. Footwear length
and width was measured with a
Brannock® device. Definition of
incorrect sized footwear not stated.
51 (69.9%) participants wore incorrect
sized footwear
28 (38.3%) participants wore footwear that was
too long
42 (57.5%) participants wore footwear that was
too narrow
22 (30.1%) participants wore footwear that was
simultaneously too long and too narrow
20 (27%) of participants wore footwear that was
simultaneously the correct length but too narrow
López-López
et al. [17]
62 participants, 29 men,
33 women, mean age
75.3 ± 7.9 yrs., height
164.1 ± 7.6 cm, weight
73.9 ± 11.3 kg. 31
participants in incorrectly
fitted footwear group,
41 participants in correctly
fitted footwear group.
Foot length and width, and footwear
length and width was measured with
a Brannock® device. Incorrectly fitted
footwear was defined as 1 mm
difference between length or width
of the foot and footwear. Each
participant completed FHSQ
(Spanish version).
Participants wearing incorrectly fitted shoes
displayed lower FHSQ scores for section related to
foot health and health status in general
Significant difference between the incorrect and
correct footwear fitting groups for the dimensions
of the FHSQ assessing pain, foot function, general
foot health and social function
McHenry et
al. [30]
56 participants, 45 men,
11 women, mean age
33.6 ± 11.7) yrs., height
174.9 ± 8.6 cm, weight
76.6 ± 12.5 kg. All
participants were rock
climbers with over 1
year of experience. Mean
age of climbing experience
10.8 ± 11.2 yrs.
Foot length in bipedal stance was
taken with Ritz stick. Climbing
footwear was measured along its
longest axis from the most posterior
point of the heel to the furthest
point anteriorly. For footwear with a
downturned forefoot, shoe were
flattened along the medial longitudinal
arch. Incorrectly fitted footwear was
defined as difference between foot
and footwear greater or less 1 UK
shoe size or equivalent.
55 (98%) participants were wearing excessively
tight climbing footwear (based on length of foot
and shoe)
Mean size reduction of 4 UK shoe sizes between
participants street footwear and climbing footwear.
51 (91%) participants experienced foot pain while
climbing
43 (76.8%) participants removed their footwear
intermittently throughout activity to relieve
discomfort
McInnes et al.
[15]
203 participants, 85
participants with diabetes,
118 control participants
without diabetes.
Both feet were measured using a
Brannock® device during relaxed
standing. Footwear dimensions were
measured using a calibrated internal
shoe size gauge. Incorrectly fitted
footwear were defined as a difference
between foot length and shoe size less
than 10 mm or greater than 15 mm.
78 (66%) of participants were wearing footwear
that were the incorrect size
42 (55%) of participants were wearing footwear
that were too short
36 (47%) of participants were wearing footwear
that were too long
In participants with diabetes, 70 people (82%)
were wearing footwear that were the incorrect size
30 (43%) were wearing footwear that were
too short
40 (57%) were wearing footwear that were
too long
Menz and
Morris [20]
176 participants, 56 men,
120 women, mean age:
80.1 ± 6.42 yrs. Participants
were residing in retirement
villages.
A footprint was taken relaxed
weightbearing, The maximum length
and width and area of the participants
foot was measured. The outline of each
shoe was traced onto graph paper, Fit
of most regularly worn footwear was
assessed. The percentage difference
23 participants (13.7%) wore indoor footwear
shorter than their feet
136 (81.4%) participants wore indoor footwear
narrower than their feet
73 (43.7%) wore indoor footwear smaller than
the total area of their feet
17 (10.2%) participants wore outdoor footwear
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 5 of 11
Table 1 Summary of included studies (Continued)
Authors Participants Method of analysis Main findings
between the foot and footwear
dimensions was calculated for length
and width measurements.
shorter than their feet.
131 (78.4%) participants wore outdoor footwear
narrower than their feet
79 (47.3%) participants wore outdoor footwear
smaller than the overall area of the foot
Women displayed a greater disparity between
foot and shoe dimensions with respect to indoor
shoe length, indoor shoe width, indoor shoe area,
outdoor shoe length, outdoor shoe width and
outdoor shoe area
The presence of corns and callus was associated
with inadequate footwear width
Moderate to severe hallux valgus was associated
with inadequate width of indoor shoes and
inadequate width and overall area of
outdoor shoes
Lesser toe deformity was associated with
inadequate length of both indoor and outdoor
shoes.
Foot pain was associated with inadequate width
of indoor shoes
Nixon et al.
[25]
440 participants. 414 men,
26 women, mean age:
67.2 ± 12.5 yrs. All participants
were war veterans recruited
from veterans affairs medical
centre. 58.4% of participants
were diagnosed with diabetes
and 6.8% had active diabetic
ulceration.
Foot size was and width were
measured during standing with
using a standardised method and
the Apex 1141 ft measuring device
(Ritz stick). Incorrect sized footwear
was defined as a size that was at
least one full US shoe size too large
or too small. The foot was also
inspected for the presence of diabetic
foot ulceration and peripheral
neuropathy (protective sensation).
25.5% of participants were wearing appropriately
sized footwear (based on length of foot and shoe)
Participants with diabetic foot ulceration were
5.1 times more likely to be wearing incorrectly
fitted footwear than participants without a
wound
Participants with diabetes and loss of protective
sensation were 4.8 times more likes to be
wearing incorrectly fitted footwear compared
to participants without neuropathy
Schwarzkopf
et al. [31]
235 participants. 71 participants
from a private clinic, 25 male,
46 female mean age 45.2 yrs. 40
participants from a diabetes foot
clinic, 18 male, 22 female, mean
age 55.6 yrs. 124 participants
from a charity care centre for
the homeless, 124 male,
0 female, mean age 44.2 yrs.
Two foot and ankle surgeons measured
foot length while standing using a
length-measuring device (Clarks meter),
foot length was represented as assumed
US adult shoe sizes. Size of the participant
current footwear was recorded.
Incorrectly fitted footwear was defined
as a difference of at least 0.5 US shoe
sizes between measured foot size and
the participants assumed footwear size.
All participants: 82 (34.9%) were wearing
incorrectly fitted footwear (based on length
of foot and shoe)
11 (15.5%) of participants from private clinic
were wearing incorrectly fitted footwear
17 (42.5%) of participants from diabetic foot
clinic were wearing incorrectly fitted footwear
54 (43.5%) participants from clinic caring for
the homeless were wearing incorrectly
fitted footwear
There were significant differences (P< 0.01)
between the number of participants wearing
incorrectly fitted footwear from the private
clinic compared to participants from both the
diabetic foot clinic and clinic for the homeless
28 (11.9%) participants from all clinics were
wearing incorrectly fitted footwear by greater
than 1.5 sizes
3 (4.2%) participants from private clinic were
wearing incorrectly fitted footwear by greater
than 1.5 sizes
4 (10.0%) participants from diabetic foot clinic
were wearing incorrectly fitted footwear greater
than 1.5 sizes
28 (16.9%) of participants from clinic for the
homeless were wearing incorrectly fitted
footwear greater than 1.5 sizes
There were significant differences (p< 0.01)
between the number of participants wearing
incorrectly fitted footwear greater than 1.5
sizes from the private clinic compared to
participants from clinic for the homeless
Female gender was associated with shoe
size mismatch (p= 0.02).
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 6 of 11
correct. This is particularly relevant for length, as it has
been suggested that appropriately sized footwear should
have a space of at least 1020 mm between the end of the
foot and the shoe [33,34]. In presenting results related to
particular participant groups in this review, a distinction
will be made between studies that deemed shoes to be in-
correctly fitted based on shoe sizing, and studies that mea-
sured differences between the dimensions of the foot and
the shoe.
Prevalence of incorrectly fitted footwear
Most studies explicitly reported fitting variables such as
length or width, or commented on overall footwear fit
by reporting only one variable, usually length. However,
there were five studies that reported the number of par-
ticipants that were wearing incorrectly fitted shoes based
on more than one variable [15,18,26,27,29]. Four
studies reported that between 63 and 72% of participants
were wearing incorrectly fitted shoes based on length
and width [18,29], while one study reported that 68% of
participants wore incorrectly fitted shoes based on three
measures (length, width and depth) [26]. One study
compared total foot and shoe area to determine footwear
fit, finding that the total area of the footwear was smaller
than total area of the foot in 47% of participants [20].
Among the studies that provided specific fitting details,
the percentage of participants wearing footwear too long
for the foot ranged between 14 [32]and73%[21](median
38% [27]) and too short between 0.6 [28]and98%[30]
(median 10% [20]). In terms of width, between 30 [32]and
88% [23](median58%[27]) of participants wore footwear
that were too narrow and one study found that only 1% of
participants wore footwear that was too wide [28]. One
study examined depth, finding that 31% of participants
wore footwear that was too shallow [26].
Association between footwear fitting, foot pain and foot
disorders
The association between incorrectly fitted footwear and
foot pain or foot disorders was investigated in eight studies
[17,18,20,23,25,28,30,31], with all but one study [31]
reporting significant associations between incorrectly fitted
footwear and some form of foot pain or foot disorder.
There were five studies that reported an association
between incorrectly fitted footwear and foot pain or im-
paired quality of life [17,18,23,28,30]. These studies
reported a strong association between tight footwear
and foot pain, with between 84 [23] and 91% [30] of par-
ticipants reporting generalised foot pain while shod.
However, the characteristics of recruited participants in-
fluenced findings. For example, the study that found that
91% of participants described foot pain was conducted
on rock climbers, who wear tightly fitted footwear to op-
timise contact with the climbing wall. There was also
evidence that loose footwear was associated with foot
pain, with 64% of participants reporting generalised foot
pain while shod [23]. Regarding quality of life measures,
one study that recruited 65 older people in Spain found
those with ill-fitting shoes displayed significantly poorer
overall foot health using the Foot Health Status Ques-
tionnaire [17]. In terms of specific regions of the lower
extremity, one study reported that incorrectly fitted foot-
wear was significantly associated with the presence of
pain in the ankle in women [28].
There were three studies that investigated the associ-
ation between incorrectly fitted footwear and foot disor-
ders [18,20,25]. Among these there was evidence that
incorrectly fitted footwear was associated lesser toe de-
formity in older people [20] and the presence of corns in
older people [18]. Importantly, there was also evidence of
a strong association between current foot ulceration
and incorrectly fitted shoes in older people with dia-
betes [18,25] with participants with current foot ul-
ceration up to 5 times more likely to be wearing
incorrectly fitted shoes compared to individuals with-
out foot ulceration [25].
Footwear fitting in specific populations
Footwear in children
Childrens feet are different to adult feet, both in shape
and posture, and are constantly changing as the child
grows [35]. In addition, the morphology of childrens feet
are more malleable than adult feet [36]. Indeed, footwear
has been used to correct pathological skeletal alignment
and foot posture among children [37]. Therefore, correct
shoe fitting in children is of paramount importance.
Only one article addressed footwear fitting in children
(under 18 years old). The study focused on children with
Downs syndrome, who are known to have flatter, shorter
feet and are more likely to have hallux valgus compared
to children without Downs syndrome [38,39]. This
study recruited 50 children with all genetic variants of
Downs syndrome (mean age: 10.6, SD 3.9, range 5
18 years) and found that 58% wore footwear that was
too narrow for their feet [16]. This indicates that chil-
dren with Downs syndrome may be unable to acquire
footwear that can accommodate the wider dimensions of
the foot associated with the condition.
Footwear in adults
Five studies investigated healthy adults [2123,31,32],
with three recruiting young female participants [2123].
Only one of the studies that recruited young females
assessed footwear length. This study of young Japanese
females found that in a sample of 51 students (average
age 21 years), 75% were wearing footwear that was lon-
ger than their feet [21]. However, the maximum differ-
ence was 14 mm, which falls in the range for correctly
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 7 of 11
fitted shoes based on the recommendation of 1020 mm
clearance between the foot and the shoe [33]. In con-
trast, 22% wore footwear that was shorter than their feet,
thus indicating a potential issue with wearing footwear
of inadequate length [21].
The two other studies that recruited young females
only considered footwear width, specifically, width in the
forefoot [22,23]. The first study of 356 American
women (average age 42, range 20 to 60 years) found that
88% were wearing footwear that was narrower than their
feet, with the average discrepancy being 1.2 cm [23].
Among these women, 37% were wearing high heeled
shoes, 49% wore flats and 14% wore sneakers. This was
followed by a subsequent study by the same authors,
using the same methods, that recruited 255 American
women (average age 41, range 2060 years) and found
86% of participants were wearing footwear that was too
narrow, with an average discrepancy of 0.88 cm [22]. No
information about shoe type was provided in this study.
Both studies also reported that those with foot deform-
ities such as hallux valgus displayed a greater discrep-
ancy between footwear and foot width, however no
information was provided as to whether this difference
was significant [22,23].
Two further studies recruited both female and male par-
ticipants using convenience sampling of individuals that
regularly attended foot and ankle clinics [31,32]. These
studies recruited participants of similar age (mean ages 44
and 49 years, respectively) and found that between 35 and
56% of individuals were wearing footwear of incorrect
length [31,32]. Only the study by Akhtar et al. [32] inves-
tigated width, and found that 64% of people were wearing
footwear that was narrower than their feet.
Footwear in older people
There is evidence to suggest that the feet of older people
are broader in the forefoot region and have a flatter medial
longitudinal arch compared young people [40,41]. Fur-
thermore, older individuals with foot pain display a greater
number of foot deformities including hallux valgus and
clawed lesser toes compared to older people without pain
[42]. These differences in foot morphology may pose a
problem for fitting, as shoes are designed to have smooth
contours, and are not designed to accommodate irregular
bony shapes associated with foot deformity [43].
Three studies assessed footwear fitting in older people,
with mean ages ranging between 69 and 80 years [1820].
The literature indicated that footwear width was of par-
ticular concern in older people. For example, a study by
Menz et al. of 176 older people (mean age 80.1, SD: 6.4,
range 6296 years) found that 78% wore outdoor shoes
narrower than their feet [20]. Similarly, a study by Chaiwa-
nichsiri et al. of 213 older Thai people (mean age 68.7, SD
5.4 years) found that 50% of women and 34% of men wore
shoes that were too narrow [19]. In both cases, investiga-
tors compared width measurements between the widest
region of the shoe and the forefoot. However, Chaiwanich-
siri et al. [19] used a higher threshold to define an incor-
rectly fitted shoe (at least 5 mm difference between the
foot and shoe) compared to Menz et al. who reported in-
correct fitting if any discrepancy between shoe and foot
width was recorded [20].
Burns et al. [18] provided additional context in relation
to shoe width, finding that 33% of older individuals wore
footwear that was the same width as the foot, but was
too long, while 15% of individuals wore shoes that were
simultaneously too wide and too long. This may indicate
that, in order to accommodate a wider forefoot, some
older people may be choosing shoes that are too long
for their feet [18].
The majority of studies including older people have
assessed the fit of shoes commonly worn outdoors [1820].
However, the fitting of indoor shoes should not be over-
looked, such is the relationship between indoor shoes and
falls in older people [44]. As was the case with outdoor
shoes, indoor shoes are commonly too narrow for the foot.
This was confirmed by Menz et al., which found that
among a sample of 176 older people, 81% of participants
wore indoor footwear that was narrower than their feet
[20]. Therefore, along with outdoor footwear it is apparent
that indoor footwear is inadequately designed to accommo-
date the foot width of older people [44,45].
The literature has suggested two reasons to explain
the overall shoe fitting findings related to older people.
Firstly, older individuals may be unable to select foot-
wear to accommodate changes in foot morphology. For
example, it may be difficult to acquire footwear that can
accommodate a wider forefoot while also being appro-
priately fitted according to foot length [46]. Secondly,
older individuals may not be aware of their correct shoe
size. Indeed, a survey of 128 older people found that
26% of men and 47% of women had not had footwear
size measured over the past 5 years [47]. If this is cor-
rect, then it is vital that health professionals ensure that
all older patients are aware of their foot dimensions and
appropriate footwear size for length and width.
Footwear in people with diabetes
The association between ill-fitting shoes and the develop-
ment of foot ulceration in people with diabetes is well
documented. Prospective studies have found that either
ill-fitting footwear alone [48,49], or minor trauma caused
by footwear is the most common precipitating factor in
the development of diabetic foot ulcers [50,51].
Five studies have investigated shoe fitting among
participants diagnosed with diabetes, with all using a
similar approach to fitting analysis based on footwear
sizing [15,25,28,29,31]. For example, two studies
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 8 of 11
considered footwear fitting to be incorrect if there
was half a size difference between the foot and footwear
[29,31] while one study applied a full size benchmark
[25]. Other studies deemed footwear size inappropriate if
the difference between foot and footwear length was out-
side a range of 1015 mm [15] or greater than 2 mm [28].
All studies recruited similar samples of individuals with dia-
betes in terms of age (mean age range 55.6 to 67.2 years)
however there was a large range of sample sizes (range 43 to
440). Among these studies, between 33 [29] and 82% [15]of
individuals with diabetes were wearing shoes of incorrect
length. Of these, between 10 [29] and 43% [15] were wearing
footwear that was too short, while between 23 [29] and 81%
(diabetic men only) [28] wore footwear that was too long.
In terms of shoe width, there was evidence among a
sample of 568 diabetic individuals with peripheral neur-
opathy that the forefoot of most individuals with dia-
betes is broader than the most common industrial shoe
width references used by shoe manufacturers [8]. This
was supported by included literature in this review. For
example, in a sample of 100 individuals (mean age 62.0
SD 14.9, range 2489 years), 46% of individuals wore
footwear that was too narrow [29]. However, of these
participants, 67% wore the correct length footwear,
which may indicate that a large proportion of individuals
with diabetes may be selecting footwear that is correctly
fitted for length, but are not considering, or are not able
to acquire, footwear of sufficient width [29].
There was no evidence that a greater proportion of
participants with diabetes wear incorrectly fitted foot-
wear (according to length) compared to matched con-
trols without diabetes [15,25]. However, there was
evidence of an association between incorrectly fitted
shoes and the presence of diabetes-related foot lesions.
For example, among a cohort of 440 male veterans with
diabetes, those with current foot ulceration were 5 times
more likely to be wearing incorrectly fitted shoes (at
least one full shoe size difference) [25].
The overall findings suggest that, even though a similar
proportion of individuals with and without diabetes wear
incorrectly fitting footwear, the consequences of doing so
for an individual with diabetes may be greater due to the
potential development of diabetic foot ulceration.
Activity- or occupation-specific footwear
Footwear is often designed to fulfil a range of activity or
occupational requirements. For instance, shoes may
need protective or traction properties in order to allow
the individual to safely and effectively carry out a re-
quired task [52]. One such is occupation is mining,
which requires workers to stand for long periods of time
on sometimes uneven, wet or unstable surfaces [53]. It
was identified in a study of 208 mining workers that the
boots worn by miners (both lace-up boots and gum
boots) were significantly narrower than the foot but also
significantly longer than the recommended 1020 mm
clearance [24]. These findings could indicate an attempt
by miners to select shoes of appropriate width by wear-
ing excessively long shoes. This in turn may contribute
to the high prevalence of foot pain reported in this
population [53].
The only study that investigated activity specific foot-
wear indicated that, among 56 rock climbers, all partici-
pants wore shoes that were smaller than the foot, with
the mean difference being the equivalent of four British
shoe sizes [30]. However, despite the reported pain, these
shoe-fitting habits were deemed necessary by rock
climbing participants to attain enhanced performance by
ensuring close contact between the foot and the climb-
ing surface.
Footwear fitting differences between sexes
Women are more likely to suffer foot pain compared to
men [54,55]. Furthermore, females suffer more foot
pain while wearing shoes compared to men, most likely
due to the narrower toe box of womens shoes [56]. Of
the studies that recruited both women and men, only
one compared shoe fitting between sexes. In this study
of older individuals, percentage difference between mea-
sures of length, width and total area was compared for
both outdoor and indoor shoes [20]. In all comparisons,
women displayed significantly greater percentage differ-
ences compared to men, thus indicating that women
were wearing relatively smaller footwear.
Three studies investigated footwear fitting among men
and women, but did not carry out significance testing to
compare fitting between the two sexes [19,28,31].
These studies provide some evidence that a greater pro-
portion of women wear incorrect sized footwear com-
pared to men. For example, one study reported a greater
proportion of women wore shoes that were too narrow
(difference greater than 5 mm between foot and shoe)
compared to men (50% women, 34% men) [19]. How-
ever, there is also some evidence that a greater propor-
tion of men were wearing footwear that was too long
compared to women. This was evident in a study of
older individuals with diabetes, including 227 women
and 172 men that found a greater percentage of men
were wearing incorrectly fitted shoes (69% men, 48%
women) [28]. Of these 31% of men and 13% of women
were wearing shoes that were at least 10 mm longer
than their feet.
Conclusions
The available evidence indicates that a large proportion
of the population (between 63 and 72%) are wearing in-
appropriately sized footwear based on length and width
measurements, and that incorrect footwear fitting is
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 9 of 11
significantly associated with foot pain, poorer overall
foot health, corns and calluses in older people and foot
ulceration in older people with diabetes. However, a
limitation of the literature is that there are variations be-
tween studies in the way that footwear fitting is mea-
sured and defined. Hence, future work should adopt
standardised approaches to assessing footwear fitting.
Of particular interest among the included literature
are findings related to specific groups of participants
that are more likely to display variations in foot morph-
ology compared to the broader population. These partic-
ipants include children with Downs syndrome, older
people, or people with diabetes. Fitting according to foot
width was a particular concern among these groups with
between 46 and 81% of participants wearing footwear
that was too narrow. In addition, there is evidence that
older people and people with diabetes may select foot-
wear of inappropriate length in order to acquire foot-
wear to accommodate forefoot width.
Overall, the high prevalence of incorrectly fitted foot-
wear suggests that greater emphasis should be placed on
footwear fitting education so people are more aware of
their foot dimensions and appropriate foot size. Further-
more, footwear manufacturers should provide an appro-
priately large selection of shoes that can accommodate
the variations in foot morphology among the population.
In particular, a greater range of widths for each length
sizing option should be made available in order to ac-
commodate feet with wider dimensions.
Funding
No funder played any role in the study design, collection, analysis or
interpretation of data, writing of the manuscript or decision to submit the
manuscript for publication.
Availability of data and materials
The datasets used and/or analysed during the current study are available
from the corresponding author on reasonable request.
Authorscontributions
AKB and HBM conceived the idea of the review. AKB carried out literature
search and extracted data. AKB drafted the manuscript with input from HBM.
Authorsinformation
HBM is currently a National Health and Medical Research Council Senior
Research Fellow (ID: 1135995).
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
AKB is associate editor of the Journal of Foot and Ankle Research. HBM is
editor-in-chief of the Journal of Foot and Ankle Research. It is journal policy
that editors are removed from the editorial and peer review processes for
papers they have co-authored.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Received: 12 June 2018 Accepted: 12 July 2018
References
1. Trinkaus E, Shang H. Anatomical evidence for the antiquity of human
footwear: Tianyuan and Sunghir. J Archaeol Sci. 2008;35(7):192833.
2. Witana CP, Feng J, Goonetilleke RS. Dimensional differences for evaluating
the quality of footwear fit. Ergonomics. 2004;47(12):130117.
3. Goonetilleke RS, Luximon A, Tsui KL. The quality of footwear fit: what we
know, don't know and should know. Proceedings of the Human Factors
and Ergonomics Society Annual Meeting: SAGE Publications; 2000. p. 5158.
4. Gorecki G. Shoe related foot problems and public health. J Am Podiatry
Assoc. 1978;68(4):245.
5. Frey C. Foot health and shoewear for women. Clin Orthop. 2000;372:3244.
6. Richards R. Calluses, corns, and shoes. Semin Dermatol. 1991;10(2):1124.
7. Luximon A, Goonetilleke RS, Tsui K-L. Footwear fit categorization. In: Tseng MM,
Piller FT, editors. The customer centric Enterprise. Berlin: Springer; 2003. p. 4919.
8. Chantelau E, Gede A. Foot dimensions of elderly people with and without
diabetes mellitusa data basis for shoe design. Gerontology. 2002;48(4):2414.
9. Hawes MR, Sovak D. Quantitative morphology of the human foot in a North
American population. Ergonomics. 1994;37(7):121326.
10. Hawes MR, Sovak D, Miyashita M, S-J K, Yoshihuku Y, Tanaka S. Ethnic
differences in forefoot shape and the determination of shoe comfort.
Ergonomics. 1994;37(1):18796.
11. Redmond AC, Crane YZ, Menz HB. Normative values for the foot posture
index. J Foot Ankle Res. 2008;1:6.
12. Luximon A, Luximon Y. Shoe-last design innovation for better shoe fitting.
Comput Ind. 2009;60(8):6218.
13. Au EYL, Goonetilleke RS. A qualitative study on the comfort and fit of ladies
dress shoes. Appl Ergon. 2007;38(6):68796.
14. Goonetilleke RS. Designing to miminize discomfort. Ergon Des. 1998;6(3):129.
15. McInnes AD, Hashmi F, Farndon LJ, Church A, Haley M, Sanger DM, Vernon
W. Comparison of shoe-length fit between people with and without
diabetic peripheral neuropathy: a casecontrol study. J Foot Ankle Res.
2012;5:9.
16. Lim PQ, Shields N, Nikolopoulos N, Barrett JT, Evans AM, Taylor NF,
Munteanu SE. The association of foot structure and footwear fit with
disability in children and adolescents with Down syndrome. J Foot Ankle
Res. 2015;8:4.
17. López-López D, Expósito-Casabella Y, Losa-Iglesias M, Bengoa-Vallejo RBD,
Saleta-Canosa JL, Alonso-Tajes F. Impact of shoe size in a sample of elderly
individuals. Rev Assoc Med Bras. 2016;62(8):78994.
18. Burns S, Leese G, McMurdo M. Older people and ill fitting shoes. Postgrad
Med J. 2002;78(920):3446.
19. Chaiwanichsiri D, Tantisiriwat N, Janchai S. Proper shoe sizes for Thai elderly.
Foot (Edinb). 2008;18(4):18691.
20. Menz HB, Morris ME. Footwear characteristics and foot problems in older
people. Gerontology. 2005;51(5):34651.
21. Kusumoto A, Ashikawa K. Foot and shoe size of Japanese female university
students. J Hum Ergol (Tokyo). 1988;17(1):915.
22. Frey C, Thompson F, Smith J. Update on womens footwear. Foot Ankle Int.
1995;16(6):32831.
23. Frey C, Thompson F, Smith J, Sanders M, Horstman H. American
Orthopaedic Foot and Ankle Society womens shoe survey. Foot Ankle Int.
1993;14(2):7881.
24. Dobson JA, Riddiford-Harland DL, Bell AF, Steele JR. The three-dimensional
shape of underground coal miners feet do not match the internal
dimensions of their work boots. Ergonomics. 2018;61(4):588602.
25. Nixon BP, Armstrong DG, Wendell C, Vazquez JR, Rabinovich Z, Kimbriel HR,
Rosales MA, Boulton AJ. Do US veterans wear appropriately sized shoes?
The Veterans Affairs shoe size selection study. J Am Podiatr Med Assoc.
2006;96(4):2902.
26. Carter K, Lahiri M, Cheung P, Santosa A, Rome K. Footwear characteristics in
people with inflammatory arthritis in Singapore. J Foot Ankle Res. 2016;9:29.
27. López-López D, Grela-Fariña M, Losa-Iglesias ME, Calvo-Lobo C, Rodríguez-
Sanz D, Palomo-López P, Becerro-de-Bengoa-Vallejo R. Clinical aspects of
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 10 of 11
foot health in individuals with Alzheimers disease. Int J Environ Res Public
Health. 2018;15(2):286.
28. de Castro AP, Rebelatto JR, Aurichio TR. The relationship between wearing
incorrectly sized shoes and foot dimensions, foot pain, and diabetes. J Sport
Rehabil. 2010;19(2):21425.
29. Harrison S, Cochrane L, Abboud R, Leese G. Do patients with diabetes wear
shoes of the correct size? Int J Clin Pract. 2007;61(11):19004.
30. McHenry R, Arnold G, Wang W, Abboud R. Footwear in rock climbing:
current practice. Foot (Edinb). 2015;25(3):1528.
31. Schwarzkopf R, Perretta DJ, Russell TA, Sheskier SC. Foot and shoe size
mismatch in three different New York City populations. J Foot Ankle Surg.
2011;50(4):3914.
32. Akhtar S, Choudry Q, Kumar R. Incorrectly fitting footwear and associated
foot problems. Orthopaedic Proceedings. 2008;90(3):4956.
33. Barton CJ, Bonanno D, Menz HB. Development and evaluation of a tool
for the assessment of footwear characteristics. J Foot Ankle Res.
2009;2:10.
34. Nancarrow S. The footwear suitability scale: a measure of shoe-fit for people
with diabetes. Australas J Podiatr Med. 1999;33(2):57.
35. Walther M, Herold D, Sinderhauf A, Morrison R. Children sport shoesa
systematic review of current literature. Foot Ankle Surg.
2008;14(4):1809.
36. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot
motion in children shoesa comparison of barefoot walking with shod
walking in conventional and flexible shoes. Gait Posture.
2008;27(1):519.
37. Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes
planus. Cochrane Database of Syst Rev. 2010;7:CD006311.
38. Concolino D, Pasquzzi A, Capalbo G, Sinopoli S, Strisciuglio P. Early
detection of podiatric anomalies in children with Down syndrome. Acta
Paediatr. 2006;95(1):1720.
39. Pau M, Galli M, Crivellini M, Albertini G. Footground interaction during
upright standing in children with Down syndrome. Res Dev Disabil. 2012;
33(6):18817.
40. Kouchi M. Foot dimensions and foot shape: differences due to growth,
generation and ethnic origin. Anthropol Sci. 1998;106:16188.
41. Echeita JA, Hijmans JM, Smits S, Van der Woude LH, Postema K. Age-related
differences in womens foot shape. Maturitas. 2016;94:649.
42. Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Foot shape of older
people: implications for shoe design. Footwear Sci. 2010;2(3):1319.
43. Luximon A, Goonetilleke R, Tsui K. Foot landmarking for footwear
customization. Ergonomics. 2003;46(4):36483.
44. Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for
older people at risk of falls. J Rehabil Res Dev. 2008;45(8):116782.
45. Sherrington C, Menz HB. An evaluation of footwear worn at the time of fall-
related hip fracture. Age Ageing. 2003;32(3):3104.
46. Bowen C, Ashburn A, Cole M, Donovan-Hall M, Burnett M, Robison J,
Mamode L, Pickering R, Bader D, Kunkel D. A survey exploring self-reported
indoor and outdoor footwear habits, foot problems and fall status in people
with stroke and Parkinsons. J Foot Ankle Res. 2016;9:39.
47. Munro BJ, Steele JR. Household-shoe wearing and purchasing habits. A
survey of people aged 65 years and older. J Am Podiatr Med Assoc. 1999;
89(10):50614.
48. Litzelman DK, Marriott DJ, Vinicor F. The role of footwear in the prevention
of foot lesions in patients with NIDDM: conventional wisdom or evidence-
based practice? Diabetes Care. 1997;20(2):15662.
49. Apelqvist J, Larsson J, Agardh C-D. The influence of external precipitating
factors and peripheral neuropathy on the development and outcome of
diabetic foot ulcers. J Diabet Complications. 1990;4(1):215.
50. Reiber GE, Vileikyte L, Ed B, Del Aguila M, Smith DG, Lavery LA, Boulton A.
Causal pathways for incident lower-extremity ulcers in patients with
diabetes from two settings. Diabetes Care. 1999;22(1):15762.
51. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation:
basis for prevention. Diabetes Care. 1990;13(5):51321.
52. McPoil TG Jr. Footwear. Phys Ther. 1988;68(12):185765.
53. Dobson JA, Riddiford-Harland DL, Bell AF, Steele JR. Effect of work boot
type on work footwear habits, lower limb pain and perceptions of
work boot fit and comfort in underground coal miners. Appl Ergon.
2017;60:14653.
54. Menz HB, Lord SR. The contribution of foot problems to mobility
impairment and falls in community-dwelling older people. J Am Geriatr Soc.
2001;49(12):16516.
55. Munro BJ, Steele JR. Foot-care awareness. A survey of persons aged 65
years and older. J Am Podiatr Med Assoc. 1998;88(5):2428.
56. de Castro AP, Rebelatto JR, Aurichio TR. The relationship between foot pain,
anthropometric variables and footwear among older people. Appl Ergon.
2010;41(1):937.
Buldt and Menz Journal of Foot and Ankle Research (2018) 11:43 Page 11 of 11
... Wearing ill-fitting or unsupportive shoes is another common cause of metatarsalgia. Shoes with narrow toe boxes or high heels increase pressure on the forefoot, exacerbating the problem [5]. ...
Article
This study examines the immediate effects of using a dome-shaped metatarsal pad on reducing central metatarsal loading and attempts to correlate central metatarsal overload with metatarsal morphology, laterality (identifying which foot more frequently experiences forefoot overload), gender, and BMI. The sample consisted of 50 participants aged between 18 and 49, all students from the Vale do Ave School of Health, without exclusion criteria, and showing at least one peak point of overload in one of the central metatarsals. This overload was measured using the isobaric variant of colometry on a pressure platform, in a standardized position as defined in the methodology. The study concludes that applying a metatarsal dome element significantly reduces peak pressure in the forefoot, confirming a statistically significant effect on reducing middle metatarsal region overload. No significant relationships were found between middle metatarsal overload and factors such as digital or metatarsal morphology, gender, or BMI, although a statistically significant relationship was noted with foot laterality, with the left foot showing greater overload. The study suggests that future research could refine these findings by categorising foot types (normal, cavus, or flat) to explore potential correlations with metatarsal overload and increasing the sample size for improved statistical reliability.
... Shoes of this design cause the big toe to press against the other toes, increasing the risk of lateral deviation. Additionally, narrow shoes that do not provide enough space for the toes can lead to structural deformities over time [18]. In this study, the prevalence of hallux valgus among female students in Indonesia was 43.1% (n = 69), which is higher than in other countries [4]. ...
Article
Problems and Purpose. Hallux valgus is a common foot deformity. Hallux valgus is more likely to occur in individuals who frequently wear shoes with pointed toes, as this footwear can contribute to the development of the condition. This incident can affect college students. However, the incidence rate of hallux valgus among students in Indonesia has not been determined. This study was conducted to determine the incidence of hallux valgus in Indonesia. Materials and methods. This research is quantitative, using online questionnaires distributed through social media. A total of 160 female students from various regions of Indonesia participated in the study. Results. Out of 160 respondents there were 36 people used shoes with 1 toe, which were affected by grade 1 hallux valgus. Among those who wore type 1 shoes, 2 individuals had grade 2 hallux valgus, 5 had grade 3, and 1 had grade 4. Among the 37 people who wore type 2 shoes, 17 had grade 1 hallux valgus, 3 had grade 2, and none were affected by grade 4 hallux valgus. Among type 3 shoe users, 17 people had grade 1 hallux valgus, 16 had grade 2, 2 had grade 3, and 1 had grade 4. For type 4 shoe users, 1 person was affected by grade 1 hallux valgus, 1 by grade 2, 1 by grade 3, and 1 by grade 4. Conclusion. HV is a common foot deformity in Indonesia. Shoe type, genetics, and physical activity are associated with a high incidence of hallux valgus in the country.
... In addition ankle collars provide greater mechanical support around the ankle, improve proprioception and reduce ankle inversion (Menant et al., 2008b), whilst, wider soles provide a larger more stable base of support (Cudejko et al., 2020). Nevertheless, the fittings of the footwear is also important as incorrectly fitted footwear may leads to foot pain, laser toe deformity, corns and calluses in older adults, risk of foot ulceration in diabetic people and overall poorer foot health (Buldt & Menz, 2018). ...
... Studies, such as a systematic review and meta-analysis, as well as results from national surveys, revealed that the prevalence of diabetes among adults in Bangladesh has significantly increased from 5 % to 14 % from 2001 to 2017 [16]. In a study in Bangladesh found that many diabetic patients didn't wear properly fitting footwear and consequently, it was contributing to several foot complications such as hammer toes, hallux valgus deformity, and foot pain [17]. ...
Article
Full-text available
The number of diabetic patients is increasing rapidly who have vulnerable feet and might be easily affected by different adversities. Since there is no available footwear sizing system for diabetic patients, manufacturers produce diabetic footwear of different sizes and fittings based on other available footwear sizing systems, which may result in inappropriate fitting. To get footwear with proper fittings, diabetic patients may go for customized or bespoke footwear based on their foot conditions, which is very costly. This study attempts to explore the foot complications of diabetic patients and categorize their feet to create a new sizing system using foot measurements from 102 male diabetic patients based on three dimensions of human feet, namely foot length, ball girth, and instep circumference. K-means data clustering is followed to categorize the data into three broad groups, namely small, medium, and large groups for footwear sizing. The developed footwear sizing system uses a sizing interval of 8 mm and a fitting interval of 6 mm. This study suggests a total of 11 sizes along with 24 different fittings for the footwear manufacturers for producing diabetic footwear. This newly developed footwear sizing system has a total of 79.41 % coverage where there are 10, 10, and 4 fittings in the small, medium, and large groups, respectively. The proposed footwear sizing system can help footwear manufacturers understand the proper size and fit of diabetic patients’ feet so that they can make appropriate footwear for diabetic patients economically.
... This would reduce the different problems created with ill-fitted footwear. Evidence results that 63 to 72% wearing in appropriately sized footwear based on length and width measurements [6], are aassociated with various foot pains as reduced mobility according to target group [7]. In addition, these findings try to attract consumers' attention and make them more conscious about their buying decision and in the meantime provide evidence to companies and shoe pattern makers to use these data to improve their product. ...
Conference Paper
Full-text available
Digital tools are implemented in various steps, such as production, merchandising, retailing, and customer service. Their implementation includes the fashion industry where product development such as garments, heels, jewelry, and accessories, is essential within all steps of production. Starting with the concept of creating 3D models, simulating, and direct digital manufacturing, including complex geometry, depicts the advantages of these technologies in the fashion industry. Reducing time, waste, and the advantages of creating, visualizing, and evaluating products at the early stages of product creation improves the process of product development. In this paper we present a methodology to implement these digital tools for design and manufacturing of shoe parts as heels. Due to the important role that heels play in shoe stability, an attempt to create heel shapes by inspirations taken from solid geometries is presented. To complete the whole design of these models the same shapes are used to create the upper part of the sandals. The methodology presents accurate and convenient manufacturing of footwear products based on product customization. Moreover, it shows a sustainable way of manufacturing footwear products.
... Moreover, the altered gait is reflected in an abnormal plantar pressure distribution [11], particularly an increase in pressure-time integrals, a critical factor in ulcer formation [23]. This abnormal gait pattern with SF may lead to foot conflict with the shoe, resulting in injuries due to increased friction and mechanical pressure, including blisters, hyperkeratosis, corns, onycholysis, and subungual hematomas [24]. These considerations are supported by the higher prevalence of foot problems observed in our findings in the SF group. ...
Article
Full-text available
Background: In this study, we hypothesized that safety footwear (SF) impacts gait patterns, potentially contributing to the podiatric symptoms reported by workers. The purpose of this work was to compare the gait analyses of workers wearing SF and sneakers using inertial sensors while also examining the occurrence of foot problems. Methods: A consecutive cohort of workers from different occupational sectors who wore SF during their work shifts were prospectively assessed through a gait analysis. The gait analysis was conducted under two conditions: first, while wearing SF, and second, while wearing sneakers. In both conditions, inertial sensors were used (Wiva® MOB). Participants also underwent a podiatric physical examination to evaluate foot problems. Results: This study shows that SF resulted in a worsening gait pattern compared to sneakers in both genders. The impact was particularly pronounced in female participants, resulting in a significant decline in walking speed and cadence. Discomfort was reported by 83.3% of participants, with a higher prevalence in females (46.6% vs. 36.6%). The SF group exhibited an elevated prevalence of foot problems, with no significant gender variations. It seems that foot problems are more likely to occur when a foot deformity, such as flat or cavus foot or hallux valgus, is present. Conclusions: This study suggests that SF may contribute to the reported podiatric symptoms among workers. Certain footwear characteristics, including weight, mis-fit, and inadequate design, may be factors associated with footwear discomfort and adverse gait patterns, potentially leading to increased foot problems among workers.
Article
Full-text available
Background: Musculoskeletal pain is a primary burden on individuals as well as social and health care systems. Annually, 2-3 million pilgrims perform the Hajj in Mecca, Saudi Arabia. The Hajj is highly physically demanding because pilgrims generally move by foot for long distances among a series of religious sites, an effort that may exceed their typical levels of physical activity. To understand the impact of musculoskeletal pain on the completion of the Hajj, it is first necessary to evaluate the extent of the problem. Accordingly, this study aimed to estimate the prevalence of musculoskeletal pain and associated factors among pilgrims during the Hajj. Methods: A cross-sectional survey was conducted during the period of the Hajj. The participants were adult pilgrims ≥ 18 years of age. Data regarding demographics, the prevalence of falls and the point prevalence of musculoskeletal pain by anatomical site were recorded. Participants were allowed to report more than one site of pain. Prevalence, crude and adjusted risk ratios were calculated. Results: A total of 1715 pilgrims were included in the analysis. The prevalence of falls was 13.76%. The prevalence of overall musculoskeletal pain (pain at any site) was 80.46%. Musculoskeletal pain was most commonly reported in the ankle/foot (38.34%), leg (29.89%), lower back (28.47%) and knee (21.84%). In general, musculoskeletal pain at multiple sites was more common in females and in older and obese individuals. However, there were variations in the importance of sex, age and body mass index as associated factors across different pain sites. Conclusion: Musculoskeletal pain is common among pilgrims. Unlike most populations examined in other studies, ankle/foot pain was the most common in pilgrims. These data provide guidance for potential preventative programs and the allocation of resources to optimize pilgrims' experiences and ability to complete the Hajj.
Article
Full-text available
Alzheimer's disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65-95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.
Article
Full-text available
Mining work boots provide an interface between the foot and the ground, protecting and supportingminers' feet during lengthy coal mining shifts. Although underground coal miners report the fit of their work boots as reasonable to good, theyfrequently rate their boots as uncomfortable, suggesting that there is a mismatch between the shape of their feet and their boots. This study aimed toidentify whether dimensions derived from the three-dimensional scans of 208 underground coal miner's feet (age 38.3 ± 9.8 years)differed from the internal dimensions of their work boots. The results revealed underground coal miners wore bootsthat were substantially longerthan their feet,possibly because boots available in their correct length were too narrow. It is recommended boot manufactures reassess the algorithms used to create boot lasts, focusing on adjusting boot circumference at the instep and heel relative to increases in foot length. Practitioner Summary Fit and comfort ratings suggest a mismatch between the shape of underground coal miner's feet and their boots exists. This study examined whether three-dimensional scans of 208 miner's feet differed from their boot internal dimensions. Miners wore boots substantially longer than their feet, possibly due to inadequate width.
Article
Full-text available
Introduction: The use of an improper shoe size is common in older people and is believed to have a detrimental effect on the quality of life related to foot health. The objective is to describe and compare, in a sample of participants, the impact of shoes that fit properly or improperly, as well as analyze the scores related to foot health and health overall. Method: A sample of 64 participants, with a mean age of 75.3±7.9 years, attended an outpatient center where self-report data was recorded, the measurements of the size of the feet and footwear were determined and the scores compared between the group that wears the correct size of shoes and another group of individuals who do not wear the correct size of shoes, using the Spanish version of the Foot Health Status Questionnaire. Results: The group wearing an improper shoe size showed poorer quality of life regarding overall health and specifically foot health. Differences between groups were evaluated using a t-test for independent samples resulting statistically significant (p<0.05) for the dimension of pain, function, footwear, overall foot health, and social function. Conclusion: Inadequate shoe size has a significant negative impact on quality of life related to foot health. The degree of negative impact seems to be associated with age, sex, and body mass index (BMI).
Article
Full-text available
Background: Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson's explored people's choice of indoor and outdoor footwear, foot problems and fall history. Methods: Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson's UK groups and stroke clubs in the wider Southampton area, UK. These collaborators handed out survey packs to people with a confirmed diagnosis of stroke or Parkinson's. Results: Three hundred and sixty three completed surveys were returned (218 from people with Parkinson's and 145 from people with stroke). Most respondents wore slippers indoors and walking shoes outdoors and considered comfort and fit the most important factors when buying footwear. Foot problems were reported by 43 % (95 % confidence intervals 36 to 52 %; stroke) and 53 % (95 % confidence interval 46 to 59 %; Parkinson's) of respondents; over 50 % had never accessed foot care support. Fifty percent of all respondents reported falls. In comparison to non-fallers, a greater proportion of fallers reported foot problems (57 %), with greater proportions reporting problems impacting on balance and influencing choice of footwear (p < 0.01) in comparison to non-fallers in each case. Forty-seven percent of fallers with foot problems had not accessed foot care support. Conclusions: Many people with stroke and Parkinson's wear slippers indoors. A high percentage of these individuals reported both foot problems and falls impacting on footwear habits and choice of footwear; however many did not receive foot care support. These findings highlight that further exploration of footwear and foot problems in these populations is warranted to provide evidence based advice on safe and appropriate footwear to support rehabilitation and fall prevention.
Article
Full-text available
Background Foot problems are common in people with inflammatory arthritis. Despite suitable footwear having the potential to alleviate pain, improve mobility and maintain independence, previous studies have found many people with inflammatory arthritis wearing poorly fitting and inappropriate footwear. Footwear styles and characteristics have not been reported in a Singapore inflammatory arthritis population. The objective of this study was to identify current footwear styles and characteristics of footwear worn by people with inflammatory arthritis in Singapore. Methods One-hundred-and-one participants with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a large public hospital in Singapore. Disease and clinical characteristics were recorded. A patient-reported outcome included current foot pain. An objective footwear assessment of style, age of shoe, fit and construction was conducted. ResultsThe majority of participants were Chinese women with a mean (SD) age was 52.0 (15.0) years old and a mean (SD) disease duration of 9.3 (0.3) years. We found 50 % of participants (n = 51) reported footwear problems. Sandals (n = 27, 26 %), flip-flops (n = 19, 19 %) and moccasin type (n = 19, 19 %) was the most common footwear choice. Evaluation of footwear characteristics found that there was a lack of motion control features. Only 32 (32 %) participants had correctly fitting footwear with regard to length, width and depth. No participant was wearing therapeutic footwear. Conclusion This study provides the first insight into footwear preferences of people with inflammatory arthritis in Singapore. Use of slip-on and poorly fitting footwear was found to be common in people with inflammatory arthritis. Further research on footwear preferences in Southeast-Asian communities needs to take into account cultural habit and preference, socio-economic status, footwear options and affordability.
Article
Lower limb injuries are highly prevalent in underground coal mining. Wearing gumboots with inadequate ankle support was thought to contribute to these injuries. Despite the uptake of leather lace-up boots, which provide more ankle support, no recent research could be found investigating the effect of this alternative work boot in underground coal mining. Consequently, this study aimed to determine whether boot type (gumboot, leather lace-up boot) influenced work footwear habits, foot problems, lower limb pain, lower back pain, or perceptions of work boot fit and comfort in underground coal miners. Chi-squared tests were applied to 358 surveys completed by underground coal miners to determine whether responses differed significantly (p < 0.05) according to boot-type. There were no significant between-boot differences in regards to the presence of foot problems, lower limb pain or lower back pain. However, the types of foot problems and locations of foot pain differed according to boot type. Gumboot wearers were also more likely to state that their work boot comfort was either ‘uncomfortable’ or ‘indifferent’, their work boot fit was ‘poor’ and their current boot did not provide enough support. The introduction of more structured leather lace-up boots appears to have positively influenced the support and fit provided by mining work boots, although foot problems, lower limb pain and lower back pain continue to be reported. Further investigation is recommended to identify which specific boot design features caused these observed differences in work boot fit, comfort and locations of foot pain and how these design features can be manipulated to create an underground coal mining work boot that is comfortable and reduces the high incidence of foot problems and lower limb pain suffered by underground coal miners.
Article
Purpose: Describe age-related differences in women's foot shape using a wide range of measurements and ages. Study design: Cross-sectional, observational study. Main outcome measurements: Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferences, high instep circumferences, and heel instep circumference. Results: 168 women from 20 to over 80 years of age, divided into seven age categories, were included. Older women had significantly greater foot-shape measurements, even after adjusting for Body Mass Index. Ball widths increased 3.1-4.0mm per decade, ball circumferences 5.6-7.4mm per decade, high instep circumferences 0.4-4.8mm per decade, and heel instep circumferences 1.8-1.9mm per decade. Ball widths, ball circumferences, and left high instep circumference plateaued in the 70-75 years-of-age category, and decreased in the oldest age category. For low instep circumference, age did not prevail significantly over Body Mass Index. Foot length was not associated with age. Conclusion: This study described women's progressive foot-shape changes with age. The findings provide a better understanding of foot-shape changes, mainly found in the forefoot. It demonstrates that for a good fit, shoe design for older adults and for younger adults should differ.
Chapter
There is a growing trend to sell many types of consumer products through the web in order to maintain or enhance a company’s competitiveness, and sometimes to establish a niche market. For products such as footwear however, manufacturers are facing quite a challenge to provide consumers with good fitting shoes. Footwear fitting is generally performed using the two variables of foot length and foot width (or girth), even though feet and shoes are three-dimensional objects. As a result, the matching between feet and footwear are quite variable and can be quite unacceptable even with the same brand of shoes. Footwear fitters speak of “perfect fit” and more commonly a “proper” or “correct” shoe fit even though the term “fit” appears to be nebulous. This chapter is an attempt to quantify and categorize footwear fit. Using digital manipulations, the foot shape was “adjusted” to the required heel height. The last and foot were then mapped to each other to determine the level of match and mismatch. The magnitude of the match or mismatch was color-coded and overlaid on the foot surface so that such color maps can be used to determine subjective preferences. The proposed footwear fit quantification can be used to predict potential discomfort and even fit-related comfort, if the material properties of the shoe are known. The method can also be used to rank different footwear lasts for any given individual.