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MedicalContinuing Education Goals and Objectives Footwear After completing this CME, should have: Assessment and 1) Knowledge of foot- wear construction and Management materials. 2) Skills to accurately assess the fit and suitabili- ty of footwear. Understanding shoe construction and materials aids in properly 3) Current knowledge fitting patients. of the footwear options available to better treat patients. Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Contin- uing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $20.00 per topic) or 2) per year, for the special introductory rate of $139 (you save $61). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. In the near future, you may be able to submit via the Internet. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned cred- its. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. 176. Other than those entities cur- rently accepting CPME-approved credit, Podiatry Management cannot guarantee that these CME credits will be acceptable by any state licensing agency, hospital, managed care organization or other entity. PM will, however, use its best efforts to ensure the widest acceptance of this program possible. This instructional CME program is designed to supplement, NOT replace, existing CME seminars. The goal of this program is to advance the knowledge of practicing podiatrists. We will endeavor to publish high quality manuscripts by noted authors and researchers. If you have any questions or comments about this program, you can write or call us at: Podiatry Management, P.O. Box 490, East Islip, NY 11730, (631) 563-1604 or e-mail us at [email protected]. Following this article, an answer sheet and full set of instructions are provided (p. 176).—Editor By Anita Williams with systemic diseases affecting leading to lower extremity ulcer- the health status of the lower ation and amputation in people Editor’s Note: This CME was origi- limb. Patients with diabetes, with diabetic neuropathy.1-5 nally published by The Society of Chi- rheumatoid arthritis, connective The benefits of appropriate ropodists and Podiatrists, and is tissue disorders, peripheral vascu- footwear in patients with reprinted by permission. lar disease and other conditions rheumatoid arthritis are reduc- associated with compromised tion in pain, and increased mo- Introduction neurological status and poor tis- bility.6-8 In the elderly population, Footwear plays an important sue viability benefit from appro- it is recognized that inadequate role in the maintenance of foot priate footwear. It is known that footwear such as badly worn health in the healthy population, footwear has been found to be a shoes or slippers contribute to and has a vital role for people precipitating cause of trauma Continued on page 166 www.podiatrym.com OCTOBER 2007 • PODIATRY MANAGEMENT 165 Footwear... cluding leather, man-made mate- and is particularly useful in foot rials, or, in the case of safety problems which require ease of Continuingthe occurrence of falls,9,10 footwear, steel and high density access to the shoe, e.g., rheuma- demonstrating the complex in- plastics. The tongue of the shoe toid arthritis, rigid ankle defor- Medical Education terplay between footwear, walk- is attached to the vamp. This is mities, etc. Also, the seam will ing, and balance. Inappropriate seen mostly in lace-up shoes and not stretch and therefore dictates footwear can therefore impact on those with fastenings at the the maximum width of the shoe. mobility, general health, inde- throat where the fit of the shoe is pendence and lifestyle. Therefore, narrowest. • Toe cap—This is a reinforc- appropriate footwear should be ing cover stitched over the front advised to these individuals with • Quarters—The sides and of the vamp. It can be decorative, the aim of preventing falls and back of the upper are termed the as in certain styles of shoe such related problems, such as frac- quarters and the top edge is as a strong oxford shoe, usually tures and loss of mobility. termed the topline of the shoe. with ornamental perforations The inner and outer sections of and wing tips.. Footwear Construction and the top line are often joined in Materials • Insole—This is the flat inside of the shoe, which covers the Parts of a Shoe midsole and filler between the There should upper and the sole. • Vamp—The upper is made be a small amount of two main sections which to- • Linings—Linings are the in- gether are molded to form the of toe spring at the side of the vamp and quarter and upper of the shoe. The front sec- can be softer material than the tion is termed the vamp and cov- front part of the upper, and hence provide more ers the forefoot and the toes. In sole so that the comfort and add to the durability some designs of shoes, the vamp of the footwear. The lining in the can be decorative and made of foot doesn’t catch bottom of the shoe is sometimes more than one piece, or embel- termed the insock (or sock lin- lished with different materials or the ground ing) and can be full length or stitching. There may be problems during walking. three quarters long. with this area if there is too much stitching and too many • Shank—The shank reinforces seams on the vamp. These pre- the middle or the waist of the vent stretching of the vamp ma- the center at the back of the shoe from underneath to prevent terial over the forefoot and toes heel. The inside of the quarter is it from collapsing or distorting. It, and may lead to pressure on usually reinforced around the therefore, needs to be completely bony prominences. The vamp is heel with a stiffener called the rigid or only slightly flexible. usually reinforced in the toe ‘heel counter’ and has the pur- Shoes with a wedge sole, or very area. This toe box retains the pose of stabilizing the rearfoot flat shoes, do not need a shank. shape of the front of the shoe (particularly important in people and prevents it from collapsing with excessive foot pronation— • Outer sole (outsole)—The onto the toes. flatfeet). In lace-up shoes the under surface of the shoe can be The toe box can be made eyelets for the laces are at the made from a variety of materials from a variety of materials in- front of the quarter. This part of and is joined to the upper in sev- the quarter covers eral different ways, e.g. welted, the tongue, which stitched, or adhesive applied. is attached to the There should be a small amount vamp or forms of toe spring at the front part of part of the vamp. the sole so that the foot doesn’t catch the ground during walking. • Throat—The Toe spring is the angle between position of this the flat surface and the height area of the shoe is the toe is off the ground in rela- dependent on the tion to the ball of the shoe. style. It is formed by the seam join- • Heel—The heel raises the shoe ing the vamp to above the ground. If there is no the quarter. A raise at the heel area or the heel is lower throat line lower than the sole then this is (ex. lace-to-toe) termed a negative heel. The mate- will provide a rial covering the area of the heel Figure 1: Shoe last wider opening Continued on page 167 166 PODIATRY MANAGEMENT • OCTOBER 2007 www.podiatrym.com MedicalContinuing Education Footwear... is an extremely skilled craft. The rate away from the foot. measurements of the last are re- The advantage to foot that contacts the ground is called lated to volume in addition to health is that the skin is less the top piece (or top lift) and this width and length and, in this re- macerated and therefore less can be replaced or repaired. spect, a last is not an exact im- likely for fungal infections to pro- pression of a liferate. Leather Last Construction foot. This is to also stretches in Relation to Shoe Fit ensure good fit and accommo- and Style and also takes Some of the dates to the Lasts are the molds on which into account the modern lining uniqueness of shoes are made (Figure 1). The changing dimen- the foot shape. design and shape of the shoe is sions of the foot materials can be The advantages dependent on the shape of the during move- of leather are last. For example, a last for a ment. ‘breathable’ or negated by the high heeled shoe needs to be ‘wick’ moisture use of synthetic shorter than the foot for which it Materials linings and/or is being designed to compensate Used in away from special coatings for the shortened ‘equinus’ posi- Footwear the foot. often used to tion in which the foot is held. In Construction protect the order for a high-heel, pump-style • Upper materi- leather. shoe to stay on the foot its last als—Leather is Some syn- will differ from the last required the most common material and thetic materials are also breath- to make a lace-up shoe. has the advantage of being perme- able, but are less supple than Last design and manufacture able so that moisture can evapo- leather.

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