O - Footwear Recs Flashcards
what type of shoe is needed if pt having trouble w GRF
cushion
what type of shoe is needed if pt’s foot is moving too much
stability
what are the 3 footwear categories
dress
casual
athletic/sport
what are the 2 main things that your footwear rec will be based on
individual needs of pt (ADLs, work, sport/rec)
biomechanical exam findings
what are the 4 goals of footwear
- protection from ground
- provide traction
- motion control
* heel stabilization
* midfoot support
* forefoot control - shock absorption (GRF)
* midsole dampens forces
* energy return
what is the primary part of the shoe that absorbs GRF and controls that force
midsole
what are the functions of the heel counter
keep calcaneus stable
don’t let it move too much
where are the most common areas to find deficits in
areas that the shoe is constructed/sewn together
what are the 5 upper footwear components
toe box
vamp
quarter panels
throat
heel counter
what does the toe box do
length, width, depth
accommodates toe deformities
what does the vamp do
covers forefoot and toes including tongue
what does the quarter panels do
contains eyelets for laces
covers midfoot and heel
what does the throat do
where vamp and quarter panels stitched together
dictates maximum girth
what are 2 materials the heel counter often made of
pressed cardboard
thermoplastic
what are the 3 lower footwear components seen in dress shoes
shank
heel
outsole
lower (dress shoes)
what are 3 functions of the shank
- steel piece that provides rigidity to midsection (not comfortable)
- less breakdown of shoe
- determines where flexpoint is with activity
lower (dress shoes)
how tall is the heel in mens dress shoes
1’’
lower (dress shoes)
what is the outsole often made of
leather or hard composite material
lower (dress shoes)
what are the 2 functions of the outsole
- abrasion resistant
- less breakdown
what are the 3 lower footwear components to athletic shoes
outsole
midsole
insole/inlay/sockliner
lower (athletic shoes)
what are 4 types of materials the outsole can be made of
- polyurethane
- blown or gum rubber
- high density carbon rubber
- cleated sole
lower (athletic shoes)
what are the characteristics of high density carbon rubber vs polyurethane blown/gum rubber
high density carbon rubber
* abrasion resistant
* most durable
* for high impact sites
polyurethant blown/gum rubber
* lighter
* breaks down faster
usually have a mix of these making up the outsole
lower (athletic shoe)
what format is recommended for a cleated sole
12-17 round total
* 8+ in front
* 4+ in rear
lower (athletic shoes)
how has cleated sole recommendations changed and why
used to rec 90deg square cleat
* great traction and grip
* but translated load up to knee and saw ligamentous injuries bc lack of give
round ones recommended now
might still see 90deg square today, but prob in track/field bc running in one plane
lower (athletic shoe)
what are the 2 main functions of the midsole
- attenuate shock at impact
- energy return
what dictates the lifespan of the shoe
midsole
lower (athletic shoe)
what are the components contributing to midsole energy return
EVA (ethylene vinyl acetate)
* variable density
* stiffer
composite
* foam and rubber blend
* softer (more mobility allowed)
lower (athletic shoes)
what are extras that can be added inside the midsole
cushioning units (fluid, air, gel)
stabilizing units for motion control (plastic)
not a lot of evidence to support cushion units
lower (athletic shoes)
single vs duo density midsole
single density (whiter) = cushion, softer
duo density (darker) = stability, durability, stiffness
darker color is a barometer for density
lower (athletic shoes)
why is midsole cushioning important
improtant to absorb shock
* walking GRF = 1.25xBW
* running GRF = 2-3x BW
* 800-1200 impacts per mile on each leg
lower (athletic shoe)
what are the 3 functions of an insole/inlay/sockliner
- dec friction b/w sock and shoe
- absorbs perspiration
- dec plantar pressure by inc surface area in contact areas
lower (athletic shoe)
why is it good for the insole/inlay/sockliner to be removeable (2)
can see construction of shoe
would take it out to put orthotic in
lower (athletic shoes)
if you note that a pt has a lot of motion in their foot what is your next move
can provide stability w footwear or orthotic
* try a firm shoe first
lower (athletic shoes)
how will the outsole/midsole impact foot orthoses (3)
- firm sole will inc stiffness of orthosis
- soft sole will dec stiffness of orthosis
- rigid orthosis will lead to faster breakdown of soft sole
needd to consider orthosis and footwear together
what is the last
shape and construction of the shoe
what are the 3 types of shapes to a last
- straight
- semi-curved
- curved
who is a straight last more appropriate for and why
pronated foot
more stable
who is a semi-curved last more appropriate for
neutral or pronated foot type
most common
who is a curved last more appropriate for and why
supinated
less stable
what is the goal of the shape of the last
to model the shape of the foot
what is the construction of the last
method of attaching upper to lower
what are the 3 main types of last constructions
- board
- slip (central or peripheral)
- combination
what are the 2 components which contribute to dress shoes being so rigid and uncomfortable
board and shank
last construction (board)
board location
function
type of shoe
runs from rearfoot to toes
* upper cemented to insole board
stabile shoe, more rigid
* limited flexibility in forefoot
seen in dress shoes
last construction (slip)
central vs peripheral
central: upper stitched together to form slipper
peripheral: upper stitched to felt material
* “more stiffness than central”
he doesn’t buy that peripheral is much more stiff than central
* yes something but it is a thin piece of felt so isn’t changing things too drastically
last construction (combination)
structure
function
who is this appropriate for
- board last to forefoot
- (making rearfoot more firm)
- stitched to toe box
ideal for motion control
increases stability
aggressive pronators
what is an important consideration if prescribing shoe based on foot type
this is oversimplistic
* need to look at LE kinetic chain and do biomechanical assessment
* need to address proximal issues
what are the 4 types of running shoes and their respective function
neutral
* cushion
stability
* support to control pronation
motion control
* added support for maximal pronation control
minimal
* minimal bulk, no heel built in
* 0mm RF - FF drop (most shoes will have slight heel lift)
what are components for proper fitting
time of day - mid day ideal
* morning = short
* evening = splayed
allow 1 thumb breadth of space b/w tip of longest toe and end of shoe
laces should be parallel when shoe is fully laced
what are 3 ways to assess for defects
glue/cement/stitching should appear durable
* where you see most break down
heel of shoe should be perpendicular when placed on firm surface
* shouldn’t rock, stay flat on table
when pressure applied to toe and heel of shoe, the shoe should break at toes
what are 4 tips for running shoe care
- always untie shoes when taking them off
- avoid running in wet shoes
- don’t wash shoes in clothes washer or in dryer
- may be appropriate to have 2 pairs
what are the 2 factors that break down the shoe the most
water and heat
why should you avoid running in wet shoes
wet midsole loses 50% of shock absorption
what is the thought behind having 2 pairs of running shoes
footwear doesn’t have same shockwear capability if you run every day
* alternate shoes b/w days
he doesn’t know how much he buys this unless you are a pro runner
what are the 2 main points guiding replacement considerations
integrity of midsole
hoke’s law for mileage
what 4 factors into the integrity of the midsole when considering a replacement
body weight
#of miles (inc impact = inc heat buildup)
running style
running surface and environment
heat and moisture are what wears out the midsole
what is hoke’s law
75,000 / BW = miles
that is the amt of miles those shoes would last
* if running more miles, drop the number
* if running outside, drop down
* running style - factor that in
this is a good place to start
tell pts to keep track of when buy shoes and how far they run, if start getting sx - maybe time to replace
heel strike vs forefoot strike
cushioning in shoes is what allows for heel strike
* high rate of loading = “impact peak”
* rate of loading is faster
forefoot strike is more gradual
* this is the running form seen when you run barefoot
why can’t you run w a heel strike unless you have running shoes on and why was this thought to be significant
without shoes, a heel strike form would have you be banging into the calcaneus
thought that running shoes cause running issues bc impacting the mechancis of the runner
what is different about the forefoot strike pattern when barefoot
changes shock absorption from RF motion to GS-complex working eccentrically to absorb the load
* takes a lot of strength
* allows body to adjust and absorb forces evenly
what type of running form is seen when you run barefoot
fore foot strike
what is concerning ab limited subtalar motion and heel strike
when hit ground, first thing is calcaneal eversion –> unable to absorb it
how does a heel vs forefoot strike change the stride mechanics
forefoot = leg underneath you
heel = breaking component w leg in front
what is important about a gradual transition (~6mo) from heel strike to forefoot strike
need to get GS-complex stronger bc forefoot strike takes a lot of eccentric strength
* when gastroc not strong enough, see achilles problems
does barefoot reduce injuries?
the form is the most important!
(barefoot forces you to run w better form)
what are 4 components to preventing injuries thru improving form
- gradual retraining gait
- avoid over striding
- inc stride frequency
- maintain upright body posture
what happens biomechanically as a result of shortening your stride
inc stride frequency, get more vertical force w leg underneath you
can shoes make your feet lazy? how do we combat this?
some people’s feet can become reliant on footwear
have them train balance and things barefoot in PT, so they can work on foot strength
* toe yoga, intrinsic strengthening
little babies should walk around without shoes to build up intrinsics
