Adequate Shoe Length?

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The advice we give to patients, concerning the length of shoes, and probably heed ourselves, goes something like this.

When you are buying a new pair of shoes make sure that there is about 0.5" or 1.25cm between the end of the longest toe and the end of the shoe and be sure to check which of your toes is the longest because it isn't necessarily the big toe.

I have two questions about this advice. The first might seem nonsensical but hopefully the second question will put me back in the land of the sane.

Why do we require any gap at all between the end of the longest toe and the end of the shoe?

If there is a need to have a gap between the end of the longest toe and the end of the shoe does this rule apply equally to the other toes?

If it does then possibly we should be advising patients to ensure that there is about 0.5" or 1.25cm between the end of the shortest toe and the the end of the shoe!

You can't watch the tele all the time.

Bill

 

This may help.

http://brannock.com/cgi-bin/start.cgi/brannock/instructions.html#fitting

Steven

 

When I have bought shoes too short (A great sale price), the problem is worst when you go down hill. The foot slides in the shoe so that the toes do hit the end of the shoe. (Those shoes weren't that cheap when considering dollar per miles worn.) They did hurt.

The forward slide could be another mechanism by which we get the pebble in the shoe.

I'd imanine that the additional length device would apply to the toe closest to the end of the shoe and that would depend on foot shape and shoe shape.

Eric

 

This is a complex question and Steven's article on the Brannock measuring device is very good.

Measuring systems are based on the heel to ball measure. This is the lineal distance between the anterior surface of the 1st metatarsal (ball joint) and the posterior surface of the heel. This is because the principle of fitting is to give the rear foot good support and to provide the forefoot with room to move. Think how critical this length is with respect to shape and position when designing an orthotic.

The length of the foot will be within a couple of millimetres of the heel to ball divided by 5 multiplied by 7. The nominal shoe size is the heel to ball divided by 2 and multiplied by 3. Many people will wear a shoe a size smaller than that simply because they don't like to think they have big feet.

A UK and US size is 1/3rd inch by definition. So 0.5" is 1 1/2 sizes and that is about an average amount to have longer than the foot. Paris Points are 3 for every 2 centimetres and so are slightly smaller than sizes by ratio of 20/25.54 or about 4/5th.

The space in front of the toe depends on the style and use of the shoe. A climbing boot will only be 1/2 size longer than the foot so that the distal hallux is close to the small rocky footholds that climbers use to ascend. Say the wearer is a size 9, the boot will only measure size 8 but is called a size 9 because it is designed for a size 9 foot. A winkle picker for the same foot will actually measure size 11 or 12 but is still called a size 9 as it is designed to fit a size 9 foot. It is all based on the heel to ball measure.

The reason for the space is to give room and air movement and as Eric says, room for the foot to move forwards when going down hill. It also gives toe shape. If the shoe is the same length as the foot it will be wedge shaped and most people don't like that look. (Wallabies from the 1980'S)

The science of last design reached it's height in the 1930's and since that period has been dumbed down for ease of manufacture and a fashion trend that is returning half way back to straight lasts. Between about 1600 and 1825, there were no lefts or rights but people wore straight lasted shoes, alternating them from one foot to the other on consecutive days. It is a fascinating study to follow the development of shape in footwear since that time until the present day.

 

Shoe fit is all about the dynamic fit, not the static fit

The reason for the extra room required in a shoe fitting is the insole is on the outside of a curve and the toes on the inside of the curve as the foot flexes, its that simple.

Test the theory yourself, put on your favorite runners/trainers then stand up, feel how far your toes are from the end of the shoe, now fully flex your foot and see how much closer your toes are to the end of the shoe.

This also counts for shear factors in a shoe under the met heads and toes and why diabetics with any issues under the MPJs & toes should go into a solid rocker sole, l think shear is more of a problem for these guys than pressure.

As l said, fit of a shoe is more about the dynamic than it is the static.

The bigger the foot, the greater that distance to the end of the shoe required, excluding children when we want some room for growth and less for a solid rocker sole that does not flex.

May l suggest the advice you give the client is to go to a trained shoe fitter, better safe than sorry.

As for going down hill, lace your shoes up correctly would be a good start

 

What a fascinating and complex subject.

So, if I understand you all and recognising the importance of the heel to ball fitting. As far as the toes are concerned, there should be a gap between the end of each toe and the end of the shoe sufficient to allow for forward movement of the ends of each toe associated with movement within the foot, eg subtalar joint pronation elongating the foot, plus any forward movement of the foot within the shoe not controlled by laces, etc?

Has any research been done to measure the range of forward and backward movement of each toe when walking?

Is it important?

Bill

 

If you read what David says, Bill, it's not the subtalar joint pronation that elongates the foot, although it does do that, it's that thickness of the insole and the sole under the foot. The surface of the sole is on the ground. The sole and insole bend with the foot at heel lift and the toes move forwards because of the difference between the inside circumference and the outside circumference of the curve made by the bending shoe.
It's like when they run the 1500 metres at the olympics, the inside lane starting point is well back from the outside starting point because the outside lane has further to go around the corner. Therefore the amount of forward movement depends on the combined thickness of the sole and insole.
If you place your bare foot on the ground and lift your heel, if anything the hallux gets shorter as the plantar fascia pulls on the proximal phalange. It's the bending shoe that pushes the toes forwards.

 

...and depth of the toe box, so often forgotten / overlooked

 

Shoe fit will also be sport dependent. Soccer cleats (i.e. football boots) are generally worn about 1 size smaller than street shoes to improve the "feel" of the ball. Rock climbing and road cycling shoes are also fit fairly tight in most cases, with the toes close to the end of the shoe.

In addition, women's pumps are generally worn with the toes against the end of the shoe in order to keep the shoe on the foot and avoid heel slippage. In addition, most women wear their shoes about one shoe size smaller than men. This is probably due to the fact that most women don't want their feet to look too big while most men don't mind if their feet look big.

However, in the ideal world, it is best to have the shoe not touching the end of the toes to prevent jamming the toes against the end of the toe box of the shoe with each step, especially during running sports (and especially downhill running). I generally recommend shoe fit to be one half a thumb's width from the end of the longest toe to the end of the shoe for walking and running shoes.

 

ln a good quality court shoe, if you sit it on the bench you will see the toe spring and heel height do not match the heel pitch, as the foot goes in, it flexes the shoe, correcting the "incorrect" pitch and toe spring, this tightens the topline of the shoe, holding it firmly on the foot, no jammed toes required.

Ballerina(still court shoes) flats are bent, thats because they dont have a heel pitch or toe spring to correct to make the topline tight

But in the second part of your statement, never a truer word has been spoken, vanity wins every time over logic.."The small red pair look better, l'll take them:deadhorse: