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Table 1 Summary of included studies

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

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 19–68) yrs. 50 participants in control group, 19 men, 31 women, mean age: 41 (range 19–65) 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 2–9 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: 2–7 mm)
Burns et al. [18] 65 participants, 26 men 39 women, median age: 82 (range 64–93) yrs. Participants were consecutive admission to hospital rehabilitation unit. Foot length was measured with the participant in a sitting position using a standard ‘Clarks’ measuring 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
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 participants’ feet 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 participants’ feet. 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 participants’ feet
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 foot–footwear width discrepancy was 0.56 cm (20% of all participants)
• For participants without deformity the average foot length–footwear 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 ‘Clarks’ measurement 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
• 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 Down’s syndrome was present among participants. Outline of each participants’ foot was traced onto a footprint mat while standing in relaxed bipedal stance. Maximum length and width of the participants’ foot 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 Alzheimer’s 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 participant’s foot was measured. The outline of each shoe was traced onto graph paper, Fit of most regularly worn footwear was assessed. The percentage difference between the foot and footwear dimensions was calculated for length and width measurements. • 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 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).