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Podiatry A form–combination, inflare, narrow heel, outflare, straight–over which a shoe is constructed


wooden or plastic model over which shoe upper and sole are formed during manufacture (see Table 1and Table 2)
  • bespoke last made to exact dimensions of patient's foot

  • board-lasted shoe upper is stitched to a board of same shape as inner sole; creates a more rigid shoe than a slip-lasted model, and can accept an orthosis

  • combination-lasted slip-lasted forepart and board-lasted rear part; creates moderately flexible but relatively light-weight shoe

  • curved last last with marked forefoot medial in-flare; indicated for highly arched foot, or runners with mid- or forefoot strike

  • generic last last that matches foot size of specific population bands

  • semibespoke last generic or bespoke last adapted to fit a similarly shaped foot

  • semicurved last last with moderate degree of medial in-flare; suitable for majority of population

  • semistraight last last with minimal forefoot in-flare; used for sports shoes

  • slip-lasted; slipper-lasted closure of upper around underside of last; outsole is fixed to underside of closed upper; flexible and light-weight shoe construction

  • straight last last with minimal/no medial in-flare; forms very supportive shoe suited to low-arched or excessively pronating feet

Table 1: Last shapes
Last typeRationale
OutflareSlight outflare along the lateral border of the shoe
The distal projection of the longitudinal bisection of the underside of the shell divides the forefoot into two unequal halves, where the lateral segment is slightly larger than the medial segment
Indicated for patients with marked pes planovalgus
Straight/ semistraightNo or very slight in-flare along the medial border
The distal projection of the longitudinal bisection of the underside of the heel divides the forefoot sole into two equal halves
The most supportive shoe shape
Indicated for patients who overpronate or those with pes valgus
SemicurvedGreater degree of in-flare along the medial border
The distal projection of the longitudinal bisection of the underside of the heel divides the forefoot sole into two unequal halves, where the medial segment is slightly wider than the lateral segment
It offers some medial support, but not so much as the straight last
The greater majority of shoes are manufactured to a semicurved last
CurvedMarked in-flare along medial border
The distal projection of the longitudinal bisection of the underside of the heel divides the forefoot sole into two unequal halves, where the medial segment is much wider than the lateral segment
Used for the manufacture of light-weight running shoes as the in-flare is reputed to maximize forward speed
Suitable for patients with non-mobile pes cavus, and for those that mid- or forefoot strike

It is important that the foot shape is compatible with the shape of the last to which the shoe is made. For example, the dorsa of the third, fourth and fifth toes will be subject to marked shoe trauma if a foot that shows excess pronation is accommodated in a shoe made to a curved last.

Table 2: Footwear and last terminology
Footwear/last elementComment
TreadlineThat part of the forepart of a shoe that is in direct contact with the ground surface when the heel height, pitch and toe spring are correct; i.e. the area that runs obliquely across the foresole, which in a well-fitting shoe corresponds to the MTPJs and thus is subject to the greatest wear. Where the treadline of the shoe and MTPJ parabola of the foot do not coincide, the foot will be subject to shoe trauma: if the MTPJ parabola lies distal to the treadline the lesser toes will be compressed
Toe springThe elevation of the toe end of the last from the horizontal surface when the seat is raised to its correct height (pitch) so that the last stands correctly on its treadline or the elevation of the toe end of the shoe from the horizontal when the sole and heel rests on a horizontal surface
The toe spring reduces the resistance to flexion that the shoe places on the foot when the foot is flexed at the MTPJs, and thus reduces both fatigue during walking and wear at the vamp area of the upper
The more rigid the outsole, the greater the effort required to allow flexion of the foot at the MTPJs; thus the more rigid the outsole, the greater the height of the toe spring. (Consider the height of the toe spring of a clog, which, although totally inflexible, allows the foot to ‘rock’ forward in response to the forward motion of the body's centre of gravity)
The toe spring of ‘slip-on’ shoes is shallow, and designed to flatten during gait, so that the quarters close into the rearfoot and the shoe does not fall off
The toe spring of a high-heeled shoe is shallow as this style of shoe automatically places the toes in a dorsiflexed position, and the degree of toe spring is only required to prevent the toe end of the sole scuffing against the ground during gait
Heel pitchThe angle of elevation of the heel seat of the last from the horizontal surface when the last is standing correctly on its treadline; the heel pitch varies directly with the height of heel of the shoe, and the toe spring will be increased if too shallow a heel is used, or decreased if too high a heel is added to the shoe
A significant increase in heel height throws the body weight forward, with the need to make a resultant compensatory alteration in back posture (an increase in the lumbar curvature, and decrease in the thoracic curvature, so that the bottom and chest are exaggerated) with constant plantarflexion of the ankle and inversion of the subtalar joint reducing normal shock absorption
FlareThe relative positions in the centre of the heel seat and the sole. Flare is determined by projecting the line that bisects the centre of the heel seat distally through the treadline of the sole of the shoe
• An in-flare shows a greater sole area medial to the line of bisection
• An out-flare shows a greater sole area lateral to the line of bisection
• straight-flare shows equal amounts of sole on either side of the line of bisection
The plantar aspect of the foot should be examined in a similar manner. The foot bisection passes:
• Through the middle of the third toe in a straight-flare foot
• Between the second and third toes in an out-flare (e.g. pes valgus) foot
• Between the third and fourth toes in an in-flare (e.g. pes cavus) foot
Misfit of foot and shoe flare will cause shoe-related foot trauma
SizingHeel to ball length:
The distance between the posterior aspect of the heel and the midpoint of the medial aspect of the first MTPJ (ideally equivalent to 0.7 of the heel to toe length)
Heel to toe length:
The distance from the heel to the toe
Both lengths should be measured to ensure that the widest part of the foot co-incides with the widest part of the shoe
Girth/width measurement (A–E fittings)
There are a number of shoe-sizing conventions (see Table 3)
StylesOxford/brogue: a conventional laced shoe with a decorative toe cap, close-fitting quarters and facings, a stitched tongue, five pairs of eyelets; unsuitable for oedematous or highly arched feet
Derby/Gibson: a conventional laced shoe with a wide throat and integral tongue, three pairs of eyelets; more suitable for oedematous and highly arched feet
Moccasin/loafer: a slip-on style with an apron front on to which the vamp is stitched; the seam does not stretch, and thus can traumatize prominent toe joints
Sandal: a shoe with a cut-away upper
Court shoe/pump: close-fitting, thin-soled, slip-on shoes, often made for women, with a high-heeled style
Sports shoes/trainers: shoes that are designed to incorporate features that protect the foot from the trauma incurred by heavy exercise
Monk shoe: an Oxford or Derby-style shoe, where the medial quarter is extended to overlap the lateral quarter, with a side buckle or Velcro fixing
Boots: footwear that extend proximally to just below the malleoli, to cover the malleoli, or as far as the knee

MTPJ, metatarsophalangeal joint.

Table 3: Comparison of UK, US and continental adult shoe sizes
• UK: There is a 8.5-mm difference in the length of the shoe between each full shoe size, and a half-size difference adds 4.25 mm to the length; children's shoes are sized from 0 (102mm long) to 13; adult shoes are sized from 1 (8.5mm longer than a child's size 13) to 13
• USA: There is a 8.5-mm difference in the length of the shoe between each full shoe size, and a half-size difference adds 4.25 mm to the length; shoe sizes are based on a child's size 0 of 100 mm long (that is, 1/12-inch shorter than the UK size 0; women's shoes are marked up 1.5 sizes greater than the UK length equivalent, and men's by 1 size greater than the UK equivalent)
• Continental: The length difference between each full size is 6.6 mm, known as the Paris point, with 3 Paris points in each 2 cm of shoe length
UK (men and women)USA (women)USA (men)Continental (men and women)

Patient discussion about last

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Q. how long dose costochondritis last

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Q. My son is ADHD and was diagnosed with ADHD last month? Are ADHD medications helpful? My son is ADHD and was diagnosed with ADHD last month. He is now 8 years old. He is taking medicines with behavior therapy. I haven’t found any improvement as yet. How long does it take for him to become normal?

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