out-sole

out-sole

non-slip, very-hard-wearing outer part of the shoe sole (see Table 1); outsole wear marks inform diagnosis as they indicate foot function and reflect pathomechanical stresses (see Table 2 and Figure 1)
Table 1: Parts of a shoe
PartFeatures
The upperThat part of the shoe that covers and encloses the dorsal, medial, lateral and posterior aspects of the foot
The upper may be made from a single piece of material, or from a number of shaped elements, including:
Toe boxThe space at the distal limit of the shoe
Toe puffThe stiffener that lines and maintains the shape of the toe box
Toe capAn additional layer of upper material that overlies the toe box
VampThe part of the upper immediately overlaying the dorsum of the MTPJs (the part of the upper subjected to maximum flexing)
TongueThe shaped strip of upper that lies between and under the facings and overlies the dorsum of the metatarsals and tarsus
QuartersThe close-fitting part of the shoe that encloses the medial and lateral aspects of the tarsus and heel and the posterior heel area
Heel counterShaped stiffeners that maintain the contour of the heel of the shoe
BackstayA strip of material that overlies the back seam that joins the quarters at the posterior heel
SoleThat part of the shoe that covers and encloses the plantar aspect of the foot
The sole is made of hard-wearing materials that both cushion and protect the foot
InsoleThe innermost part of the sole on which the foot rests, often cushioned
ShankA metal strip extending from the middle of the heel to the tarsus
Bottom fillingsInfill material used to level out the space between the insole and the outsole where the shank is positioned (not including where the outsole is directly moulded to the upper)
WeltA strip of leather stitched between the upper and the outsole
OutsoleThe part of the shoe in direct contact with ground surface, made of a material that withstands hard wear, shock-absorbs and aids traction
HeelLifts added to the area of the outsole area that lies under the rearfoot

MTPJ, metatarsophalangeal joint.

Table 2: Diagnosis of foot function from shoe wear marks
WearmarkCharacteristics
Normal wear Outsole and heel
Posterolateral heel wear
Heavier wear across sole at treadline, especially at 1 and 2 MTPJs
Heavier wear distal to 1 MTPJ due to hallux toe off
Insole/insock
Uniform discoloration of heel seat
Lateral discoloration at waist (corresponding to lateral midsole)
Distal discoloration due to toe pulps, 1cm from end of insole
Lining of upper
Even discoloration of posterior, medial and lateral areas of quarters
No unevenness of wear due to foot moving within shoe
No indentation or wear at lining of toe puff
Upper
No part of the upper should overhang the sole or welt
No distortion of the upper
Shallow, oblique crease corresponding to metatarsal formula and the treadline of the outsole
Symmetrical quarters
Hallux limitus/rigidus Outsole and heel
Excessive posterolateral heel wear
Excessive wear and/or spin wear marks under 2 and 5 MTPJs secondary to abductory twist
Minimal wear under 1 MTPJ but greater wear under IPJ hallux
Reduced toe spring Insole/insock
Discoloration of lateral heel seat
Heavy discoloration and wear below 2 and 5 MTPJs
Minimal discoloration and wear below 1 MTPJ
Discoloration and wear at distal phalanx of hallux
Lining of upper
Discoloration of lateral area of quarters
Excess wear of lateral vamp area in 5 MTPJ area
Excess wear of medial dorsal vamp at 1 MTPJ consistent with osteophyte formation at 1 MTPJ
Upper
Bulging of upper at the lateral/posterior quarters in the heel area
Bulging of lateral vamp over the outsole consistent with prolonged rearfoot inversion
Increased obliquity of transverse crease
Dorsal bulging of vamp in area of 1 MTPJ
Lateral drift of throat of shoe and distal drift of lateral facing in relation to medial facing
Pes cavus Outsole and heel
Excessive posterior (transverse) heel wear
Excessive wear at treadline
Minimal wear proximal and distal to treadline
Exaggerated toe spring
Insole/insock
Heavy discoloration and wear of heel seat
Heavy discoloration and wear below 1 and 5 MTPJs
Discoloration and wear at pulps of toes, due to clawing
Lining of upper
Discoloration of medial, lateral and posterior areas of quarters
Wear of tongue lining
Wear of lining of upper toe box due to retracted toes
Upper
Bulging of upper at the posterior quarters in the heel area
Wear of upper margin of back stay
Bulging/stretching of anterior quarters due to tarsal 'humping'
Facings diverge proximally
Deep transverse crease
Dorsal bulging of vamp over toes
Pes planovalgus Outsole and heel
Posterolateral heel wear
Anterior medial heel wear
Collapse of shoe waist (shank may break)
Excessive wear under 2, 3 and 4 MTPJs
Excessive wear along distal medial area of sole
Insole/insock
Excessive wear under 2, 3 and 4 MTPJs
Excessive wear at medial waist area
Excessive wear at 3, 4 and 5 toe pulps
Lining of upper
Discoloration of medial, lateral and posterior areas of quarters
Excess wear of medial toe box area
Upper
Bulging of upper at the medial, lateral/posterior quarters in the heel area
Bulging of medial quarter over outsole
Shallow transverse crease
Medial bulging of vamp in area of 1 MTPJ if hallux abductovalgus is present
Bulging of lateral toe box secondary to clawing of lesser toes
Medial drift of throat of shoe and distal drift of medial facing in relation to lateral facing

Note: Wear marks are always less marked in shoes made of synthetic materials.

MTPJ, metatarsophalangeal joint; IPJ, interphalangeal joint.

Figure 1: Shoe wear marks seen in cases of (A) chronic hallux limitus; (B) pes cavus; (C) pes plano valgus seeTable S5. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006).
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