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The contribution of incorrectly fitting footwear to the development of foot pain and deformity has been citied as an etiologic factor but is something that has not been fully evaluated. We examined the relationship between footwear characteristics and the prevalence of common forefoot problems in patients attending foot clinic.

Methods: Prospective study measuring shoe size (width & Length) and foot measurements in 50 patients attending foot clinic with foot problems. Comparison made with 50 random people with no foot complaints. Deformities, medical histories and pain scores were documented.

Results: Clinic patients: Mean age 49 range(19–68). 12 male 38 female. 21 out of 50 wearing shoes half a shoe size too small, 7 patients wearing shoes half a shoe size larger. 32 patients wearing shoes narrower than feet mean 6mm (range 2–9mm.) Deformities: 27 hallux valgus, 3 bunionette, 6 hammertoes, 5 callosities. Mean pain VAS 5 range (3–10). 11 patients were diabetic, 6 had peripheral vascular disease.

Random patients: Mean age 41 range(19–65). 19 male 31 female. 7 out of 50 wearing shoes half a size smaller, 13 wearing shoes half a size larger, 15 wearing shoes narrower than feet mean 4 mm (range 2–7mm). Deformities: 6 hallux valgus, 3 hammer toes, 8 callosities. Mean pain VAS 1 (1–3). 8 people were diabetic.

Conclusion: A large proportion of patients attending foot clinic wore ill-fitting shoes. Women wore shoes that were shorter and narrower compared to their feet than men. Wearing shoes smaller and narrower than the feet was associated with hammer toes, hallux valgus deformity and foot pain. Incorrectly fitting footwear may be a significant contributing factor associated with forefoot pathology and foot pain. These findings highlight the need for footwear assessment in the management of foot problems.

Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.