Assessing And Understanding The Impact Of The Shoe Upper

Having a better understanding of the anatomy of a shoe can be helpful in advising patients on shoewear, particularly when there is foot deformity or irritation from shoes. With this in mind, let us take a closer look at the upper of a shoe.

Toe box. Conditions that require a deep toe box include hammertoes and hallux extensus. Reaching inside the toe box and feeling wear from any of the toes is a good indication that your patient’s toe box should be deeper. Soft leather and mesh toe boxes are helpful options for proximal interphalangeal joint (PIPJ) callus formation due to rigid hammertoes.

Vamp. This part of the shoe covers the arch and offers a bridge between the toe box and the opening of the shoe or topline. You want the vamp of the shoe to fit snugly. If this is too loose, heel slippage occurs and causes blisters. If it is too tight, compression occurs and this can contribute to neuroma formation and bunion pain.

Counter. The counter is the back part of the upper, which wraps around either side of the heel. The counter can be soft (collapsible) or stiff (non-collapsible).

Soft counters help if there is a Haglund’s deformity or retrocalcaneal bursae. Stiff counters are helpful if your patient has excessive rearfoot pronation that has led to pathology including plantar fasciitis, Achilles tendonitis, posterior tibial tendonitis and peroneal tendonitis. A firm heel counter can also help with patellofemoral syndrome and iliotibial band syndrome, especially if this is due to genu valgum.

In the next blog, I will discuss the lower half of the shoe.