I recently produced a video on The Lifetime Athlete YouTube Channel entitled Interpreting Shoe Wear. This quick lesson touched on some of the major areas in shoewear analysis that can assist clinicians and athletes alike in solving pain and performance problems.
Interpreting shoe wear patterns is extremely effective in supporting your other examination findings, such as postural assessment, gait analysis, and various table tests. This is especially valuable with runners but actually can be helpful for athletes in any shod, weight-bearing sport.
All you need for a good footwear exam is a pair of shoes that you or the athlete in your sights has worn for a while in the primary sporting activity. Shoes that are older and dirtier work best, because they will show the wear patterns more definitively.
Here are the main categories I went over in the video:
- Outsole Wear Patterns: Here we generally see two primary patterns, which are initial contact and toe-off. If a shoe is used for a lot of walking, initial contact will be a heel strike and the wear will be evident on the lateral heel of the shoe. With toe-off, we generally will see (in a desirable situation) the outsole worn down under the first metatarsal head (inside ball) and big toe. Lateral toe wear can suggest a condition of under-pronation, in which the athlete is not accessing his/her inside edge for maximum propulsive power at push-off.
- Midsole Compression: Ideally, we want to see some compression lines in the medial midsole near the first met head, which indicates optimal propulsive pressure distribution. If the medial midsole is compressed significantly near the heel, this can be indicative of excessive pronation (rate, amplitude, duration) issues.
- Heel Counter Breakdown: In the case of the heavy heel striker or severe (over?) pronator, the heel counter area in the shoe can actually deviate over the medial edge of the shoe. Newer shoes have less substantial heel counters than models from several decades ago, so this pattern is not uncommon.
- Upper Failures: Uppers are made of various fabrics these days, with leather not seen as much or often. While shoes are lighter here, they are generally less durable. Sometimes you’ll see a scuffing pattern around the ankle collar if one or both shoes is kicking the other they pass. This can suggest a narrow base of gait, potential weakness or stiffness up the chain, or a turned out toe off. None of these may be of great concern but if the pattern is exceptionally asymmetrical, further analysis is warranted. Big toes can rip out when the toe box is either too narrow (width) or shallow (height). Little (5th) toes tear through when the last (shoe shape) is too curved for the foot living in it.
- Sockliner Pressure Distribution: Probably the most telling of wear patterns, a sockliner or insole will actually behave as a long-term pressure or force plate, showing where the foot has been primarily loading over time. This takes some skill and practice to interpret, but usually you are looking for a line of pressure that emanates from the lateral midfoot and goes out through the 1st met head and big toe. Excess lateral or medial loading at various points in this distribution can correlate with other findings and point you in the right direction when trying to solve loading problems.
Those are some basic areas that I have learned to examine in athletes over the past 40 years of working in this capacity. If you’d like a few more details, or a visual, check out the video. If you are a PT, coach, or trainer looking to learn more about gait mechanics and shoe wear, schedule a Collegial Consultation with me. I’m always happy to provide mentorship opportunities for my colleagues. If you are an athlete or fitness enthusiast who wants some personalized assistance with this subject, snag a Coaching Consultation. Thank you for reading and have a wonderful day.