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Basic Shoe Anatomy. The components of the footwear are important to aid in the selection of the shoes to most benefit the patient. . With Shoes the Last Comes First.

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basic shoe anatomy
Basic Shoe Anatomy

The components of the footwear are important to aid in the selection of the shoes to most benefit the patient.

with shoes the last comes first
With Shoes the Last Comes First

Shoes are made over a “last.” The last is the generic foot model produced to the specifications of the manufacturer. The last determines the shape and profile of the shoe. A variety of measurements are taken into consideration beyond the ones we are able to measure including waist, ball, instep girth, throat opening and the last break point.

basic shoe anatomy3
Basic Shoe Anatomy

top line

padded collar







  • Uppers
  • portion of the shoe that covers the top of the foot
  • includes vamp, tongue, quarters, etc.
  • area that is seen.

Uppers before attached to sole. This material is lycra.

uppers vamp
  • Vamp
  • covers the toes and a portion of the instep
  • the front portion of the shoe
  • All closed toe shoes have a vamp


uppers quarter
  • Quarter
  • The back portion of a shoe or boot
  • Meets the vamp to form a majority of the uppers


uppers tongue
  • Tongue
  • Several types of tongues
  • Can protect from debris
  • Sewn in shoe or as one with the vamp

The apron tongue or kiltie are popular on golf shoes and help keep grass out.

This tongue is one with the vamp.

The bellows tongue is a stitched-in tongue, giving protection from the elements and the ingress of debris.

balmoral bal
Balmoral (Bal)
  • A type of shoe where the tongue is stitched at the throat of the vamp.
  • Although sometimes more appealing and stylish, this particular opening does not offer much adjustability in fit or fluctuation for the foot.
  • The quarters overlap the vamp
  • Creates a wider opening shoe
  • Makes donning and doffing easier
  • Often prescribed for patients with limited dorsiflexion or flexibility and/or internal braces

Heel foxing

goes over the quarter; sometimes will have perforations or a different color creating a two tone shoe.

Foxing can also be over the quarters or the quarters can be cut away and the foxing in its place.

shoe anatomy
Shoe Anatomy

Achilles notch-area usually found in athletic shoes which accommodates for the Achilles tendon.

shoe anatomy13
Shoe Anatomy

Toe caps normally go over the vamp, but the vamp can be cut away and the toe cap in place of it.

shoe anatomy14
Shoe Anatomy

Saddles are the materials that go over the instep. A saddle can be the same color as the shoe but it is normally a contrasting color.

internal stiffeners
Internal Stiffeners
  • Counter
  • Located in the heel area
  • Retains the shape of the shoe
  • Also provides additional stability, especially when extended
  • Toe Box
  • The stiffener in the toe of the shoe
  • Retains the shape of the shoe
  • Provides protection for the toes
internal stiffener
Internal Stiffener
  • Shankpiece
  • The center section or “bridge” between the sole and the front of the shoe
  • Found between outsole and insole
  • Mild spring effect on weight bearing
  • Can be made of wood, plastic, nylon, steel or other materials
  • Sole-
  • Bottom portion of the shoe
  • Sole includes outsole, midsole and insole
  • Usually made from a durable material, such as, rubber or leather

Sole thickness is measured in “irons.”

One iron equals 1/48th inch.

A sole that measures 12 irons is ¼ inch thick.

  • Outsole
  • Portion of the sole which comes into contact with the ground
  • Provides traction and can be made with rockers or rollers.
  • Variety of functional properties, such as, flexibility, durability, traction, insulation, and dimensional stability
  • Midsole
  • Additional soling placed between outsole and insole.
  • Are common in wingtip shoes, work boots and athletic shoes.
  • Used to give the shoe more heft or a sturdier, more rugged look
  • Insole
  • “Hidden components of the shoe”
  • Attaches to the outsole, vamp and quarter—anchors the shoe together
  • Different from an insert
shoe anatomy21
Shoe Anatomy

Insoles vs. inlays

The insole is glued, stapled or sewn into place in a shoe.

The inlay goes on top of the insole and is removable.

The inlay will be the portion which comes into contact with the foot.

The inlay will be removed in a diabetic shoe and replaced with an insert.

An insert can accommodate or assist with correcting during ambulation.

shoe anatomy22
Shoe Anatomy


Identifying the anatomy of the shoe using a non-therapeutic shoe.






Top lift

rocker sole
Rocker Sole

This therapeutic shoe has a mild rocker sole which promotes proper gait.

Toe Spring

rocker sole24
Rocker Sole

More severe forefoot rocker sole.

shoe tests
Shoe Tests

Three tests can be done to check the stability of shoes:

Flex Test—by pushing down on the shoe, the breakpoint, should be firm but not provide significant resistance. The breakpoint of the shoe is under the met heads.

Torsion Test—by twisting the shoe in opposite directions, this will check the stability of the soling. If the shoe twists over on itself, inadequate support.

Counter Test—by grasping the heel of the shoe, apply pressure to the heel counter with you finger. If the counter collapses with little/no resistance, the shoe is not supporting the heel.

the final shoe test
The Final Shoe Test

Don’t forget Style and Comfort

Style—If the shoes are accommodating AND appealing, the patient is more apt to wear the shoes.

Comfort—it also does not matter how many tests it passes, if the shoe is not comfortable, then nobody will wear them.

shoe modifications
Shoe modifications

Shoes can be modified to assist with additional disorders of the foot besides diabetes.

Leg Length discrepancies may require a sole lift.

Any internal or external shoe modifications should be referrred to a C.Ped., orthotist or Podiatrist.

shoe modifications28
Shoe modifications

A Ball & Ring stretcher is used is used to provide relief in a specific spot on a shoe. Most often times used with bunions.

shoe modifications29
Shoe Modifications

Shoe stretchers or “shoe trees” can be used to stretch the overall width of a shoe. Additionally, these stretchers can reduce tension in specific areas, such as, where a bunion occurs.

minor shoe modifications
Minor Shoe Modifications

Tongue pads-Prevents heel slippage by making your foot more snug in your shoe. Self adhesive.

Insert spacer-used primarily in case of edema; also can be used with different garments.