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Application for Grant-in-Aid of Ad-hoc research project submitted to MUHS Nashik

1.  Title of the project: Creating Community awareness regarding footwear by knowing

footwear choices of young people -A pilot study

2.  Name of Investigators:

i)  Dr.RonikaAgrawal, principal M.A. Rangoonwala College ofPhysiotherapy,2390-B,

K. B. Hidyahillah Road,Azam campus, Pune, India

ii)  Mr. Siddhartha D.Mourya, Student 3rd Year, M.A. Rangoonwala College

ofPhysiotherapy,2390-B, K. B. Hidyahillah Road,Azam campus, Pune, India 

3. 

Introduction:The foot is a complex structure of 26 bones and 33 joints, layered with an intertwining web

of more than 120 muscles, ligaments, and nerves.The foot serves the important functions like

supporting weight,acting as a shock absorber, serving as a lever to propel the leg forward

and helps in maintaining balance by adjusting the body to uneven surfaces.Foot injuries can

be difficult to properly diagnose and treat. Bearing the weight of the entire body, the foot is

under tremendous stress. The foot absorbs tremendous shearing and loading forces,

sometimes reaching over 20 times the person's body weight. Individuals having high arch

and low arch should wear appropriate footwear as high arch can causes lower back pain,

possible tendency to lower limb injuries.

Low arch can often cause pain or discomfort in the following three stages:

  Pain and weakness in the tendon

  The arch flattens but is still flexible

  The foot becomes rigid and possibly painful at the ankle. Sometimes people

report fatigue, pain, or stiffness in the feet, legs, and lower back 

Nearly all cases of foot pain can be attributed to one of the following:ill-fitting shoes, high-

impact exercise and certain medical conditions.

Inappropriate kind of footwear or devices have been shown to be significantly associated with

various pains. Prolonged or continued using of appropriate kind of footwear lead to severe pain

and even abnormalities in the joints and muscles. Often it is ignored or not noticed or recognized.

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Such risk is considered very high in elderly people; however, women are at higher risk then men

for severe foot pain, probably because of high-heeled shoes. Some people have cosmetic surgery

done to fit into high-heeled shoes.

Purpose: Comfort or proper fit of the shoe does not come as priority when young people make

footwear purchases .They go by the design and brand value of the shoe. Very few studies

regarding this have been done in Indian scenario.

Need for study:

People suffer with minor medical conditions, which in certain cases extend to level, which

requires medical attention. This study would provide information regarding percentage of people

from society whether they have awareness about using appropriate kind of footwear or devices.

Thus obtained information can be utilized for long-term study in a wider range of people,

whichcan provide development of community awareness program for formulating better

prevention strategy. 

4.  Aims:

To create community awareness regarding footwear by knowing the footwear choices of 

young people

5.  Objectives:

o  To assess the level of awareness of using appropriate footwear

o  To asses impact of pamphlets about appropriate foot wear choices

6.  Review of literature

1) Branthwaite H.et al (2012) has stated that "Modern footwear has been associated with the

development of foot pain and pathology in the ageing adult. Yet this foot health issue does

not seem to alter the footwear purchases made by younger women. In total, 162 teenage girls

were questioned regarding shoes purchased over a 6-month period".

The results indicated that footwear choices are activity specific and participants chose the

style and design of shoes related to the image they wanted to portray. Association of 

footwear choice to foot function and health was not found to influence choice of footwear.

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2) Sara Muller et al, (2012), Robert JB et al, (1998), mentioned in their studies that running

shoes are designed to accommodate various arch types to reduce the risk of lower extremity

injuries sustained during running. Yet little is known about the biomechanical changes of 

running in the recommended footwear that may allow for a reduction in injuries. It is

speculated whether the awareness in people and knowledge of shoe sellers can help in many

situations to avoid possible conditions by wearing improper shoes.

3) YI-Wen Chang et al (2010) did a study to measure foot arch in standing ,level walking

,vertical jump &sprint start twenty three healthy subjects were recruited in this study.

Significant difference between non-weight bearing condition and standing were found on

arch height , arch angle and arch index . Arch height was gradually decreased in loading

phase but suddenly increased in push  – off phase during level walking ,vertical jump and

sprint start .vertical jump and sprint start require significantly greater ranges of arch height

change than level walking. The finding of this study can be interpreted in the field of 

orthopedics and sports footwear design.

4) ShupingXiong et al (2010) did research on the right feet of 48 healthy individual(24 men

and 24 women )were measured ,and various metrics ,including the arch height index ,the

navicular height to arch length ratio ,the arch index ,the footprint index ,subjective ranking

,the modified arch index ,the malleolar valgus index ,and the mid dorsal angle were

determined .Correlation analyses result showed that the arch index obtained from inked foot

measure has a moderate to high correlation .

Study concludes that the midfoot dorsal angle may be appropriate metric for characterizing

the foot arch because it is quick and easy to measure, without the tedious procedure

associated with area calculation and dimension measurement

6) MU¨ Ndermann, et al (2001).Studied the relationship between footwear comfort of shoe

inserts and anthropometric and sensory factors. They concluded that Shoe inserts of different

shape and material that are comfortable are able to decrease injury frequency. They also

showed that subject specific characteristics influence comfort perception of shoe inserts.

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7) Robert J. Butler, Irene S. Davis and Joseph Hamill (1998) conducted a research on interaction

of arch type &footwear on running mechanics. Purpose of study was to evaluate effect of motion

control and cushion trainer shoes on running mechanics in low and high arch runners.Twenty

high arched and 20 low  – arch recreational runners (>10miles per week) were recruited for

study.Three dimensional kinematic and kinetics were collected as subject ran at 3.5 ms-1}5%

along a 25m runway.

A significant interaction was observed in the instantaneous loading rate such that the low  – 

arched runner had a lower instantaneous loading rate in the motion control condition and the

high arched runners had a lower instantaneous loading rate in the cushion trainer condition.

Significant main effect of shoe were observed for peak positive tibial acceleration,peak to peak 

tibial acceleration, mean loading rate, peak eversion and eversion excursion

These result suggest that motion control shoes control rear foot motion better than cushion

trainer shoes.

8) Finestoneet al., (1992). conducted a prospective study of the effect of the appropriateness of 

foot-shoe fit and training shoe type in the incidence of overuse injuries among infantry recruits it

was found that three shoe widths for each shoe length size were necessary to adequately

accommodate the recruit population's foot anatomy. Recruits compensated for the lack of 

available shoe widths by choosing larger shoe sizes. However, this compensation did not result

in an increase in the incidence of overuse injuries. Recruits who trained in basketball shoes had a

lower incidence of overuse injuries of the feet than recruits who trained in infantry boots, but the

overall incidence of overuse injuries was the same in both groups.

7) Methodology:

Study design :observational analytical study

Sample size :200

Sample technique :random sampling

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Questionnaire: A questionnaire has been designed keeping in mind regarding footwear choices.

Subjects will be asked to fill this questionnaire .All the participants will be given consent form

prior to filling the questionnaire

After filling the questionnaire the participant will be made aware by giving well designed

pamphlet which will be containing information regarding health problem due to inappropriate

footwear and before buying footwear what all aspect should be taken in account, then again they

will be given questionnaire to check if awareness has been created regarding right footwear

Materials used – pen, paper, consent letter and questionnaire

Inclusion criteria -Age group 18-28 years

-Normal individuals

-Both males and females

-Willing to participate

Exclusion criteria- Medical students and physiotherapy students.

8) Expected outcome

The information obtained, would be utilized for long-term study in a wider range of people,

which would provide development of community awareness program for formulating better

prevention strategy of foot pain

9) Results: Statistical Analysis of data will be done using SPSS version 13.

10) Bibliography

Branthwaite H, Chockalingam N, Jones M, Grogan S. Staffordshire University,

Footwear choices made by young women and their potential impact on foot health.J Health

Psychol. 2012

Anne Mu¨ Ndermann, Darren J. Stefanyshyn, and Benno M. Nigg.Relationship between

footwear comfort of shoe inserts and anthropometric and sensory factors.Medicine & Science in

Sports & Exercise. 2001: 1935-45. 0195-9131/01/3311-1939/ 

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Basford , J. R., and M. A. Smith.Shoe insoles in the workplace. Orthopaedics 11:285 – 288,

1998.

ShupingXiong, Ravindra S. Goonetilleke, Channa P. Witana, Thilina W. Weerasinghe, Emily

Vim Lee Au. Foot Arch Characterization: A Review, a New Metric, and a Comparison. J Am

Podiatr Med Assoc 100(1): 14-24, 2010

YI-Wen Chang, Wei Hung, Hong Kong, Yen-Chen Chiu, HOrng-Chaung H Measurement of 

Foot Arch in standing, Level Walking, Vertical Jump and Sprint Start. Journal of department of 

exercise and health science ,national Taiwan college of physical education ,Taichung Taiwan

,404,R.O.C 28 june 2010

Orendurff MS, Rohr ES, Segal AD, Medley JW, Green JR 3rd, Kadel NJ. Regional foot pressure

during running, jumping, and landing.Am Journal Sports Med. 2008 Mar; 36(3):566-71. Epub

2007

Robert J. Butler, Irene S. Davis, and Joseph Hamill.Interaction of Arch Type and Footwear on

Running Mechanics. Am. J. Sports Med. 2006; 34; 1998

Sara Muller and Edward Roddy.A Rasch Analysis of the Manchester Foot Pain and Disability

Index.Online :http:/www.jfootanklers.com/content/2/1/29

Chen H, Nigg B M, and Koning J D. Relationship between plantar pressure distribution under

the foot and insole comfort. Clin.Biomech. 9:335 – 341, 1994.

Cowan D. N., B. H. Jones, And J. R. Robinson. Foot morphologic characteristics and risk of 

exercise-related injury. Arch. Fam. Med. 2:773 – 777, 1993.

Fauno, P., S. Ka Lund, I. Andreasen, and U. Jorgensen. Soreness in lower extremities and

back is reduced by use of shock absorbing heel inserts. Int. J. Sports Med. 14:288  – 290,

1993.

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Finestone, A., N. Shlamkovitch, A. Eldad, A. Karp, and C. Milgrom.A prospective study of 

the effect of the appropriateness of foot-shoe fit and training shoe type in the incidence of 

overuse injuries among infantry recruits.Mil. Med. 157:489 – 490, 1992.

Gardner, L. I., J. E. Dziados, B. H. Jones, et al. Prevention of lower extremity stress

fractures: A controlled trial of a shock absorbent insole. Am. J. Public Health 78:1563 – 1567,

1988.

Hennig, E. M., G. A. Valiant, and Q. Liu.Biomechanical variable and the perception of 

cushioning for running in various types of footwear. J. Appl. Biomech. 12:143 – 150, 1996

Tentative budget for research- Rs 25000

Appendix 1 Questionnaire-pre awareness

Questionnaire-post awareness

Appendix 2: :(pamphlet) - Medical conditions caused due to improper footwear

- Factors to consider before buying footwear

Appendix 3: Consent form

==========================================================

Appendix 1: Medical conditions caused due to improper footwear 

1) Plantar fasciitis is a foot condition in which inflammation is brought on by too much

stretching taking place of the plantar fascia, which is the tissue that extends the full length of the

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foot bottom. Plantar fasciitis can lead to other problems such as heel spurs, arch pain

andexcessive heel pain

2) Bunions, another common foot condition, are a very obvious bump that forms on the inside of 

the foot around the joint of the big toe. Corns are a build up of dead skin cells that are made

worse by the rubbing of ill fitting shoes. Corns are usually found on the toes, the top or sides, and

they form a thick hardened spot that contains a cone shaped middle, which exposes the nerve and

causes pain discomfort (wearing pointed toe shoe)

3) Morton's neuroma metatarsalgia is a condition that causes inflammation in the metatarsal

region of the foot (the area right before the toes or the ball of the foot). This condition causes

bones to squeeze a nerve between the 3rd and 4th metatarsal head

4) Hammertoes can occur in any of the big toes with the exception of the big one. In both

hammertoes and claw toes a toe is raised higher than it should be and this leads to a great deal of 

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pressure and pain. An ingrown toenail takes places when a toenail grows directly into the skin or

else it grows over the side of the toenail causing a great deal of pain.

5) Heel Pain: The heel is the largest bone in the foot. Heel pain is the most common foot problem

and affects 2 million Americans every year. It can occur in the front, back, or bottom of the heel.

Types of heel pain include:

  Achilles tendinitis

  Bursitis of the heel

  Excess pronation

  Haglund's deformity

  Heel spur syndrome

  Plantar fasciitis

Due to wearing flat heel shoe

5) Forefoot Pain: Forefoot pain refers to pain and discomfort felt toward the top of the foot. The

rate of forefoot pain and deformity increases with age. When a cause cannot be determined, any

pain on the ball of the foot is generally referred to as metatarsalgia.

Forefoot pain may be due to:(high heel)

  Morton's neuroma

  Sesamoiditis

  Stress fractures

High Heel Shoes: High heeled shoes can predispose the foot and the body to many different

imbalances as opposed to a flat shoe. Any elevated heel under a shoe automatically initiates an

altered series of foot and body biomechanics. Standing barefoot, the falling line of body weight

normally forms a perpendicular angle with floor. The body weight is distributed 50-50 between

the heel and the forefoot. The moment any heel elevation, even the most minimal, is applied to

the shoe, the normal 90 degree perpendicular of body weight is altered. The higher the heel the

greater the body column changes. The heel on a man's shoe is about one inch in height. On

women's shoe it varies from one to five inches and up to six inches in more extreme footwear.

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Pain in the ball of the foot region leading to a bursitis of the joints in the ball of the foot result

from the added pressure due to the elevated heel. Instead of 50% of the body weight in the heel

and 50% in the ball of the foot, with an elevation in the heel 90% of the body weight is now

concentrated in the ball of the foot and 10% in the heel. High heeled shoes prolonged and

extensive use can lead to many disabling deformities ranging from low back pain to the foot

pain.

Shoes and Sneakers: Shoes are an important part of you clothing, comfort and fashion. Selecting

the appropriated shoe for a specific activity and having it fit properly are the key elements for

comfort, function and safety.

==========================================================

Factors to consider before buying shoes

Choosing 'Healthy' Shoes

.

• Ideally, heels should be no more that 1 inch in height.

• The toe box must be sufficiently tall and wide to allow the front part of your foot to

sit comfortably in the shoe without being jammed into the toe box material of the

shoe.

• The shoes should be roomy enough to allow your foot to, assume its natural shape

without being compressed.

• The heel of the shoe should cradle the heel of the foot so that your heel doesn't ride

up and down as you walk, causing friction and calluses.

• Materials in the heels and soles should not easily compress when you walk- rubber

heels and leather soles are best, Real leather allows your feet to breath .Fake leather and

synthetic material can lead to excessive sweating and fungal infection in the nails, skin

Questionnaire

Personal Information Sheet number

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Name : Sex: M

F

Date of Birth :

Mobile no/other:

Define basic type of footwear you wear (Tick on the following

image)

Do you have pain in your foot/ankle? Yes No

Are you aware of foot problem caused due to

wearing ill-appropriate footwear

Yes No

Please indicate the average daily

pain you feel, from 0 to 10.

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Have you ever felt pain in foot

only due to wearing footwear

Yes No

Which type of 

footwear do you

like to wear?

Slippers Sport shoes High heels Sandals Office

shoes

Oth

Which feature is the mostimportant to you when buying

shoes?(can choose more than one)

Brand Design Style Price Proper Fit Com

How many times per year do you

purchase shoes?

0-1 2-3 4-5 >6

How much time does it take to

look for the shoes you want?15 minutes 30 minutes 1 hour 2 hours

Do you change size of thefootwear for improved comfort

fitting

Yes No Do you wear activity specificfootwear like office shoe for of

,sports shoe for sports etc

From where do you purchase

footwearInternet shopping

sites

Going to stores Yes No

Do you use or buy the shoe with

modification?Yes No

Chose shoe inserttype  1 2 3 4 5 6 7(witho

any

modifi

n)

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Questionnaire 2(after creating awareness by

distributing pamphlet)

Which factors will you consider

before buying foot wear

Brand Designer

features

Price Proper

fit

comfo

After reading pamphlet are you aware of health

problems due to inappropriate footwear

Yes No

Now how much time will you spend before

purchasing footwear

(For proper comfort and fit)

15 min 30 min 45 min 1hr

Will you now change the size of the footwearFor improved comfort, fitting

Yes No

Will you consider all the aspects given in

pamphlet before purchasing footwear

(footwear width ,heel height,etc)

Yes No

What material is used in the shoe

insert?Silicone Soft leather Silicone

gel + air

Do n

kno

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CONSENT FORM

I, __________________________________________, age, _____years

Consent to be the subject in this research study. I have read the ‘Consent Form’ and understand

the consequences associated with participation. I have had the procedure explain to me & the

investigator has answered my question concerning the procedure involved in this study. I also

agree that the results of this research study can be used for presentation purpose on the

understanding that anonymity will be fully preserved.

Signature of the subject :____________________________________

Signature of the investigator:

Signature of witness :