Fig. 45g2. Principle VII – The toes. b) To obtain a square type foot.
1. An Egyptian type foot remaining may result in recurrence of deformity or in longitudinal overpressure notably in the MTP joint. However a slight excess of the grant toe length is well tolerated.
2. A Greek type foot is not well tolerated if a second hammertoe deformity previously exists.
3. So we have to obtain a square type foot which is the best tolerated by footwear (above all by ladies footwear).
hallux valgus is more difficult to treat, thirdly because the second toe excessive length is often accompanied by the corresponding metatarsal excess of length.
– Square type foot: The security is to reach a square type foot, which is not only an elegant foot, but also very well tolerated regarding the footwear.
This introduces the eighth and last principle.
Eighth Principle
Obtain a foot which fits to elegant shoes
The eighth principle is to obtain a foot which fits to elegant shoes (Fig. 45h1-2-3-4-5).
First, a few words about my experience as a
“shoemaker”. Since 1981, I have studied feminine shoes with designers and also technicians and last manufacturers. From 1985 to 1995 I was additio- nally a shoemaker. I made myself the lasts, trying to combine comfort and elegance. Twice a year, I launched a collection “Spring/Summer” and
“Autumn/Winter”. It was a very exciting period in which I learned a lot of things about shoes, com- fort, fashion… and the foot. I wrote some papers on this subject [19]. Unfortunately a medical sur- geon is not a businessman and this period fini- shed in 1995. However, the same year, I met L. Piclet and Ph. Alberola, who created a society for medical and comfort shoes (Romans Industrie) which actually make the Type I heel support shoe, the Type II and at last some models of Type III which are good-looking.
376 Forefoot Reconstruction
Fig. 45h1. To obtain a foot which fits to elegant shoes. a) The conflicts forefoot/shoes 1.
1. “Doctor, I am coming because I cannot wear shoes any more!” This sentence is more used than “it hurts”
or “it is painful”. So that the forefoot surgery has to deal closely with the footwear.
2, 3. Problem: “What could I wear today?” (among dozen of shoes). In these ones I feel good! Finally her choice is old slippers…
4, 5. The resulting pressure on the forefoot, due to the first high heel shoes (court shoe) in France in the fifties, with the fashion designer Jacques Fath.
6, 7. I studied the compromise between the height of the heel and tolerable pressure on the forefoot: 5.8 cm is correct.
Regarding the shoes which were made 20 years ago, the general concept of shoes has changed: The lasts have been improved, as well as generally the comfort of the shoes, even if the high heel ladies shoes still remain, fortunately for the elegance.
Let’s come back to forefoot surgery and the eighth principle : “to obtain a foot which fits to
elegant shoes”. This is unusual when we read books about foot surgery. On the contrary, I emphasize this dimension: Certainly, we first have to obtain a painless foot, but 95% of our forefoot patients are women and they are more and more younger current, since they come ear- lier to surgery, thanks to the reliability of the current procedures. We just have to look at the
Fig. 45h2. To obtain a foot which fits to elegant shoes. a) The conflicts forefoot/shoes 2.
1. I performed a study on 1,300 women in 1985. Average rate of emerging conflicts with the shoes (c sh.) and emerging hallux valgus deformity (HV): Conflicts appeared as soon as the girls wear shoes. (At this time the footwear was more feminine than today.) Hallux valgus appeared in most cases around 15 years – so juvenile – but this was not painful, and the second pick was towards 50 years.
2. Study of average rate of conflicts foot / shoe. Note an average of 35% but we observe the three peaks: A small in the twenties, a more important in the thirties, and a big one from the fifties.
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Fig. 45h3. To obtain a foot which fits to elegant shoes. b1) My experience of shoemaker (1985/1995).
1, 2. Final works on the last, to add or to remove material in order to follow the good anatomy.tt 3. The width at the level 3/4 I found to be the most important for the toes.
4. A last and its sole.
5. The importance of the “axe d’emboîtage” (axis from the rear part of the sole). Where does it pass on the fore part?
6. The problem is to provide enough place for the toes while keeping narrow tip shoes.
7. Drawings sole studies.
8. This is the result of the sole study I made: With this sole, the problem is almost resolved, but we have to make a compromise with this and the shoe cosmetic appearance.
9. In a nutshell, the main schedule of conditions of the shoe line I devised during these years.
Fig. 45h4. Principle VIII – To obtain a foot which fits to elegant shoes. b2: my experience of shoemaker c) Some examples of the LSB shoes: Collection 1993.
1. The lasts used in 1993.
2, 3, 4. Some shoes of the collection Automne/Hiver 1992/1993.
5, 6. Some shoes of the collection Printemps/Été 1993.
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Fig. 45h5. Principle VIII – To obtain a foot which fits to elegant shoes. c) The corresponding surgery.
1. This operated foot is not compatible with usual women’s footwear: The great toe is too long and too large.
Too long the fourth and fifth toes.
2. This foot can fit to women shoe with a square type foot and no problem with the two last rays. We must obtain such a foot.
3. Example of foot for which we obtained a correct shape.
4. This test reproduces the forefoot aspect to be obtained. With the techniques we presented all along this book, we can do it.
5. One of our patient: 3.5 postoperative month. All our patients are not like her but this is what we would like to achieve everytime!
foot that must fit to elegant shoes to make the appropriate “forefoot reconstruction”.
So, coming back to the title of this book, we know that a house to be built must be comfor- table. It is better if this house is also elegant! In our present “petit guide” we give our patients on the first consultation, there is a picture of high heel and acute tip shoes. We say to our patients:
“We want to allow you to wear this shoe after surgery if you want and not to forbid it.”
So if we can offer to our feminine patients the opportunity to choose their shoes not only following the comfort but also following the cosmetic appearance and the fashion, I think we have fulfilled our goals in forefoot reconstruc- tion.
