Joe Nimble

The science of foot dysfunction and cure part 4 – pressure patterns.

“A compromised foot structure is a major perpetuating factor in chronic musculoskeletal pain throughout the body” 

(Janet Travell, 1993)


Parts one to three of this series highlighted that structural deformities of the forefoot (shoe-shaped feet) are common (Nix et al., 2010) and are caused by time in shoe-shaped shoes (Munteanu et al., 2017), and that structurally compromised feet are unstable and either roll in or roll out when loaded with bodyweight (Yavuz et al., 2009; Chou et al., 2009; Plank, 1995). The final post of this series will show how a simple footprint, and the pressure patterns it captures, can reveal both functional issues and the compromised forefoot structure that causes them.

Footprint of the ‘decompensated’ shoe-shaped foot.

Characterised by a shoe-shaped forefoot structure, the ‘roll in’ function is revealed as high pressure on the medial border of the first metatarsal head and big toe (Doxey, 1985, fig 5).


Footprint of the ‘compensated’ shoe-shaped foot.

Characterised by a shoe-shaped forefoot structure, the ‘roll out’ function is revealed as high-pressure on the lateral and medial metatarsal heads (Doxey, 1985, fig 5).


Those with the first footprint commonly suffer knee injuries, those with the second suffer stress fractures and ankle sprains (Williams, McClay and Hamill, 2001). Trigger point pain in the lower legs, upper legs, hips and even the torso head and neck are also common as the body strives to compensate for the unstable foot (Travell and Simons, 1993).

To restore stable foot function, forefoot structure must be restored. Fortunately, the plasticity that permitted development of shoe-shaped feet also permits restoration of foot structure and therefore foot function (Knowles, 1953). The cure is simple:


1. Wear foot-shaped (functional) shoes with space for the toes to spread and the foot to widen and flatten and;

2. Load the feet with body weight creating the force to stimulate restoration of foot shape and function.


Joe Nimble® functional footwear is based on these concepts and this science.



Chou S, Cheng HK, Chen J, Ju Y, Wong MA: The role of the great toe in balance performance. Journal of Orthopaedic Research. 2009; 27:549-54.

Doxey, GE: Management of metatarsalgia with foot orthotics. The Journal of Orthopaedic and Sports Physical Therapy. 1985; 6(6): 324-333.

Knowles, FW: Effects of shoes on foot form: An anatomical experiment. Medical Journal of Australia. 1953; 1: 579-581.

Munteanu SE, Menz HB, Wark JD, Christie JJ, Scurrah KJ, Bui M, Erbas B, Hopper JL, Wluka AE: Hallux valgus, by nature or nurture? A twin study. Arthritis Care & Research. 2017; 69: 1421-1428.

Nix S, Smith M, Vicenzino B: Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. Journal of Foot & Ankle Research. 2010;3:21.

Plank M: The pattern of forefoot pressure distribution in hallux valgus. The Foot. 1995; 5(1):8-14.

Travell JG & Simons DG. Myofascial Pain and Dysfunction:The Trigger Point Manual. Baltimore: Lippincott Williams & Wilkins; 1993.

Williams, DS, McClay, IS, Hamill, J: Arch structure and injury patterns in runners. Clinical Biomechanics. 2001; 16: 314-347.

Yavuz M, Hetherington VJ, Botek G, Hirschman GB, Bardsley L, Davis BL: Forefoot plantar shear stress distribution in hallux valgus patients. Gait and Posture. 2009; 30(2):257-9.


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