October 2014

Out on a limb: Fashion sense

1Limb-JordanaBy Jordana Bieze Foster

High fashion typically means bad news for lower extremity health. But that may be starting to change, and in ways that might surprise you.

Discussions about fashion and feet begin, of course, with high-heeled shoes. Researchers are learning more and more about the myriad ways high heels can deform skeletal structures and adversely affect gait, balance, and joint loading (see “High heels: Elevating the discussion,” page 16). We now even have 3D images that dramatically illustrate the way bones shift and toes crumple when wedged into high-heeled footwear. Still, women everywhere find the aesthetic and psychosocial attributes of high heels difficult to resist.

But some designers believe an intelligent technical approach can minimize the negative effects of high heels without compromising the aesthetics. Silvia Fado is one of them. Fado’s new line of high heels, Kinetic Traces, features ergonomic elements designed to absorb shock in a manner similar to high-end running shoes. One pair of shoes replaces a stiletto heel with a hydraulic spring, for example, which won’t do much to prevent hammertoes and might not improve balance either, but could potentially help reduce proximal joint loading. Maybe Fado’s designs won’t solve all of  the problems related to fashion and foot health, but this type of nontraditional approach is at least a step in the right direction.

Technological innovations in other areas of fashion may also have interesting implications for foot care. One example is a 3D printed cape and skirt set, recently acquired by the Museum of Fine Arts in Boston, which was constructed using a seamless integration of rigid and flexible materials in a collaboration between a Dutch fashion designer and a Massachusetts Institute of Technology professor.

Other than the fact that it weighs 15 pounds, the outfit itself is unlikely to have any direct implications for lower extremity health. But the materials technology that made the outfit possible very well could radically change the way we think about footwear and orthotic design.

Practitioners and orthotic labs often use more than one material to create an orthotic device, but with traditional subtractive manufacturing techniques, those materials must be applied in layers. With 3D printing, the options for integrating different materials within a single device increase exponentially. Given the findings from Georgia Tech showing that stiffness varies within different regions of the foot (see “Pluses and minuses of additive and subtractive approaches”), these new manufacturing capabilities could lead to much more detailed customization of foot orthoses to reflect the variations observed within a particular foot.

If this type of technology can be used to make a 15-pound high-fashion 3D cape and skirt set, then using similar technology to create a more effective foot orthosis shouldn’t be too much of a stretch. And that’s good news for all patients, regardless of their fashion preferences.

It’s certainly true that the objectives of the fashion industry often clash with those of lower extremity healthcare practitioners. But fashion isn’t always the enemy. Sometimes it can even be an inspiration.

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