Keys To Identifying And Treating Vamp Disease

John Mozena, DPM, and Paul Clint Jones, DPM

   However, we believe the major aggravating factor to nerve compression is the vamp of the shoe and a tight shoelace. We will refer to this as vamps disease II.5

How Tight Lacing And Incorrect Shoe Size Can Trigger Vamp Disease

The vamp of the shoe covers the dorsum of the foot and includes the tongue. The throat of the shoe is the central portion of the vamp proximal to the toebox. The throat of the shoe dictates the maximal girth permitted by the shoe itself. The eyelets are on each side of the throat and will extend to the top of the collar. The eyelets in many athletic shoes extend onto the collar itself.6

   In an informal office study, after measuring the shoe size of approximately 100 men and 100 women, we found that the majority of women wear shoes that are too small, causing abnormal pressure on the dorsum of the foot.7 We found that generally, men wear shoes that are too large. This can present a problem in both cases. Both sexes have a tendency to lace the shoes too tight, creating a strangulation of the superficial and deep peroneal nerves in both cases.

Case Study One: Treating A ‘Generalized Ache’ From Shoe Gear

A 17-year-old male presented with a bump on the dorsum of his foot of several years’ duration. He stated the pain was worse over the last three years and described the pain as a generalized ache, especially in certain types of shoe gear.

   Direct palpation of the dorsal midfoot exostosis elicited the patient’s primary pain. The patient's musculoskeletal exam was normal with the exception of a prominence on the dorsal aspect of the second metatarsocuneiform area. Vascular, neurological and dermatological exams were normal. X-rays revealed an intermetatarsal angle of 13 degrees and tibial sesamoid position of a three with a mild bilateral hammertoe of the second digit. A bilateral exostosis was also present on the X-ray at the second metatarsocuneiform joint area.

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