Metatarsalgia, Morton’s Neuroma, Shoe Construction, and OESH

I know, that’s a lot but this post that I’ve been promising to write on behalf of all you OESHers who have told me that OESH has helped with metatarsalgia and Morton’s Neuroma, has been a long time in the waiting.

Pain in the forefoot, specifically pain in the ball of the foot, occurs far more often in women than it does in men. Metatarsalgia, Morton’s neuroma, and a loss of the fat pad under the ball of the foot are some common diagnoses associated with pain in the forefoot area.

Why does pain in the forefoot occur more often in women than in men? The obvious answer is that we women tend to have poorer choices in footwear. But perhaps not so obvious is that it isn’t just high-heeled and narrow and pointy-toed shoes that place greater pressure under the balls of our feet.

The sole in a typical women’s shoe, be it a dress, casual or athletic shoe, cradles the bottom of the foot. By cradling the bottom of the foot, I mean that the shoe sole curves up along the outside and the inside parts of the foot where we place our bodyweight. This cradling of the sole, which isn’t really noticeable until you dissect apart a shoe, has been standard to shoe construction for, well, a long, long time.

During the course of my 20+ years of research studying the biomechanical effects of footwear, I was observing that this cradling in the shoe sole adversely affects the forces up through the foot. Essentially, the cradling tends to bunch up the ball of the foot and focus pressures under the areas of the forefoot that most commonly become painful.
This cradling in a shoe sole gets more pronounced as the cushioning in the sole starts to break down – which occurs almost immediately with wearing a new shoe. The cushioning under the ball of the foot quickly becomes compressed, which creates even more pressure in that area.

In developing OESH, I was relentless in making sure that it did not cradle the bottom of the foot like most shoes do. Eliminating this cradling effect in OESH entailed changing what is called the “last” of the shoe, which is the standard, uniform shape of the foot that shoes are constructed upon. The bottom of a typical shoe last is curved from side to side. This curve in shoe-manufacturing speak is called the “crown,” which in turn, forms the cradling in the shoe sole. I learned that virtually all women’s shoes, not just dress shoes, but women’s “comfort”, and athletic shoes have a fairly pronounced crown, especially in the forefoot.

I began asking all the many people I’d gotten to know in the shoe industry why this pronounced crown was standard when clearly it wasn’t good biomechanically. Most people outside the shoe industry assumed that it had some sort of biomechanical basis so I expected to hear what that basis might have been. But instead the typical response was “that’s just the way it’s always been done.”

Then I learned from one of the oldest people I’ve met in the industry what is probably the real answer. In the old days, when the shoe upper was attached to the sole, it was considered more elegant, especially in women’s shoes, to hide the stitching and the ends of the shoe upper material on the inside part of the shoe. Putting a crown in the shoe last simply provided the room to hide the stitching and excess material. Nowadays in shoe manufacturing, with sophisticated means to attach the upper to the shoe sole, that extra space really isn’t needed anymore, so the crown, from a shoe-making perspective, is completely unnecessary.

But the standard crown in shoe lasts and the resultant cradling in the typical shoe sole has become a longstanding tradition that is now very hard to break. Getting the factories I was working with to eliminate the crown and cradling in OESH was not easy. It involved new tooling, new equipment and new protocols. I wish all shoe manufacturers would eliminate the crowns from their shoe lasts and the resultant cradling in their shoes but I realize that doing so would be very costly given their current manufacturing infrastructure.

At least with OESH, I can ensure that there is no unnecessary cradling of the foot, as there is no crown in the OESH last and consequently all OESH footwear. It took a little tradition breaking to make OESH, but mostly it took some sophisticated materials and a lot of hard work.

More and more women who have metatarsalgia and Morton’s Neuroma are going out of their way to tell us how much they enjoy their OESH. Many women have told us that they are able to stand and walk longer in OESH than in any other shoe. Clearly, they appreciate the unique construction of OESH and all the hard work behind it.

If you have metatarsalgia, Morton’s neuroma or pain associated with a loss of fat pad under the ball of the foot, please let us know your OESH experience by writing us at

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