Midfoot Cut-outs: A Shoe Innovation That Has Brought With It New Technology And Some Old Foot Problems
by Mark Reeves, D.P.M., F.A.A.P.S.M.
Recently, shoe manufacturers have begun to utilize an innovation in manufacturing shoes that removes midsole and outsole materials from the midfoot region of athletic shoes (commonly called midfoot cut-outs or midfoot scalloping). This was done in an effort to lighten the shoes and in some cases to actually increase midfoot torsional movement. These midfoot cut-outs
have grown in popularity to include almost all manufacturers and athletic shoe styles.
This innovation has brought the desired weight reduction of shoes but this design has also increased the frequency and severity of foot injuries, especially medial column pathologies. In particular, the problems that seem to be caused or aggravated by this innovation are plantar fasciitis, plantar fascial strains, posterior tibial tendonitis, sesamoiditis, functional hallux limitus, sesamoiditis, and stress fractures. Therefore, it is imperative in treating athletes that shoegear be evaluated and careful attention given to the presence or absence of midfoot cut-outs.
In an attempt to maintain the lighter nature of shoes with midfoot cut-outs and also maintain stability (both torsional and flexion) many manufactures have started adding reinforcement materials including graphite, plastics, and rubber primarily. This author has found that the graphite plate midfoot reinforcement has proven the strongest while fulfilling the manufacturer's desired loss in shoe weight. The greatest problem associated with addition of graphite plates to maintain midfoot stability is breakage during normal shoe use. We have encountered several athletes with a foot injury related to graphite plate breakage on the affected side.
Careful shoegear evaluation should be performed as part of the normal evaluation of all athletes, especially in light of these recent shoe design changes which can potentially have a negative effect on athletic performance.