Inside Insights On Shoewear Modifications

By David J. Levine, DPM, CPed

Slipping on the heel and feeling that shoes are too tight or too big are sensations that we have all experienced with shoes that do not fit properly. We know not to wear shoes when they do not fit or feel right on our feet. Factor in those who are dealing with the effects of neuropathy, poor circulation, edema and obesity, and it is clear that shoes are not just a fashionable accessory, but essential medical devices that help protect and manage certain conditions we treat. Shoes are the foundation for podiatric treatment. Even more importantly, in the realm of wound healing, surgical intervention is wasted without ensuring that patients wear the proper footwear after the procedure. Our patients need help and advice on what they put on their feet. This can be a difficult issue because of the emotions and subjective nature that are linked with shoes. However, the therapeutic shoe bill has helped facilitate a renewed awareness of shoes in the podiatric community. Approximately 10 percent of DPMs are dispensing shoes, a dramatic increase over eight years ago when the therapeutic shoe bill was at its inception. However, fewer than 10 percent of DPMs are dispensing more than 10 pairs of shoes per month. Key Factors To Keep In Mind When Fitting Shoes Even though fitting shoes starts with a simple measurement of the foot, it is not always easy. In addition to obtaining a measurement, assessing the shape, volume, anatomy and even the function of the foot are important factors in determining what type of shoes will work and fit best. Putting everyone in the same style or type of shoe not only does not work, it is not good practice. With the many different foot types in our population, different lasts or shapes of shoes are necessary. The most accurate way to find out what shoes are right for your patients is to actually have them try on different shoes in different widths, sizes and lasts. Ordering individual shoes based on measurement alone is guesswork at best. This approach will only serve to frustrate you and the patient when the shoe does not fit properly. You may wind up sending the shoes back, reordering another pair or, worse yet, talking yourself or the patient into believing the fit of the shoes is “good enough.” This is no different than going into a shoe store and finding out your size is not in stock. If a shoe salesperson brought out a larger width or size and told you it was close enough, there is a good chance you would be put off by this kind of service. If clinicians do this to patients who have neuropathy or peripheral vascular disease, they are putting them at risk too. Some feet that we treat cannot possibly fit into a pair of shoes taken off the shelf, no matter how wide or large a size you try. In those cases, custom molded shoes are necessary. An estimated 5 percent of our population actually needs custom molded shoes because of severe deformities. (There are various pros and cons to the casting, fabrication and dispensing of custom molded shoes, a subject that is beyond the scope of this article.) On the fringe of this population of people are individuals who can almost fit into off-the-shelf shoes but need a little bit of extra help. For these people, customizing shoes is clearly the best option. This approach has many advantages. Customizing shoes facilitates ready acceptance by patients from a cosmetic standpoint. These customizations are easily reproducible and repairable. Indeed, the latter advantage makes customizing shoes cost effective as well. Once one has ensured that a pair of shoes fits properly, there are many ways to safeguard the foot. Simply incorporating a multidensity insert may be all that is necessary to protect and prevent problems. However, custom orthoses — whatever the type — may not be enough. In those situations, the shoe functions as the starting point for several biomechanical controls that can affect the foot and gait in a positive way. Modifying shoes is an excellent way to gain mechanical advantage over the foot. There are several different shoe modifications one can employ. These modifications can prevent surgical intervention, help patients walk better and even earn you money by doing the right thing. A Primer On Rocker Sole Shoe Modifications The rocker sole shoe modification has many variations and one can actually perform this modification in a variety of ways in shoes of different styles.

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