Key Insights On In-Office Shoe Modifications For Athletes

Author(s): 
Jenny L. Sanders, DPM

Podiatrists routinely fit patients for diabetic shoes but what about shoes for feet with less severe pathology? What about the patient who is a runner and has a bunion? What do you do when an orthotic causes squeaking in your patient’s shoes and using powder to stop the squeak does not work?

   As podiatrists, we can teach our patients easy and fast shoe modifications that can mean the difference between comfort and pain, and solidify your reputation as an expert on all things feet, including shoes.

   With this in mind, let us take a closer look at some of the most common pathologies we treat and ways to modify regular shoes to accommodate those pathologies.

What You Should Know About Modifying Shoes For Bunions

Bunions are one of the most frustrating conditions patients can have when it comes to shopping for shoes. If patients are able to find a shoe wide enough to accommodate the forefoot, they subsequently experience heel slippage because of the correspondingly wide rearfoot in the shoe.

   In patients who have bunions, lace shoes are always best because this allows for a variable fit. Ideally, you want to find shoes that lace to at least to the level of the metatarsophalangeal joints distally as this will help better accommodate a wide forefoot. Most patients will try to loosen the laces to ease forefoot pressure but loosening the laces is generally not sufficient to alleviate constriction. Loosening the laces also increases transverse and sagittal plane motion, which contribute to heel slippage and improper fit.

   A better approach is to skip the most distal set of eyelets entirely, starting the lacing instead at the second set of eyelets. This significantly reduces forefoot compression and allows for an instant increase in forefoot width without affecting rearfoot fit.

   Another recommendation is for bunion patients to purchase shoes with forgiving material (such as mesh or cutouts) over the medial eminence. Medial and lateral mesh uppers allow for expansion at the forefoot without causing heel slippage at the rearfoot.

   Patients with bunions will also want to avoid any stitching or trim over the medial eminence as this will make that part of the shoe less forgiving. If your bunion patient purchases a running shoe with trim in this area, you can easily remove it with a scalpel blade. Running shoe trim is generally not incorporated into the upper but is stitched on and is more decorative in nature.

   Shoe stretchers also work well. Most patients are not aware that there are several different types of shoe stretchers in at least five different sizes including those for boots, flats and high heels. Stretchers also have holes for plugs, which you can strategically place where needed for extra stretching over bony prominences.

How To Accommodate Hammertoes

Hammertoes. As with bunions, instruct patients to find shoes that have forgiving material in the toe box. Again, mesh and cutout uppers work particularly well. Patients can purchase a vamp or toe box stretcher which, unlike a traditional width stretcher, will create extra depth in the sagittal plane as opposed to the transverse plane.

   High heels frequently do not have sufficient toe box depth and many women experience dorsal joint irritation as a result. An easy solution is to cushion and relax the toes with toe combs. Patients typically use these soft foam spacers plantarly in the sulcus but when patients use them dorsally on the toes, they prevent friction irritation from the shoes.

Essential Tips On Modifications For Retrocalcaneal And Metatarsocuneiform Exostoses

Retrocalcaneal exostosis. Many patients with a retrocalcaneal exostosis are resigned to wearing an open back or soft heel counter shoe. In cases in which there is a bursae or painful exostosis, adding off-weight padding to the inside of the shoe where the prominence rubs can really make a difference.

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