Shoe Modifications Flashcards
Internal Shoe Modifications
Heel Grip Tongue Pad Metatarsal Raise FF Extension Valgus/Varus Wedges Heel Pad
when are internal shoe modifications used
shoe modifications are primarily used for improving shoe fit rather than treatment of a condition
Heel Grip
-wraps around the inside of the shoe
why should heel grips be avoided
- forces the foot into the toebox
- instead the grip should be cut in half and placed it on either side of the shoe to prevent from pushing the foot forward
is heel slippage normal
yes, a little bit is
Tongue Pad
- a better choice for heel slipping
- also used to help relieve irritation on the dorsum of the foot
Metatarsal Raise used
- directly on the foot
- as an orthotic modification
- as a shoe modification
MT raise used for pathology such as
- neuroma
- hyperkeratoses sub 2-4 MT heads
- pain sub 2-4 MT heads
MT raise used for shoe fit when pt has
shallow feet
FF extension used for
a shallow foot, too deep of a toebox
Valgus/Varus wedge used for
- may help with shoe fit
- not always a good idea b/c pushes the foot medially
valgus heel lift can prevent
pronation is some ppl
Heel pad
- for shoe fitting purposes, indicated for malleolar irritation from the topline
- may also be used when the heel counter is too rigid and too concave
External Shoe Modifications
Flares Stabilizers Rockers Bars Excavations Sole expansions Closures
External Shoe Modifications
- may be used as a single therapeutic modality or in conjunction other modalities such as foot orthoses
- often reserved for more severe pathology or deformities
Flares
- may be heel or full length of device
- usually heel flares
- increases the base of support
lateral heel flare forces
- early pronation at heel strike
- prevents lateral roll-over (excessive RF inversion) in midstance
medial heel flare
- decelerates pronation in midstance
- helps prevent the foot from rolling over (in the direction of pronation)
Stabilizers
- act to increase the base of support
- helps reinforce the upper in terms of the shoe’s ability to prevent the foot from rolling over the shoe
- extends from the sole to about 1/2 way up the upper of the shoe
Stabilizers are also known as
flanges or buttresses
Medial Stabilizer
-indicated for pronatory problems such as posterior tibial tendon dysfunction and severe flexible flatfoot
Lateral heel stabilizer
- indicated for lateral instability such as severe RF varus such as found with residual clubfoot
- may also be used for pts who demonstrate excessive lateral shoe wear
Rockers
- sole modifications that allow the shoe to take some of the motion less motion is required by the foot/LE
- angle and base of gait must be taken into account
heel rockers allow for
-a more controlled loading at heel contact
heel rockers are useful in pts with
-decreased ankle joint motion
heel rockers are required for
very rigid soled shoes (to prevent Frankenstein gait)
FF Rockers decreases or eliminates the need for
MTP motion
FF Rocker indicated for such conditions as
hallux limitus/rigidus, MTPJ arthritis, painful plantar MT head hyperkeratoses
Toe Rockers provides for
- toe-off
- important for rigid soled shoes
double rockers help to
offload the midfoot
Heel to Toe Rocker used for
very rigid foot/ankle
-do not use bilaterally!
MT bars used to
- off load the MT head
- decrease motion requirements at MTPS
MT bars are not good for pts with
neuropathy, drop foot
Excavations
-the sole of the shoe may be “excavated” ( a hole is cut into it) either internally or through the outsole to help off-load an area
Excavations can be used to
off load bony prominences, ulcers, areas of severe hyperkeratoses
Sole Expansions
- widens the sole of the shoe
- may be used for HAV, tailor’s bunions or midfoot deformity (such as mild midfoot, collapse in Charcot neuroarthropathy)
Closures may be used for
- unable to reach feet (ie. back problems, obesity)
- unable to manipulate hands (ie. severe rheumatoid arthritis effecting the hands)
- significant and or changing edema
Velcro closure provides for
-god support and adjustability for those who have difficult with laces but can reach their feet
Elastic laces allow for
changing edema, may be used for patients with difficult reaching their feet
Side or Back closure may be used for
-patients who have difficult reaching their feet
custom molded shoes used for
- Charcot foot
- stage 3 PTTD with rigid, severe abduction of the FF on the RF
- severe congenital deformity
- Rheumatod Arthritis with significantly deformity
- Status post partial foot amputation with shoe filter required
custom molded shoes made from
- casts of pt’s feet
- cast must go above the ankle
- may be b-vavle (most difficult but easiest to remove)
- univalve
- STS socks
Custom Molded shoes
- have a very rigid sole (some sort of rocker is required)
- covered by medicare as part of the Therapeutic Shoe Bill (only for pts with diabetes who meet the specific requirements)
