Shoe Modifications

Question 1

Internal Shoe Modifications

Answer 1

Heel Grip
Tongue Pad
Metatarsal Raise
FF Extension
Valgus/Varus Wedges
Heel Pad

Question 2

when are internal shoe modifications used

Answer 2

shoe modifications are primarily used for improving shoe fit rather than treatment of a condition

Question 3

Heel Grip

Answer 3

-wraps around the inside of the shoe

Question 4

why should heel grips be avoided

Answer 4

• 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

Question 5

is heel slippage normal

Answer 5

yes, a little bit is

Question 6

Tongue Pad

Answer 6

• a better choice for heel slipping

- also used to help relieve irritation on the dorsum of the foot

Question 7

Metatarsal Raise used

Answer 7

• directly on the foot
• as an orthotic modification
• as a shoe modification

Question 8

MT raise used for pathology such as

Answer 8

• neuroma
• hyperkeratoses sub 2-4 MT heads
• pain sub 2-4 MT heads

Question 9

MT raise used for shoe fit when pt has

Answer 9

shallow feet

Question 10

FF extension used for

Answer 10

a shallow foot, too deep of a toebox

Question 11

Valgus/Varus wedge used for

Answer 11

• may help with shoe fit

- not always a good idea b/c pushes the foot medially

Question 12

valgus heel lift can prevent

Answer 12

pronation is some ppl

Question 13

Heel pad

Answer 13

• 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

Question 14

External Shoe Modifications

Answer 14

Flares
Stabilizers
Rockers
Bars
Excavations
Sole expansions
Closures

Question 15

External Shoe Modifications

Answer 15

• 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

Question 16

Flares

Answer 16

• may be heel or full length of device
• usually heel flares
• increases the base of support

Question 17

lateral heel flare forces

Answer 17

• early pronation at heel strike

- prevents lateral roll-over (excessive RF inversion) in midstance

Question 18

medial heel flare

Answer 18

• decelerates pronation in midstance

- helps prevent the foot from rolling over (in the direction of pronation)

Question 19

Stabilizers

Answer 19

• 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

Question 20

Stabilizers are also known as

Answer 20

flanges or buttresses

Question 21

Medial Stabilizer

Answer 21

-indicated for pronatory problems such as posterior tibial tendon dysfunction and severe flexible flatfoot

Question 22

Lateral heel stabilizer

Answer 22

• 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

Question 23

Rockers

Answer 23

• 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

Question 24

heel rockers allow for

Answer 24

-a more controlled loading at heel contact

Question 25

heel rockers are useful in pts with

Answer 25

-decreased ankle joint motion

Question 26

heel rockers are required for

Answer 26

very rigid soled shoes (to prevent Frankenstein gait)

Question 27

FF Rockers decreases or eliminates the need for

Answer 27

MTP motion

Question 28

FF Rocker indicated for such conditions as

Answer 28

hallux limitus/rigidus, MTPJ arthritis, painful plantar MT head hyperkeratoses

Question 29

Toe Rockers provides for

Answer 29

• toe-off

- important for rigid soled shoes

Question 30

double rockers help to

Answer 30

offload the midfoot

Question 31

Heel to Toe Rocker used for

Answer 31

very rigid foot/ankle

-do not use bilaterally!

Question 32

MT bars used to

Answer 32

• off load the MT head

- decrease motion requirements at MTPS

Question 33

MT bars are not good for pts with

Answer 33

neuropathy, drop foot

Question 34

Excavations

Answer 34

-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

Question 35

Excavations can be used to

Answer 35

off load bony prominences, ulcers, areas of severe hyperkeratoses

Question 36

Sole Expansions

Answer 36

• 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)

Question 37

Closures may be used for

Answer 37

• unable to reach feet (ie. back problems, obesity)
• unable to manipulate hands (ie. severe rheumatoid arthritis effecting the hands)
• significant and or changing edema

Question 38

Velcro closure provides for

Answer 38

-god support and adjustability for those who have difficult with laces but can reach their feet

Question 39

Elastic laces allow for

Answer 39

changing edema, may be used for patients with difficult reaching their feet

Question 40

Side or Back closure may be used for

Answer 40

-patients who have difficult reaching their feet

Question 41

custom molded shoes used for

Answer 41

• 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

Question 42

custom molded shoes made from

Answer 42

• casts of pt’s feet
• cast must go above the ankle
• may be b-vavle (most difficult but easiest to remove)
• univalve
• STS socks

Question 43

Custom Molded shoes

Answer 43

• 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)