External Pedorthic Shoe Modifications
When shoe modifications are applied correctly, or used in conjunction with foot orthotics, the results can be quite remarkable.
Modifying Off-the-Shelf Footwear: Advantages
Working with their store-bought shoes allows them to control, to some degree, the style, color, and shape of the shoe. These shoes also are less expensive than custom-made shoes and perhaps will allow for some variety over time.
Flares: The sole may be much worn, the upper may be stretched and sagging over the welt, and the counter may have broken down.
Wedges: If the foot is flexible and some correction is desired, an external wedge can be applied to the shoe. Wedges can be at the heel, the sole, or applied heel to sole.
External counters: External counters are made by layering firm neoprene or crepe from the ground to up above the welt and onto the quarter of the shoe.
Cushion heels: This is simply the replacement of a triangular wedge, taken from the heel, with a lower durometer sponge rubber.
Elevations: Shoe lifts to accommodate leg-length discrepancies are probably the most common adjustments seen on regular shoes.
Rockers: Rocker soles reduce energy consumption as they propel the body forward after the center of gravity has passed over the apex of the rocker.
Roller sole--This sole has no flat spot in the midfoot. There is a gentle curve from heel to toe. It allows the patient to roll through from delayed heel strike to toe off.
Metatarsal bars: All met bars are designed to help metatarsalgia and relieve plantar pressure by adding a wedge of firm material across the sole of the shoe just proximal to the met heads.
Stiffeners:They are usually made from spring steel or carbon fiber, and they run from mid-heel to forefoot.
Guards Toe guards, also known as "bumper guards," are the addition of a harder plastic or coating onto the front portion of the shoe to prevent it wearing down too quickly.
Internal Pedorthic Shoe Modifications
The advantages of internal modifications are that they are frequently less expensive, and they are usually easily replaced if they become worn. They also come into direct contact with the foot, acting at the site of concern.
Heel cushions: Cushions have been shown to relieve mild cases of plantar fasciitis or early heel pain syndrome. Cushions can be made from a wide variety of materials of various durometers. Foams, sponge rubbers and silicone all are possibilities.
Heel elevations: Shoe lifts to accommodate leg-length discrepancies are probably the most common adjustments seen on regular shoes. Internal heel lifts are made from firm cork or neoprene.
Heel wedges: This is similar to adding extrinsic posting to a foot orthotic. For supinators with heel varus, the wedge should be placed on the lateral side. A Barton's wedge is longer and extends from the heel to just behind the met head on the effected side.
Metatarsal pads: Met pads come in many different sizes, heights, and materials ranging from spongy PPT and felt to harder orthopedic rubbers.
Schaphoid pads: Scaphoid pads can be made from a variety of materials, firm or soft rubbers or even leather. They are cemented into the shoe at the medial arch, giving extra support under the midfoot.
Excavations: These refer to any depressions or cutouts created to the inlay or insole to reduce pressure in a localized area.
Stretching: One of the simplest adjustments to make to any shoe is to stretch it. Shoes can be stretched in both length and width if necessary, adding slightly more volume.
Carbon plates: The insertion of a carbon footplate into a shoe will limit flexion. This is a good alternative to cementing a permanent steel shank into the shoe's midsole as the plate is both transferable and eventually removable.
There are many other changes that can be made to shoes such as: relasting to accommodate extra-wide feet; conversions from lace to Velcro closures; additions of firmer counter materials, etc. Some of these techniques have been in use in the pedorthic field for more than 100 years. Skilled shoemakers and cobblers can be quite ingenious in the methods they employ to adjust shoe fit.