These can be a simple as lacing techniques to the
more complicated shoe lifts. These are needed when the present
shoe or a suitable over-the-counter shoe doesn't come with all
the required characteristics needed and a custom-made shoe from
scratch isn't affordable.
Tongue pads, excavations, stretching, flares, buttresses, rocker
soles, elevations, lacing to Velcro conversions are some of the
more common modifications.
Tongue pads can be used to cushion the instep, decrease the depth of the shoe
or help excavate relief pockets for prominent foot bumps on the
Excavations can be done internally on the shoe platform that the foot rests
upon. These are necessary when the orthoses are not able to relieve
enough pressure by themselves. Examples would be for dropped metatarsal
heads, midfoot collapse as with the Charcot foot.
the shoe on the upper is common for hammer toes and bunions. The
stretch is most successful when wetted and when done on an all
leather upper where no seams or stitching reside. Some thermomoldable
uppers are designed with this in mind and when carefully heated
can be shaped into the desired fit.
Flares are an
external sole widening technique that can widen the base of whichever
side of the shoe requires it. Most common material used is EVA
(ethyl vinyl acetate) which is easily moldable, grindable and
comes in different densities and colours.
very similar to flares but continue further up the shoe to cradle
the shoe upper for more stability.
Soles vary for their purposes. A rocker is decreased
thickening of the plantar surface of the shoe sole to aid in forward
of backward roll as seen on a rocking horse. When added to the
shoe they are usually done on both shoes to prevent height variations.
A heel rocker can decrease foot slap that occurs
with a rigid squared heel. Most runners have this naturally for
increased shock absorption and decreased foot whiplash into pronation.
When rockering is done at the toe of the shoe it
can aid those with limited extension of the large toe when pushing
off or when extension of the toes causes pain for the patient.
The flex point of the rocker starts where the big toe joint is.
Rockering back towards the middle of the shoe causes
more instability for the patient but helps to decrease load on
the heel and forefoot areas and aids those with fused ankles.
The new full rocker sole types as seen in the MBT or Sketcher
shoes suggest that it simulates a more natural barefoot movement
creating more active musculature to strengthen the feet and torso.
These are contraindicated for those with present balance issues.
lifts are used to balance leg length discrepancies in patients.
They are done on one shoe only and can be elevated full sole or
heel only or a combination of both. The patient should only do
this when functional (non-structural) leg length differences can't
be accommodated for such as with physiotherapy.
people are born with small structural differences that the body
can adapt to without discomfort. When the true (structural) leg
length difference cannot be adjusted to consideration must be
made as to how long the patient has gone without the height difference.
It is suggested to start with ½ the measured difference
and slowly raise the height. If for example someone recently broke
their leg and lost some leg length, the full amount would be added
full sole to the shoe right away.
Often clients lift the heel only inside the shoe
for convenience and cost issues but this may cause trouble at
the pelvis since it is now rotated forward more on the lift side.
Eventually the lift has to go externally since the height needed
is too much for the shoe to keep the heel from popping out the
Adjustable Internal Shoe Heel Lift
Velcro conversions may be needed if the client has difficulty lacing his shoes but
doesn't want to buy new shoes with Velcro or can't find a suitable
Sometimes lacing changes to elastic or spring laces