External Pedorthic Shoe Modifications:
When shoe modifications are applied correctly, or use in conjunction with foot orthotics, the results can be quite remarkable: aiding in the transfer of forces; off-loading at-risk or sensitive areas of the foot; rebalancing or realigning the musculosketal system; accomodating fixed deformities; and controlling motion.
Flares--widens the shoe, resisting rotation, making it more difficult for the wearer to roll out in that side.
Wedges--If the foot is flexible and some correction is desired, an external wedge can be applied to the shoe. Medial or lateral heel wedges add an extrinsic posting to the sole of the shoe t promote heel varus or heel valgus respectively.
Eternal Counters--The effect is to fully support the foot and ankle, provide a wider base, and reduce flexing.
Cushion Heels--allows the heel of the shoe to compress at heel strike and absorbs some of the impact forces.
Elevations--Shoe lifts to accommodate leg-length discrepancies are probably the most common adjustments seen on regular shoes.
Rockers (Fore and Rearfoot)--Rocker soles reduce energy consumptionas they propel the body forward after the center of gravity has passed over the apex of the rocker. Rockers can also help patients with limited ranges of motion at the ankle or metatarsophalangeal (MTP) joints.
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. This unloads the pressure from the met heads, allowing for rapid transfer from the shafts of the metatarsals to the distal end of the toes, with limited extension of the digits.
Stiffeners--Sole stiffeners can be added to almost any shoe to limit flexion.
Internal Pedorthic Shoe Modifications: As we all know, there are two sides to every story. Having considered te outside, it is now time to look at some of the changes that are possible inside a shoe. Much like the marvels of plastic surgery, a little nip here and tuck there can optimize the feel and fit of a shoe without having to compromise the outward appearance.
Heel Cushions--Cushions have been shown to relieve mild cases of plantar fasciitis or early heel pain syndrome.
Heel Elevations--Shoe lifts to accommodate leg-length discrepancies are probably the most common adjustments sen on regular shoes.
Heel Wedges--A mild correction for a probated foot displaying heel valgus is the insertion of a "pear" shaped wedge under the medial heel.
Metatarsal Bars-- The addition of the metatarsal pads onto the shoe sole will help alleviate the symptoms of metatarsalgia by building a met arch, and transferring some of the weight bearing pressure from the met heads unto the met shafts.
Schaphoid Pads--When a shoe is too narrow in the shank to accommodate a foot orthotic, they often are the only alrenative for providing some support.
Excavations--These refer to any depressions or cutouts created to the inlay or insole to reduce pressure in a localized area.
Stretching--Shoes can be stretched in both length and width if necessary, adding slightly more volume.
Carbon Plates--Patients with met head fractures, hallux limitus, or turf toe often require restricted range of motion at the met heads. The insertion of a carbon footplate into a show will limit flexion.