Shoe prescription

Question 1

Don’t forget….

Answer 1

To read the research articles about shoe prescription

Question 2

Shoe types: motion control

Answer 2

• straight last (last=bottom of shoe)

- firm heel counter and extra midsole support/rollbar

Question 3

Shoe types: stability

Answer 3

• straight to semi-curved last

- firm heel counter and adequate midsole support

Question 4

Shoe types: cushion

Answer 4

• curved last
• minimal firmness of heel counter
• minimal to no medial arch support/primarily cushion

Question 5

Straight last vs. curved last for pronated/supinated

Answer 5

Straight last: better for pronated
Curved last: better for supinated
BUT each patient is an individual so you have to decide based on each case

Question 6

Examining heel counters

Answer 6

You do not want the heel to collapse easily when you push on it

Question 7

Recommendations for runners to change shoes

Answer 7

• write the date you bought the shoe on the shoe
• shoes last through about 300-400 miles of running (or anywhere from 250-500 miles)
• runners need to pay attention to soreness during and after runs to help decide if they need a new pair
• may need 2 pairs of shoes if they run more than once/day

Question 8

Recommendations for balance

Answer 8

• avoid excessively elevated heel heights that displace COM anteriorly
• provide heel lift when patient has very tight triceps surae soft tissues and DF limitations
• shoes with a raised collar may enhance stability
• wider sole materials may enhancd stability/balance
• avoid shoes with rocker-bottom sole design
• wear shoes and avoid walking in bare feet

Question 9

Recommendations for slipping

Answer 9

• avoid use of shoes with very hard sole materials
• use shoes that have wider and deeper grooves in the sole material
• rougher sole surfaces and metal coils applied to the sole surface may prevent slipping
• counsel patients to take shorter step lengths on slipper surfaces

Question 10

Recommendations for patients at risk for falling

Answer 10

• wear shoes indoors and avoid going barefoot or wearing only socks indoors
• wear shoes with lower heels and larger contact areas of the sole material
• avoid wearing slippers
• wear athletic-type/canvas shoes as opposed to other shoes

Question 11

Recommendations for shock absorption

Answer 11

• wear shoes with thicker sole materials that have moderate stiffness
• consider replacing shoes after walking the equivalent of 500 miles
• shoe sole materials will be more effective shock absorbers if older individuals perform weight bearing exercises indoors during cold weather

Question 12

Recommendations for knee OA

Answer 12

• patients with medial compartment knee OA should wear flexible shoes with laterally wedged insoles
• patients with lateral compartment knee OA should wear very supportive shoes with medially-wedged insoles
• patients with medial compartment knee OA should avoid wearing shoes with elevated heels

Question 13

Recommendations for hallux rigidus

Answer 13

• wear shoes with a rocker-bottom sole
• wear shoes with very stiff sole materials, especially at the toe break of the shoe
• use rigid sole plates inside the shoes, within the shoes sole materials, or added to the bottom of the patients foot orthosis

Question 14

General fit recommendations

Answer 14

• a thumb’s width of space should be available between the end of the longest toe and the end of the shoe
• clinician should be able to grasp a slight amt of the upper materials across the dorsum of the metatarsals
• the patient should be able to move his/her toes up and down freely and should not feel pressure of the shoes against the dorsal aspect of the toes or nails