the shoe serves as the foundation for…
an orthosis
what is the standard height of a heel
1 inch
when might a higher heel be indicated (2)
- if there is decreased flexibility in the hindfoot
2. if there is pain in the heel
what does increasing the height of the heel do
transfers weight toward the metatarsal heads
what are the consequences if a heel is too high
the individual will need to compensate for the increased ankle PF by either flexing at the hip or knee or hyperextending at the knee then increasing lumbar lordosis
difference between low and high quarter shoes
low quarter - extend to just below the malleoli
high quarter - extend above the malleoli
what do low quarter shoes allow for
ankle mobility
when may low quarter shoes be indicated
when ankle stability is not an issue or if they are being fit for a plastic orthosis which extends above the malleoli
are low or high quarter shoes easier to don
low quarter shoes are easier to don
when are high quarter shoes indicated
when there is ankle instability and support is required externally from the shoe
with the Blucher shoe, the tongue is an extension of…
the vamp
for Blucher shoes, is there a separation between the lace stay and vamp
yes
can the throat of the Blucher shoe be opened relatively wide
yes
for the Balmoral shoe, is there a separation between the anterior portion of the lace stay and the vamp
no
in the Balmoral shoe, is the tongue a separate piece sewn to the vamp and anterior quarters
yes
is the Blucher or Balmoral more preferable
Blucher
why is the Blucher more preferable than the Balmoral
it is more easily donned
downside of lace-to-toe
cosmetically less acceptable (ugly AF)
when are specialty options for closure options (elastic laces, velcro, etc.)
they are indicated when fine motor dexterity and function are compromised
describe function of a last
the last is the mold over which the components of the shoe are molded, therefore cannot be identified on the shoe itself
what is an inflare
the vamp of the shoe is angled moderately inward
what is an outlfar
the vamp of the shoe is angled outward
what is a straight last shoe
the vamp is straight
typical shoes have a _____ last, which is mildly curved inward
regular
is a regular last useful to attempt to correct or accommodate a deformity
no
when may an inflared shoe be warranted
to correct a flexible forefoot abduction (pronation) or to accomodate a rigid forefoot adduction (supination)
when may an outflared shoe be warranted
to correct a flexible forefoot adduction (supination) or to accommodate a rigid forefoot abduction (pronation)
when may a straight last be warranted
to correct a mild forefoot adduction or abduction deformity
newborn shoes are typically constructed from a _____ last, making it difficult to distinguish left and right
straight last
what characteristic would an in-depth last produce in a shoe
depth of the shoe is increased
when would an in-depth last be indicated (4)
- when pads or a plastic inset will be worn inside the shoe
- to accommodate dressings
- when there is increased edema in the foot
- severe deformities in the foot
when may a custom molded shoe be warranted
when there is a significant deformity in the foot which could not be accommodated in an extra depth shoe with inserts
key ares to identify for shoe fitting (3)
- length
- width
- depth
guideline for shoe length
shoe length should be 1/2 inch longer than the longest toe
the widest part of the shoe should be aligned with…
the 1st metatarsal phalangeal joint
how to measure depth in shoe fitting
examine the fit of the vamp and toebox for adequate clearance
what position should fit be evaluated in
in a weightbearing position (because the foot spreads when it’s open) and non-weightbearing position if there is a flexible deformity
what else may be considered that may influence size of the foot (2)
- time of day
2. prior activity level
at the end of the day or after exercise, the foot can experience a ___ shoe size increase
1 - 1.5 shoe size increase
a lift is primarily used to…
accommodate for a leg length discrepancy
when else may a lift be used
to promote greater ease in swing on the contralateral side
how much of a life can be accommodated within a shoe
approximately 1/2 inch
what is the function of a cushioned heel
absorbs shock during loading as HS
when is a cushioned heel indicated
when there is heel pain and may also be prescribed when the individual is using a solid AFO to assist with forward weight shift
the overall function of a rocker sole, metatarsal bar, and rocker bar?
to promote smooth transition from heel strike to push off while relieving stress from the metatarsal heads
what is a rocker sole
extends the length of the sole of the shoe
what is a metatarsal bar
a strip of leather or rubber placed just posterior to the metatarsal heads
what do the rocker styles do
serve to reduce stress at the metatarsal heads during pushoff phase of gait
when are the rockers indicated
whenever there is pain in the metatarsal heads
what does a flare do
increases the medial-lateral surface area on the bottom of the shoe
where can a flare be placed
medial or lateral
does a wedge maintain thickness universally on both sides?
no - one side is thicker than the other
when a wedge is placed on the bottom of the shoe or between the inner and outer soles, what happens
the shoe is tipped in a desired direction
two types of wedges
heel wedge or sole wedge
heel wedges directly influence…
calcaneal position
what do heel wedges do to 1. flexible deformities and 2. rigid deformities
- corrects flexible deformity
2. supporting a rigid deformity
a sole wedge originates…
distal to heel
a medial sole wedge will create a ____ effect on the forefoot
inversion
a lateral sole wedge will create a ____ effect on the forefoot
eversion
function of a flare
increase individual’s BOS when they are wearing shoes and may prevent inversion/eversion injuries
function of a wedge
help correct flexible deformities or support rigid deformities
what is a Thomas Heel
an extension of the breast of the heel anteriorly on medial side
what does a Thomas Heel do
increases stability of the sole of the shoe when there is pronation
what is a Reverse Thomas Heel
the breast of the heel is extended anteriorly on the lateral side
can heel wedges be combined with Thomas/Reverse Thomas Heels?
yes
the Thomas Heel (when utilized) is more likely to be used to increase the stability of the sole of the shoe when there is…
supination
are Thomas Heels still popular?
not really
what is a scaphoid pad
convex paid used within the shoe to support the longitudinal arch
what is the proper positioning of a scaphoid pad within the shoe
the pad is placed under the longitudinal arch
what is a metatarsal pad
soft domed shaped pad that supports the metatarsal arch and relieves pressure from the metatarsal heads by shifting pressure to the metatarsal shafts
where should a metatarsal pad be placed
just posterior to the met heads and just anterior to the cuneiforms
function of a heel spur
relieve pressure on the heel
