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Post-Polio Health (ISSN 1066-5331)

Vol. 17, No. 1, Winter 2001

Footwear for Polio Survivors

Dennis J. Janisse, C.Ped., National Pedorthic Services, Inc., Milwaukee, Wisconsin

Dennis presenting at GINI's Eighth International Post-Polio and Independent Living Conference in June 2000.Dennis Janisse is President and CEO of National Pedorthic Services, Inc. In addition to his duties at NPS, he is a Clinical Assistant Professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin and the Director of Pedorthic Education for P.W. Minor & Son, Batavia, New York. He teaches pedorthics courses at Northwestern University Medical School, Ball State University School of Medicine, and the Medical College of Wisconsin. He is Past President of the Pedorthic Footwear Association and an honorary member of the American Orthopaedic Foot and Ankle Society. Mr. Janisse presented at GINI's Eighth International Post-Polio and Independent Living Conference in June 2000.

People who had polio tend to have problems with their feet; however, there are a lot of things that can be done with footwear to help alleviate these problems.

Foot Problems

A variety of foot conditions can be described.

Pes cavus foot is a foot with a high arch, which also tends to be fairly rigid. A normal foot is more flexible and can better handle the stress of walking; therefore, footwear for the pes cavus foot needs to have extra cushioning and shock absorption to make up for the rigidity.

Varus heel is a heel that turns out, causing one to walk on the outside of the foot in the heel area. This causes excess pressure on the heel and up into the midfoot area because one's weight is meant to be spread out over the entire heel and midfoot surface.

Forefoot valgus means that the front part of the foot turns inward, so the outside of the foot is higher off the ground than the inside. This puts extra pressure on the first metatarsal head. (The metatarsal is the bone that is found just below the toe joint and extends to the middle part of the foot. The metatarsal head is the rounded front section of that bone, found just below the toe. The metatarsals are numbered 1-5, with 1 being at the big toe and 5 at the little toe. The region of the metatarsal head is sometimes referred to as the "ball" of the foot.) The combination of a varus heel and a forefoot valgus creates a kind of twisted foot that can make shoe fitting more difficult.

Metatarsalgia refers to pain (suffix "-algia") in the metatarsal area.

Additional problems include:

Toe deformities. The most common toe deformity seen in polio survivors is hammertoes. Instead of being straight, the toes are permanently bent, resembling the head of a hammer.

Mis-mated feet. People who had polio often have feet that are two different sizes, especially if the polio affected only one side.

Leg length discrepancy. Having polio on only one side can also cause one leg to be shorter than the other.

Muscle atrophy. Polio can cause the muscles to become weak and not function properly. A common manifestation of this in the foot is a condition sometimes referred to as "drop foot" where there is little muscle control in the foot and it tends to be in a position where it "drops" off at the ankle. This can often be a cause of falling, because of the lack of muscle control the foot tends to drag along the ground, and it becomes easy to trip and fall.

Loss of sensation. This is fairly rare, but in more severe cases of polio there can be a loss of sensation in the feet.

Falling. People who had polio tend to fall a lot. All of the foot problems mentioned tend to make one less stable on his or her feet, and therefore more likely to fall. But, muscle weakness and atrophy are probably the biggest contributors to falling.

Treatment Objectives

Several objectives can be accomplished with appropriate footwear.

Accommodate rigid conditions. Extra cushioning is needed for rigid foot conditions such as pes cavus.

Control flexible conditions. The footwear should provide support and control for flexible foot conditions caused by muscle weakness or atrophy (e.g., "drop foot").

Accommodate toe deformities. Hammertoes, because they are bent, take up more space in a shoe, so the shoe needs to be deep enough in the toe area.

Relieve excessive pressure. Anytime one has a foot that is not typically shaped, areas of excessive pressure are created. These areas tend to be the outer part of the heel and midfoot and the first metatarsal but, given individual foot variations, are certainly not limited to these.

Provide shock absorption. In addition to extra cushioning needed in specific high pressure areas, it is important to have plenty of shock absorption overall to protect feet that tend to be somewhat fragile.

Prevent falling. There are a variety of things that can be done with footwear to improve stability and to help prevent falling.

Provide a good fit. The goal is to be sure that shoes fit properly; poorly fitting shoes will only cause additional problems.

Improve gait. If the footwear does all of the above, then, ideally, it will improve one's ability to walk.

Types of Footwear

There are four basic types of footwear.

Shoes. Choosing the right shoe in the right size is the first step.

Shoe modifications. Shoes can be modified in a variety of ways to accommodate most feet.

Orthoses. These are sometimes called inserts or insoles or even orthotics, but the proper term in the world of prescription footwear is orthoses (singular is "orthosis"). These are most often custom-made from a model of one's foot.

Custom-made shoes. Because shoes come in such a variety of shapes and sizes and can be modified in many ways, custom-made shoes are needed only in cases of severe foot deformities.

Continued ...