Post-Polio Health (ISSN 1066-5331)

Vol. 17, No. 1, Winter 2001

Footwear for Polio Survivors (pg 2)

Shoes

The most common type of shoe used for polio survivors is called an in-depth shoe. It is called an in-depth shoe because it has 1/4 to 3/8-inch more depth throughout the shoe to accommodate an orthosis. A lot of today's athletic shoes can be considered in-depth shoes because they have removable insoles and therefore some extra depth. In-depth shoes also have other important characteristics that are helpful for people with foot problems, including:

Strong counter. This refers to the back part of the shoe that fits around the heel. A strong counter helps control a varus heel and provides stability for the heel area. (See Figure 1, immediately below, to identify the parts of a shoe.)

Figure 1, showing an illustration of a shoe and describing the parts

Deep toe box. The toe box is the front part of the shoe where the toes are. The extra depth pro-vides plenty of room for a forefoot valgus or for hammertoes.

Shock-absorbing sole provides the needed shock absorption.

Removable insole. Most in-depth shoes have a removable insole which can also provide shock absorption or can be replaced with a custom-made orthosis.

Wide range of sizes. Most regular shoes purchased at a shoe store come in a limited range of sizes and only one (medium) width. (This is usually a B for women and a D for men.) In-depth shoes come in a greater range of sizes and in widths from very narrow (AAA) to very wide (EEEEE).

Heat moldable. Some in-depth shoes are lined with a material that allows them to be molded when heat is applied.

A word about shoe fitting: If you have foot problems, it is important to have a pedorthist or other professional shoe fitter help you obtain the right fit. Pedorthists can help you get the right size [length and width] and shape for your foot. And remember - shoe sizes vary by style and manufacturer. You can have your feet measured, but this only gives you a guideline for what size to start with. The right size is the one that fits your foot!

Shoe Modifications

There are a variety of shoe modifications available for polio survivors. Here are some of the most common.

Extension. If one has a leg length discrepancy, an extension can be built onto the sole of the shoe to even out the leg length and to help one walk better. An extension can also be built onto the heel section for a foot that is in the "dropped" condition. Figure 2 shows a full extension (top) and a heel-only extension (bottom).

Figure 2.Figure 2 photo showing full extension on top shoe and heel-only extension on bottom shoe

Flare. This is a piece of material that is added onto the side of the sole to help control the varus heel. It might be added only to the heel area or it could go all the way along the side of the shoe, and will help prevent the feeling that the foot is falling off the side of the shoe. When it is built on the outside of the shoe it is called a lateral flare. A flare can also be built on the inside of the shoe for people with the opposite problem; this is called a medial flare. A flare also gives a greater surface area that is in contact with the ground and will help one feel more stable. (A lateral flare is pictured in Figure 3.)

Figure 3.

Photo of a shoe with a lateral flare

Heel wedge. This is another way to help control a varus heel. A wedge of sole material is inserted to make the sole better match the slantedness of the heel. (See Figure 4.)

Figure 4.

Figure 4 Heel Wedge

Fiberglass lateral counter. A piece of fiberglass can be added to the outside portion of the counter to further control a varus heel.

Cushion heel. A wedge of shock absorbing material can be added at the heel area to provide additional shock absorption for the heel area.

Figure 5.

Figure 5 shows rocker sole.Rocker sole. This is a specially shaped sole that helps the foot to "rock" from heel to toe during the normal course of walking. (See Figure 5.) Most walking shoes are made with a rocker sole, but one can be added to other shoes. Not only does it help with walking, but when shaped properly, it also helps to take pressure off the metatarsal heads.

Leather tip. When one foot tends to drag along the ground, a leather tip can be added to the toe of this shoe to help it slide better and prevent falling. (If you have this condition, it is also a good idea to stay away from athletic shoes with lots of traction because they tend to stick to the ground and get easily caught, especially on carpeting.)

Velcro closing. If tying shoes is hard work, shoes are available with a velcro closing, or it is possible to modify a pair of regular tie shoes to have a velcro closing but still look like they have ties. (See Figures 6A and 6B.)

Figure 6A.

Photo for Figure 6A showing velcro closing in open position.

Figure 6B.

Figure 6B showing velcro closing in closed position.

Orthoses

Custom-made foot orthoses are made from a model of the foot, so they match up to the contours of the foot exactly. This is called "total contact" and is especially helpful for eliminating areas of excess pressure – the total contact evens out the pressure over the entire surface of the foot. An orthosis also provides an extra layer of shock absorption and can have special materials added to further customize it. These include: meta-tarsal pads to relieve pressure on the metatarsals; a soft, spongy material which can be added to specific problem areas to provide extra cushioning; firmer materials to help control varus heel and valgus forefoot; even a heel extension can be built into an orthosis. (Figure 7 shows an orthosis with a metatarsal pad added.)

Figure 7.

Figure 7 showing orthosis with a metatarsal pad added.

Where to Get Footwear

There are several places where you can get prescription footwear (sometimes still referred to as "orthopedic shoes"). These include podiatrists, orthotists, specialty shoe stores, shoemakers or shoe repair people and pedorthists. Podiatrists tend to focus on orthoses; they usually do not have shoes or do shoe modifications. An orthotist specializes in braces, and shoe stores only offer shoes. A shoemaker tends to focus more on repairs but sometimes can do modifications. The best person to go to for the complete range of shoes, modifications and orthoses is a Board Certified Pedorthist. This person will have the initials "C.Ped." after his or her name. This confirms that he or she has received training in the field of pedorthics, has passed a comprehensive examination, and keeps up-to-date on the latest developments in the field.

A pedorthist is like a pharmacist for footwear; he or she works from a physician's written prescription. A pedorthist is trained in foot anatomy, diseases affecting the foot, shoe construction, materials, modifications and orthoses. Usually pedorthists have offices that work like doctor's offices where one makes an appointment. A pedorthist will perform a foot examination, talk about foot problems and discuss footwear needs. He or she does not diagnose problems but can often help the physician to figure out the best combination of shoes, modifications and orthoses. Pedorthists maintain an inventory of shoes, and can special order whatever type of shoe that might be needed. A full-service facility will also have a lab where shoe modifications are done and orthoses are made.

Follow-up is encouraged. Often, there may be adjustments or modifications necessary once one has worn the footwear for a while. A pedorthist might also be able to spot a problem and make a recommendation for a correction before it becomes a serious problem. As one ages with polio, the feet and footwear needs may also change, so a pedorthist just might become a regular member of the health care team.

The cost of prescription footwear varies depending on what is needed. Most pedorthists do not charge for office calls or followup - the cost is built into the footwear. Prices for in-depth shoes vary from approximately $60 for a simple athletic or walking shoe to $200-$250 for a heat-moldable shoe.

Custom-made shoes begin at about $350 a pair. The cost of external shoe modifications start at about $20 for simpler modifications such as a heel elevation, and range to $90-$130 for a more complicated modification such as custom rocker soles. Orthoses range from $200 to $450 a pair. Some insurance companies cover prescription footwear, to varying degrees, if the physician provides a written prescription.

National Pedorthic Services (NPS) is a full-service pedorthic facility with two locations in Milwaukee, WI. National Pedorthic Services (NPS) is a full-service pedorthic facility with two locations in Milwaukee, WI.

Corporate Headquarters: 7283 West Appleton Avenue, Milwaukee, WI 53216, 414-438-1211,
800-949-6771, info@nps-foot.com, www.nps-foot.com)

Milwaukee - South side: 2745 West Layton Avenue, Ste 103, Milwaukee, WI 53221, 414-282-8888
NPS also has locations in IN, Indiana; Muncie, IN; Saint Louis, MO; Rochester, NY;
Fond Du Lac, WI; and Greenbay, WI.

Contact the Board for Certification in Pedorthics for a certified pedorthist in your area: Pedorthic Footwear Association/Board for Certification in Pedorthics, 2517 Eastlake Avenue East, Ste 200, Seattle, WA 98102,
888-530-CPED, www.cpeds.org.

For information about a volunteer non-profit organization that "matches up people with their shoe opposites,"
contact The One Shoe Crew, PO Box 285, Rio Linda, CA 95673, 916-991-0412

This article was first written for the Post-Polio Resource Group of Southeastern Wisconsin.