Shoe and Foot Orthosis

Function of shoes
1. To minimize the pressure on sensitive, deformed structures.
2. To redistribute weight toward pain-free areas to improve the comfort.
3. Serve as a foundations of orthosis.
4. Increase regional orthosis function.
5. Limit motion of painful, inflamed, or unstable joints.
6. Correct flexible deformities.
足部輔具的分類

Parts of the shoe

Regional of the shoe
1. The upper parts: vamp, quarter, toe box, throat, insole board, topline.
2. The lower parts: outsole, shank, heel.

1. Sole
 Outer and inner soles are separated by
compressible filler.
2. Ball
 Widest part of the sole and
corresponds to the
area of the metatarsal heads.
3. Shank area
 From the anterior border of the heel
to the ball.
A steel piece may be used to reinforce the
shank
area.
4. Toe spring
 The space between the anterior sole
and the
floor.
5. Heel
 Leather with rubber on the plantar
surface is
commonly used
o Spring Heel: Lowest heel & one-eighth
inch (1/8) high
o Oxford Heel: three quarters to one inch
high (6/8” to 8/8”)
o Military Heel: one and one quarter
inches high (10/8”)
o Cuban Heel: Highest heel & one and a
half inches high (12/8”)
 It’s the ideal height of a
shoe & a medical
customized type of shoe.
1. Sole
 Outer and inner soles are separated by
compressible filler.
2. Ball
 Widest part of the sole and
corresponds to the
area of the metatarsal heads.
3. Shank area
 From the anterior border of the heel
to the ball.
A steel piece may be used to reinforce the
shank
area.
4. Toe spring
 The space between the anterior sole
and the
floor.
5. Heel
 Leather with rubber on the plantar
surface is
commonly used
o Spring Heel: Lowest heel & one-eighth
inch (1/8) high
o Oxford Heel: three quarters to one inch
high (6/8” to 8/8”)
o Military Heel: one and one quarter
inches high (10/8”)
o Cuban Heel: Highest heel & one and a
half inches high (12/8”)
 It’s the ideal height of a
shoe & a medical
customized type of shoe.
Lower parts
1. Sole: outer and inner soles are separated by compressible filler.
2. Ball: widest part of the sole and correspond to the area of the metatarsal heads.
3. Shank area: from the anterior border of the heel to the ball.
(1) A steel piece may be used to reinforce shank.
4. Toe spring: the space between the anterior sole and the floor.
5. Heel: leather with rubber on the plantar surface is commonly used.
(1) Heel height is critial for affecting the relative loading of the anterior and posterior portions of the foot.
(2) Height is measured from the outer sole to the plantar surface of the heel.
(3) Orthosis measure elevation at the center of the heel at a point of corresponding to the calcaneal
tuberosity.
6. Heel counter:
(1) Posterior portion of the upper part between the quarters.
(2) Used to reinforce the quarters to preserve the shape & support the calcaneus.
(3) Increase the posterior stability of the shoe.
Upper parts
1. Vamp: anterior section of the shoe
(1) Sewn or molded of soft leather to minimize pressure on dorsal areas of the foot.
2. Quarters: posterior section of the shoe
(1) low, mid, high quarter shoes.
(2) Low quarters
- One in which the quarters extend a level just below the malleoli.
- The shoe is quite cosmetic and does not restrict ankle motions.
- Example: Oxford.
(3) 3/4 high shoes
(4) High shoe
- Covers the malleoli and grips the ankle better it reduces the piston action and resists back and forth
sliding at the foot.
- Example: boot.
3. Throat: opening at the base of the tongue
4. Tongue: strip of leather lying under the laces.
(1) Piece attached to the vamp.
5. Toe box: reinforce the vamp to preserve the shape of the vamp & protect the shoe from trauma
(1) Types: narrow, wide, hard (depend on the need of patient)
Extra-depth and molded shoes
1. These device occupy space, reducing the room available for the foot.
2. An extra-depth shoe may be indicated if a shoe sized fit the foot alone with thus be too small or rather
than
provide the patient with shoe of a greater width and length.
3. For patients with severe foot deformity, often secondary to Diabetic neuropathy or arthritis, a custom-
molded shoe be utilized to accommodate the deformity and resitribute weight-bearing pressures.
Evaluation of fit
1. Four phases of shoe fit:
(1) Static fit
(2) Weight-bearing fit
(3) Functional fit
(4) Thermal fit
2. Three basic measurement
(1) Arch length
(2) Toe length
(3) Width
https://podohub.com/getting-foot-measurements-from-a-foot-tracing/
Internal shoe modification
 Glued to the inner sole, because they are like closer to the foot.
 They are mechanically more effective than external ones.
1. Medial longitudinal arch pad (scaphoid pad, navicular pad)
(1) The support is rubber, cork or plastic foam.
(2) The modification extends from a point 1 cm posterior to the 1st metatarsal head to the anterior tubercle
of the calcaneus with the ape, 0.5 – 1 cm in height.
(3) Located between the sustentaculum tali (talonavicular joint) and the navicular tuberosity (toe break –
COG)
(4) A resilient support lessens the impact of hard walking surface and affords more even distribution of
weight bearing.
(5) All arch supports tend to apply an upward and laterally directed force to support the medial longitudinal
arch.
(6) Prevents depression of subtalar joint and flattening of the arch
(7) Indications: pes planus or pes planovalgus.
2. Metatarsal pad
(1) Convex component that may be incorporated in an insert or may be a resilient domed piece glued to
the inner sole so that is apex is under the metatarsal shafts.
(2) The pad transfers stress from the metatarsal heads to the shaft and is effective in reducing plantar
pressure in patients with diabetic neuropathy.
(3) The apex of the dome is located posterior to the heads and is 0.2 – 0.5 cm in height.
(4) From the apex, the pad gradually feathers posteriorly and feathers more abruptly anteriorly.
(5) From side to side, the width and feathering depend on how many metatarsal head require relief.
(6) If all five heads are involved, the side-to-side feathering will be slight and often called an internal
metatarsal bar.
3. Heel wedge
(1) A medial heel wedge can rotate the hindfoot into inversion.
(2) Lateral heel wedge can evert the hindfoot to avoid pressure on the cuboid.
(3) The wedge is usually 0.2-0.5 cm (1/8-1/4 in) thick on the medial side.
4. Sole wedge
(1) A wedge of firm material is incorporated on the lateral (or medial) half of the sole.
(2) Used to accommodate fixed deformity of the forefoot.
- Lateral sole wedge tend to evert or pronate the forefoot.
- Medial sole wedge tend to invert or supinate the forefoot.
(3) Outer edge of the wedge is 1/8 to 1⁄4 thick
5. Heel elevation (heel lift)
(1) A layer of firm material is added to the heel as compensation for leg length discrepancy (LLD) or fixed
euquinus deformity.
(2) The height of the elevation is determined by placing temporary lift blocks under the heel to align the
pelvis.
(3) A heel elevation less than 0.5 cm may be placed inside the shoe.
6. Calcaneal pad (heel cushion relief)
(1) Anterior tapered pad covering the entire heel seat with an excavation under the center of the pain.
(2) Absorbs shock at heel contact
(3) Indication: patient with rigid ankles.
7. Reversal wedge

Upper modification
1. Shoe closures
(1) Lace stays
(2) Velcro closure
- A more elaborate form of adjustable closure.
- Can managed by one with poor coordination.
- The flaps are sewn over the lace stays..
External shoe modification
An external modification ensures that the patient wears the appropriate shoes and does not reduce shoe
volume, but will erode as the individual walks and is somewhat conspicuous.
 Advantage
Do not reduce shoe volume so that foot function may be altered without interfering with proper fit.
 Disadvantage
Modifications are separated from the plantar surfaces of the foot by thickness and rigidity of the shoe
sole
and heel.
They are visible from the outside, detracting from the appearance of the shoe
They are subject to wear from walking surface, gradually losing their effectiveness if not replaced.
1. Rocker bar
(1) To rock the foot from heel strike to toe-off without metatarsal bending.
(2) Reduce pressure under the metatarsal heads and can assist gait by easing and increasing forward
propulsion in mid to terminal stance.
(3) It can reduce enough motion at the first MTP joint, mitigating the pain associated with hallux rigidus.
(4) The apex of the rocker must be proximal to the pressure area.
(5) It also reduce heel-strike forces on the calcaneus and talus, and reduces the ankle motion.
(6) A rocker bar consists of firm material with skived anterior and posterior edges placed across the sole.
2. Metatarsal bar
(1) It placed posterior to the metatarsal heads -> transfer stress from the joint to the metatarsal shaft.
(2) Their plantar surfaces are much flatter then the rounded contour of the rocker bar and thus provide a
broader are of contact with the floor but less resistance to rollover.
3. Thomas heel
(1) Commonly used for children with foot flat.
(2) Heel extension (medial length to heel) can offer medial support, particularly for heavier individuals.
(3) Reverse Thomas heel -> provide stability to the lateral longitudinal arch.
(4) Intended for flexible pes valgus.
4. Hauser bar (comma bar)
5. SACH heel
(1) A wedge of compressible rubber is inserted into the heel to absorb impact at heel strike.
(2) It provides slight plantar flexion, the cushion heel is indicated when the patient wears an orthosis with
a rigid ankle.
(3) After heel strike, the soft rubber absorbs impact, reducing stress on the heel and ankle, as well as
diminishing the moment of force tending to flex the knee.
6. Keel heel
(1) This prosthetic foot allows motion similar to that of SACH feet.
(2) The forefoot is able to conform to uneven terrain but remains supportive and stable during walking.
7. Sole wedge
(1) A wedge of firm material, usually leather, is incorporated on the lateral (or medial) half of the sole.
(2) Used to accommodate fixed deformity of the forefoot.
(3) Lateral sole wedge tend to evert or pronate the forefoot.
(4) Medial sole wedge tend to invert or supinate the forefoot.
8. Heel wedge
(1) Used to help accommodate a rigid deformity or correct flexible deformities of the hindfoot.
(2) When a wedge is used, the. Opposing heel counter must be sufficiently firm to resist any tendency of
the hind foot to slide along the inclination created by the wedge.
(3) Medial wedge can aid in realigning flexible pes valgus or can accommodate rigid pes varus by filling
the void between the sole and the floor on the medial side.
- A medial wedge is incorporated in a Tomas heel.
- Designed to rotate hindfoot in the direction of inversion.
(4) Lateral wedge
- Designed to rotate hindfoot in the direction of eversion.
- It compensates for fixed forefoot valgus, allowing the entire distal foot contact the floor.
9. Heel flare
(1) An extension attached, either medially or laterally, to the sole of the shoe intended to provide
mediolateral ankle stability.
(2) The slare can be added to the heel only.
(3) Not intended to correct a deformity but rather only to control motion.
(4) Indications: posttraumatic subtalar instability, hindfoot contracture, tone disorders that increase the
tendency to roll the ankle.
(5) The increased distance from the subtalar axis to the border of the flare result in a corresponding
increase
in moment of force generated around the subtalar axis.
(6) This increased moment tends to produce or to resist eversion or inversion of the hindfoot.
(7) Medial flare is used to resist inversion; lateral flare is used to resist eversion.
Foot orthosis
1. Introduction
(1) It is usually a 3-quarter length insert which extends from the posterior border of the shoe to a point just
posterior to the metatarsal heads.
(2) A full length insert which covers the entire sole of the foot is less often used.
 (3) The orthosis is often contoured to provide medial longitudinal arch support and may also have an
anterior
convexity to support the metatarsal arch and relieve pressure on the metatarsal heads.
(4) It may also be thickened in various areas to serve as wedge.
2. UCBL (University of California at Berkeley Laboratory) insert
(1) Rigid plastic orthosis molded over a modified of the mid and hindfoot.
(2) The insert encompasses the heel and extends forward terminating at a point just posterior to the
metatarsal heads.
(3) It has posterior and sidewalls, covering the heel and both sides of the foot to a level just below the
malleoli.
(4) A very effective longitudinal arch support because it helps maintain the optimal position of the
calcaneus
relative to the talus and stabilize the intertarsal and tarsometatarsal joint.
3. Heel cup
(1) A rigid plastic insert that covers the plantar surface of the heel.
(2) Used to prevent lateral calcaneal shift in the flexible flat foot.