FE-401: Manufacturing of Footwear Technology-IV

(Orthopedic Footwear)

Md. Mukter Alam

Lecturer
ILET, University of Dhaka
 Deformity (toes, unevenness of the length of the lower limbs, etc.)

Orthopedic Footwear

Instability (following a toe amputation for example)

Difficulty in putting on shoes (rheumatoid arthritis, dwarfism, etc.)

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 Diabetes

Diabetes is a chronic condition. This means that it lasts for a long time, often for someone's whole life. Diabetes
mellitus (medical term of diabetes) actually refers to a group of diseases that affect how your body uses blood
glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for
the cells that make up your muscles and tissues. It's also your brain's main source of fuel. Glucose comes from the
food and is also made in liver and muscles. Blood carries the glucose to all of the cells in body. Insulin is a chemical
(a hormone) made by the pancreas. The pancreas contains clusters of cells called islets. Beta cells within the islets
make insulin and release it into the blood. Insulin helps the glucose from food get into cells. If body does not make
enough insulin or if the insulin doesn't work the way it should, glucose can't get into cells. It stays in blood instead.
Blood glucose level then gets too high, causing pre-diabetes or diabetes.

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 Types of Diabetes

Type 1 Type 2

Gestational diabetes (GDM)

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Symptoms of Diabetic Feet
As a diabetic, it is important to remain alert to any problems with your feet. Taking the proper precautions
will help prevent injury and keep your feet healthy. Below are a few symptoms to look out for:
 Loss of feeling in your feet
 Changes in the shape of your feet
 Foot ulcers or sores that do not heal

Diabetes and foot problems facts

 Two main conditions, peripheral artery disease (PAD) and peripheral neuropathy, are responsible
for the increased risk of foot problems in people with diabetes.
 People with diabetes have an increased risk of ulcers and damage to the feet.
 A number of different kinds of foot problems can occur in people with diabetes. These include
bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails.
 Treatment depends on the exact type of foot problem. Surgery may be required for some cases.
 Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life-
threatening if bacterial infection develops (wet gangrene).
 Many diabetes-related foot problems can be prevented by good control of blood sugar levels
combined with appropriate care of the feet.

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Diabetic Footwear:
Specialized custom-made footwear which is used to prevent different complications of foot due to diabetes such
as: strains, ulcers, calluses or an even amputation etc. is called diabetic footwear. It is also known as therapeutic or
medicated shoe. CMS, the Centers for Medicare and Medicaid Services, determines some essential criteria for
manufacturing of diabetic footwear. This is under various codes which are known as HCPCS codes. HCFA
Common Procedural Coding System is a coding system used to describe outpatient services provided to the
patient. HCPCS Codes A5500, A5501, A5512 and A5513 are provided for diabetic shoe. Definition for diabetic
footwear is given by HCPCS codes are:
A depth shoe (A5500) must meet the following definition to qualify for
the benefit category:
1. Has a full length, heel - to - toe filler that when removed provides a
minimum of 3/16" of additional depth used to accommodate custom -
molded or customized inserts.
2. Is made from leather or other suitable material of equal quality.
3. Has some form of shoe closure.
4. Is available in full and half sizes with a minimum of three widths so that
the sole is graded to the size and width of the upper portions of the shoe
according to the American standard last sizing schedule or its
equivalent. This includes a shoe with or without an internally seamless
toe. 6
•A custom-moulded shoe (A5501) must meet the following definition
to qualify for the benefit category:
1. Is constructed over a positive model of the patient's foot.
2. Is made from leather or other suitable material of equal quality.
3. Has removable inserts that can be altered or replaced as the patient's
condition warrants.
4. Has some form of shoe closure. This includes a shoe with or without
an internally seamless toe.

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 Why Diabetic Shoes

Diabetic shoes are not only meant to increase comfort in diabetics who wear such shoes. There is a special purpose
to the creation and use of diabetic shoes. Diabetic shoes are designed specifically to help diabetics avoid issues
such as skin breakdown, especially if a person is currently suffering from a foot disease.
Some people may be lulled into a sense of complacency that their feet are fine and free from risk, but the truth is
that there is a high possibility for them to experience conditions that can manifest in as little as a few hours (such
as a skin ulcer on the bottom of the feet might develop under a few hours if the feet are under constant pressure
and friction). If a diabetic person (or a person with poor blood circulation) does not take particular care of their
feet, there may even be a risk of amputation should further complications arise.
Diabetic shoes can help to prevent these issues and aid in keeping the risk of bigger feet issues low in persons with
diabetes and persons who have poor blood circulation. For example, it lowers the strain on the feet and keeps the
possibility of developing calluses and ulcers lowered. The pressure and friction on the feet caused by daily
movement becomes lowered and lessened.

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Objectives of Diabetic Footwear

 Relieve areas of excessive pressure: Any area where there is excessive pressure on the foot can lead to skin
breakdown or ulcers. Footwear should help to relieve these high-pressure areas, and therefore reduce the
occurrence of related problems.
 Reduce shock and shear: A reduction in the overall amount of vertical pressure, or shock, on the bottom of the
foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
 Accommodate, Stabilize and Support Deformities: Deformities resulting from conditions such as fat pad
atrophy, hammertoes and amputations must be accommodated. Many deformities need to be stabilized to relieve
pain and avoid further destruction. In addition, some deformities may need to be controlled or supported to
decrease progression of the deformity.
 Limit motion of joints: Limiting the motion of certain joints in the foot can often decrease inflammation,
relieve pain, and result in a more stable and functional foot.

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Diabetic Shoes: Essential Features

1. Available in multiple widths

2. Able to accommodate prescription and/or custom orthotics
3. Removable orthotic foot bed
4. Multiple layers of removable insoles (at least one extra removable insole layer)
5. Wide, roomy toe box to prevent the toes from being cramped
6. Seamless lining that is soft and smooth
7. Light weight, padded top line, cushioning upper & lining
8. Breathable construction
9. Anti-fungal & anti-bacterial lining
10. Deep & wide design to insert big insole
11. Sufficient ventilation
12. Meets the minimum HCPCS A5500 requirements

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Classification of Diabetic Footwear

1. According to stage of Diabetic period: a. Indoor diabetic Footwear

 Pre-diabetic Footwear b. Outdoor diabetic Footwear
 On-diabetic Footwear  Walking Shoe
 Feet affected diabetic Footwear  Running Shoe

Material Selection for Diabetic Footwear:

Several types of materials can be used for manufacturing ideal diabetic footwear. These can be either natural or
synthetic.
 Fine - grain natural chrome free leather
2. According to Wearingpurpose:
Stretchy synthetic material
 Fabrics
 Inter Lining
 Soft lining of vegetable tanned, suede, EVA, or Napha
leather
 Several types of Orthotics made of PVC, PU, EVA
 Good and hard Toe - puff & Stiffener
 Velcro fastening straps
 Light weight PU sole
 Leather & MCP combined Insole
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Ecological Leather for Diabetic Footwear:
Chromium (III) sulphate (Cr2(SO4)3) is a toxic chemical commonly used as leather preservative in the tanning
process. It is often associated with cancer of the respiratory tract, skin ulcers and renal failure. Chrome free means
that the special soft leather used in making of diabetic footwear does not involve the use of Chromium sulphate.
Chrome, like other chemicals, can be absorbed into the skin through direct contact or ingested by babies sucking
the shoes. By using Chrome free method of tanning such as vegetable tanning, Aldehyde tanning etc., we help to
reduce the amount of toxic waste. Now a days, the Chrome free leather is claimed as eco-friendly.

Some things to look for in good shoe designs for
diabetics are:
 Diabetic Shoes need to have a breathable
construction - sandals and fabric shoes are good for
this.
 Deep and wide designs that allow room for custom
made insoles.
 Designs with no interior scams (or covered scams) to
prevent rubbing injuries.
 Diabetic shoes need a roomy "toe box" to prevent
pinching or squeezing of the toes.
 Elastic or easily adjustable fit, to prevent the diabetic
shoe from sliding around on the feet.
Advantages of Ecological (Chrome free) Leather:
 Lighter in colour and can be converted into
pastel shade leathers
 Shrinkage temperatures of at least 70° C
 High softness and good lightness
 Natural sensation and pleasant touch
 Beauty over the time
 High performance leather often better than
chrome tanned leather
 Leather can be burnt without the hazard of
chromium (VI) formation
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Orthotics:
The word Orthotics is derived from a Greek word “ortho” which means "to straighten" or "align". An orthosis
(plural: orthoses) is an externally applied device used to modify the structural and functional characteristics of
the neuromuscular and skeletal system". It is a specialty within the medical field concerned with the design,
manufacture and application of orthoses.

Orthotics combines knowledge of anatomy and physiology, pathophysiology, biomechanics and engineering.
Patients benefiting from an orthosis may have a condition such as spina bifida or cerebral palsy, or have
experienced a spinal cord injury or stroke. Equally, orthoses are sometimes used prophylactically or to optimize
performance in sport.

There are many different conditions that can be helped using orthotics inserts. The foot plays an important role in
the kinetic chain of the entire lower body and problems can cause pain and injuries further up. For example,
runner's knee, shin splints and IT band syndrome may be caused by a collapsed foot arch that is placing excess
strain on the body. It's essential for medical orthotics to be fitted by a professional; otherwise, they can cause
more problems.

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 To Control, guide, limit and/or immobilize an extremities, joint or body segment for a particular reason.

 To restrict movement in a given direction.

 To reduce weight bearing forces for a particular purpose.

Purpose of Orthotics
 To aid rehabilitation from fractures after the removal of a cast.
 To assist movement generally.

 To correct the shape and function of the body, to provide easier movement capability or reduce pain.

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 Classification of Orthotics

 Functional Orthotics  Accommodative Orthotics

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Function of Foot Orthotics
The usual indications for foot orthoses are
• to relieve pressure on areas that are painful, ulcerated, scarred, or callused, to support weak or
flat longitudinal or transverse foot arches, and
• to control foot positions and thus affect the alignment of other lower limb joints.

All are concerned with improving foot function, controlling foot motion, reducing shock
absorption and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics
Orthotics are mechanical devices which are placed in a shoe (shoe inserts) to assist in restoring or maintaining
normal alignment of the foot, relieve stress from strained or injured soft tissues, bony prominences, deformed bones
and joints, and inflamed or chronic bursae (e.g., arch supports). Removable foot supports are placed inside the shoe
to manage different foot symptoms and deformities.

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Different Types of Foot Orthotics
Cushioning Insoles: Insoles slip into the shoe to provide extra cushioning and support.
Insoles are often made of leather, gel, foam, or plastic. These products make feet more
comfortable, give optimal absorption of the shock generated from every day and high
impact heel strike. The impact and force on the heel, joints, and back are thereby
reduced, helping to relieve pain and discomfort. Materials Used for Foot Orthotics
Arch supports: Some people have high arches. Others have low arches or flat feet. Arch • Soft or flexible foot orthoses
supports generally have a "bumped up" appearance and are designed to support the foot's • Rigid orthotics
natural arch.
• Semi-rigid orthotics
Heel liners: Heel liners, sometimes called heel pads or heel cups, provide extra
cushioning in the heel region. They may be especially useful for patients who have foot
pain caused by age - related thinning of the heels' natural fat pads.
Heel wedges: Depending on design, these are used to promote inversion (turning inward)
or eversion (turning outward), and prevent the hind foot (the ankle region) from sliding
down the incline created by the wedge.
Toe crests: These are crescent-shaped pads that are placed behind the second, third and
fourth phalanges to reduce stress and fill the void under the proximal (closer to the body
or metatarsals) phalanges.

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A Selection of Therapeutic Shoes by Professionals
Selection of therapeutic shoes for general foot pathologies, different ranges cover daily needs to ensure optimal
walking comfort in all circumstances.

Comfort shoes
The comfort shoes selected by expert guarantee sufficient space for the forefoot and toes. The
interior space prevents rubbing and compression of the instep. They are available in three widths:
standard, wide and extra-wide, to fit all body types. These comfort shoes meet the specific needs of
sensitive, swollen or diabetic feet, deformed toes and hallux valgus.
Made of natural or synthetic materials, four different styles are offered for sale: dress shoes,
sneakers, slippers and sandals. Each range is available for both women and men. Finally, most
models offer a removable insole that can be replaced by a custom-made foot orthosis.

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Regular shoe insoles are designed specifically to cushion our feet
and absorb as much shock as possible. Orthotics correct and
optimize the functions of our feet to enable an even distribution
of weight and remove pressure on heels, the ball of the foot,
bunions and corns between the toes.

How Orthotics Differ from Regular Shoe Insoles

Benefits of Using Orthopedic Shoes

Orthopedic shoes are for anyone who needs support for the structure and
mechanics of the foot, ankle and leg. Among the design elements that
separate orthopedic from regular shoes is a firm heel support to cushion
the rear of the foot. Others are “upper” orthopedic shoes that eliminate
pressure on bunions and hammertoes as well as seamless uppers to
preclude any rubbing or abrasion.
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