Chapter 5 – What to Look for in an Orthopedic Shoe


Characteristics of Quality Orthopedic Shoes

Orthotics

Orthopedic Shoes by Condition

Foot pain? Knee pain? Back pain? It does not matter where it pinches or X-ray of footaches, orthopedic shoes can relieve pain quickly. But the right pair of shoes offers more than just relief. It can prevent foot deformities and injuries, and in some cases, it can even correct them.

In this chapter, you will discover how to:

and much more! If you suffer from a common foot deformity or injury, it is time to see how orthopedic shoes can dramatically improve your quality of life.


Characteristics of Quality Orthopedic Shoes

Though orthopedic shoes are often designed to treat specific conditions,Foot bones there are a few basic characteristics that are consistently important across the board. Look for these key features the next time you go shopping for orthopedic shoes.

  • A wide and deep toe box: Hammertoe, claw toe, corns, calluses, blisters, and bunions are simply a few of the foot deformities that can be caused or aggravated by toe boxes that are too narrow or too shallow. Cramming your toes into a shoe is simply not worth the long-term consequences to your health. Your toes should be able to spread out comfortably in your shoes with wiggle-room to spare. Opt for round or square toes over pointy-toed shoes.
  • Removable insoles: Purchasing shoes with removable insoles allows you to change the size of your shoes in order to accommodate the swelling of your feet. It also enables you to replace your shoes’ insoles with custom orthotics. Finally, removable insoles work wonders when it comes to drying your shoes quickly and thoroughly. Dry shoes are important when it comes to preventing bacterial or fungal infections such as Athlete’s foot or fungal toenail infections.
  • Firm heel counter: Heel counters are designed to add stability to the shoe. To check if a shoe has a firm heel counter, press your thumbs against the back of the heel. If the heel bends inward easily, it does not have a firm heel counter. If the heel resists bending, a firm heel counter is present.
  • Contoured foot bed: Orthopedic shoes should complement the natural curves of the foot. Contoured foot beds are designed to fit and support your feet in all the crucial places.
  • Slight heel: Heels are sometimes considered a negative feature in shoes for people with foot injuries or deformities, but in some cases, a slight heel is helpful. Look for shoes that provide a subtle lift. Anything from a 1/2 inch to 1 and 1/2 inch heel could be appropriate for your specific condition.
  • Rocker bottom sole: Shoes with a “rocker bottom” sole have an outsole that points slightly upward at the toe and the back of the heel so that the foot rolls smoothly through its stride without putting excessive pressure on the ball of the foot.

Note: Rocker bottom soles are not for everyone. Check with a doctor to make sure that this feature is beneficial for your condition.

  • Seamless interior: Smooth interiors are especially important for people with conditions such as diabetes or lymphedema, or who are vulnerable to minor foot injuries. A seamless interior helps to protect the delicate skin of the foot from friction along the seam line.
  • Breathable uppers: Keeping the foot dry is important when it comes to keeping the foot infection free. Shoes that are made out of breathable materials promote air circulation and keep the shoe free of sweat and other moisture.
  • Padded tongue and collar: An ultra-soft tongue and collar helps to prevent irritation that can lead to minor foot injuries such as blisters and calluses.
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Orthotics

Foot or ankle orthotics are devices designed to support, align, or protect the feet and ankles. They also are used to correct or to prevent deformity. Orthotics are sometimes referred to as orthopedic inserts or devices. They can be as simple as a foam insole that you purchase at a drug store or as complex as a brace you have custom-made by a podiatrist.

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Rigid OrthoticsMaking impressions for orthotics

These orthotics are capable of changing the way the foot functions. They are usually made by a podiatrist. The traditional method is to take a plaster cast of the patient’s foot, but many podiatrists use high-tech methods such as laser systems or semi-weight bearing foam. (Note 6) The goal of all these methods is to provide the patient with a
custom-fit. Most rigid orthotics are made from a hard plastic or compressed fiber.

Rigid orthotics can be used to prevent extreme overpronation, make uneven limbs level when wearing shoes, and address pain in the lower back and upper legs.

Note 6: Another method involves the patient standing on a bed with small rods that correspond to the sole of the foot. The way the rods move when the patient stands on them provides the podiatrist with information about the foot’s shape.

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Soft Orthotics

These orthotics are designed to absorb shock and alleviate pressure in key points of the foot and ankle. They are made from soft, pliable materials such as cork, leather, foam, and rubber. Some insoles are even made from viscoelastic polymers, a gel-like substance.

Soft orthotics can be used to treat plantar fasciitis, runner’s knee, cavus foot (high arch), and foot problems related to diabetes.

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Semi-Rigid Orthotics

These orthotics are designed to enhance balance and agility in the foot and ankle. They are primarily used by athletes, or people who exert an above-average amount of stress on the bones of their feet. Semi-rigid orthotics are made from alternating layers of soft and rigid material.

Semi-rigid orthotics are usually sport-specific. They are also sometimes used by people whose careers force them to be on their feet all day.

No matter which type of orthotic you use, it is important to adjust your shoes to accommodate the orthotic. Sometimes people go up an entire size. Remember: When shopping for new shoes, bring your orthotics with you.

Also, it is important to note that orthotics can do as much harm as good. If you overcorrect for a certain condition, you could end up exacerbating the condition or creating a new problem. Most of the orthopedic insoles that are available over-the-counter are safe to use without consulting a podiatrist first. But if you notice any foot, ankle, knee, leg, or back pain, it is best to check in with your doctor. Orthotics that significantly change the way the foot functions are only available through a podiatrist—and with good reason!

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Orthopedic Shoes by Condition

As mentioned earlier, what you need out of your orthopedic shoe will depend on the specific needs of your feet. Different foot types, conditions, injuries, and deformities all require slightly different combinations of key orthopedic features. Use the catalogue below as a basic guide when shopping for shoes suitable for a particular condition.

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Achilles Tendinitis

Achilles tendinitis occurs when the Achilles tendon becomes inflamed or irritated. It is often related to sports injuries, particularly overtraining, or a sudden increase in physical exercise. A sore and swollen Achilles tendon can also be a sign that shoes are not supporting the feet properly.

Avoid shoes with:

  • little to no cushioning in the heel
  • heels higher than 1 and 1/2 inches
  • no heel
  • little to no arch support

Look for shoes with:

  • lots of cushioning, particularly in the heel
  • a heel somewhere between 1/2 inch and 1 and 1/2 inches
  • excellent arch support
  • motion control features (see Chapter 3 for more details)

Notes: Heel lifts are available at your local drugstore and your podiatrist’s office. By adjusting the size of your heel, you can change the amount your Achilles tendon stretches. A higher heel means a shorter tendon. This can help you recover from injury, but it also can permanently shorten your tendon. A lower heel means a more stretched tendon. Ask your doctor for details.

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Arthritis

There are several types of arthritis. The condition can be genetic, the result of disease or infection, or it can develop over time due to injury or general wear and tear. Although arthritis can strike at any age, it is the leading cause of disability among people who are over 55.

Avoid shoes with:

  • little to no cushioning
  • little to no shock absorption
  • shallow or narrow toe boxes

Look for shoes with:

  • lots of cushioning
  • excellent shock absorption
  • excellent arch support
  • wide and deep toe boxes
  • rocker bottom soles
  • removable insoles for easy size adjustment
  • hook and loop fasteners (e.g., Velcro®) for easy size adjustment

Notes: Arthritis is often accompanied by corollary deformities such as bunions, hammertoe, etc. Choose shoes that will prevent these deformities from forming, or accommodate them if they have already developed.

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Bunions

A bunion is a common foot deformity characterized by a pronounced bump that develops at the base of the big toe. The bump is actually the enlargement of the joint near the first metatarsal bone. Bunions are sometimes accompanied by a condition known as hallux valgus, which occurs when the big toe angles toward the little toe instead of pointing straight ahead. Bunions are a hereditary condition that can be exacerbated by wearing ill-fitting footwear.

Avoid shoes with:

  • pointed toes
  • narrow or shallow toe boxes
  • heels higher than 1 inch

Look for shoes with:

  • square or round toes
  • deep and wide toe boxes
  • seamless interiors to prevent irritation
  • slight heels

Notes: Sometimes people with bunions choose to go up a shoe size in order to accommodate the deformity. There are a variety of orthotic devices for people with bunions including toe separators, bunion cushions, and bunion splints.

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Cavus Foot

Please see “High Arches.”

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Claw Toe

Please see “Hammertoe.”

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Club Foot

Clubfoot, or Giles Smith Syndrome, is a birth defect that causes one or both feet to turn inward so that the toes point to the middle of the body. The feet also appear as if they are rolling over, so that the tops of the feet are where the soles of the feet should be. Children affected by clubfoot tend to have feet that are shorter and broader than the average child’s feet. Muscles in the calf may also be affected, resulting in the lower leg being disproportionately small.

Special shoes exist for people with club feet but recommendations are best left to a doctor. Often children who are undergoing the Ponsetti method of treatment will use a combination of casts, splints, and orthopedic shoes.

Children who are successfully treated for club foot are more likely to end up with feet of two different sizes. The former club foot tends to be significantly smaller than the normal foot. Please see Chapter 1 for more information on mismatched feet.

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Diabetic Foot

The combination of poor circulation and decreased sensation caused by neuropathy makes it difficult for people with diabetic foot to detect foot pain. Small cuts, blisters, and other foot injuries often go unnoticed and therefore untreated. Infections develop more easily and are harder to treat without the proper circulatory defense. Diabetic foot can lead to foot deformities such as calluses, corns, bunions, and hammertoe. In more serious cases, foot ulcers can develop on the foot, and under extreme circumstances, amputation may be necessary in order to prevent an infection from spreading to the rest of the body.

Avoid shoes with:

  • narrow or shallow toe boxes
  • little to no cushioning
  • heels higher than 1 inch

Look for shoes with:

  • wide and deep toe boxes
  • removable insoles for a flexible fit
  • rocker bottom soles
  • firm heel counters for increased stability
  • hook and loop (e.g., Velcro®) fasteners for easy size adjustments
  • seamless interiors

Notes: People with diabetes often benefit from orthotics designed to protect and support the foot. Inserts made with a material called Plastazote® change shape based on heat and pressure. This enables the insert to accommodate specific hot spots and pressure points.

For more information on diabetic foot care, see 101 Foot Care Tips for People with Diabetes by Baltimore podiatrist Neil M. Scheffler, DPM, FACFAS.

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Flat Feet or Fallen Arches

Flat feet (also known as fallen arches) is a common condition that occurs when the foot’s arch collapses. Some people are born with flat feet, while others develop it as they age. People with low or fallen arches are generally over-pronators. (For more information on pronation, please refer to Chapter 1 and Chapter 3.)

Avoid shoes with:

  • little to no arch support
  • excessive cushioning
  • a soft, flexible fit

Look for shoes with:

  • good arch support
  • motion-control or stability features (please see Chapter 3 for more information)
  • a firm heel counter for added stability
  • a sizable medial post
  • a straight last

Notes: Over-the-counter and prescription orthotics are readily available for people with flat feet or low arches.

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Hammertoe

Hammertoe is a common foot deformity that occurs when the middle joint of the toe becomes bent. If the upper joint is bent, the condition is technically referred to as mallet toe. If both joints are bent, the condition is classified as claw toe. Hammertoe is caused by muscle/tendon imbalance in the lesser toes; it is sometimes linked to wearing ill-fitting footwear.

Avoid shoes with:

  • narrow or pointed toes
  • shallow toe boxes
  • heels higher than 1/2 inch

Look for shoes with:

  • deep, wide and square toe boxes
  • slight heels (approximately 1/2 inch)

Notes: Open-toed shoes sometimes help to relieve pressure on the deformity.

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Heel Pain

Please see “Plantar Fasciitis.”

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High Arches

Most of the body’s weight rests on the ball of the foot and the heel, with the arch off the floor. This condition is less common than flat feet or normal arches, and it is sometimes linked to underlying orthopedic or neurological conditions.

Avoid shoes with:

  • little to no shock absorption
  • little to no cushioning
  • little to no arch support
  • extensive stability features such as a medial post, heel counter, etc.

Look for shoes with:

  • little to no shock absorption
  • lots of cushioning
  • good arch support
  • soft midsoles
  • a “flexible fit”

Notes: Othotics are widely used to cope with high arches. Sometimes ankle braces are also needed; alternatively, wearing a high-top shoe can give the ankle extra support.

High arches are sometimes accompanied by corollary deformities such as calluses, corns, and hammertoe. Choose shoes that will prevent these deformities from forming or accommodate them if they have already developed.

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Lymphedema

Lymphedema is a condition that causes swelling in the arms and legs. It
occurs when the body retains interstitial fluid (Note 7) (usually due to a blockage in the lymphatic system) instead of draining the fluid properly. In rare it after surgery, trauma, or radiation treatments for various cancers.

Avoid shoes with:

  • little to no cushioning
  • little to no arch support
  • narrow or shallow toe boxes
  • open toes or exposed heels
  • heels higher than 1/2 inch

Look for shoes with:

  • wide and deep toe boxes
  • mesh above the toes for breathability
  • removable insoles for adjustable size
  • hook and loop fastenings for adjustable size

Notes: Shoes that expose the foot should be avoided at all costs. That means no flip-flops, sandals, slip-ons, or slip-ons. Shoes for people with lymphedema should not be tight; it is important to accommodate the foot at its largest size.

Note 7: Interstitial fluid is the fluid that bathes and surrounds cells in the body.

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Mallet Toes

Please see “Hammertoe.”

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Metatarsalgia

Metatarsalgia is a painful condition that is localized in the metatarsal region of the foot (i.e., the ball of the foot). It occurs when the metatarsal heads become inflamed, and it is often caused by repeated stress on the ball of the foot.

Avoid shoes with:

  • narrow or shallow toe boxes
  • pointed toes
  • little to no cushioning
  • little to no arch support
  • heels higher than 1/2 inch

Look for shoes with:

  • extra cushioning, particularly beneath the ball of the foot
  • excellent arch support
  • rocker bottom soles

Notes: People with metatarsalgia often benefit from purchasing shock-absorption gel inserts. The more general goal is to remove excess pressure from the ball of the foot. This means no high heels, lots of cushioning, and shoes that allow the foot to smoothly roll from heel to toe without putting pressure on the metatarsal area (e.g., shoes with rocker bottom soles).

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Plantar Fasciitis

Plantar fasciitis is a condition that causes extreme arch and heel pain. It occurs when the plantar fascia, the thick fibrous tissue that stretches from your heel along the bottom of your foot to your toes, is stretched beyond its limits.

Avoid shoes with:

  • no arch support
  • little to no cushioning
  • a heel higher than 1 and 1/2 inches
  • no heel

Look for shoes with:

  • a slight heel (1/2 to 1 and 1/2 inch)
  • excellent arch support
  • excellent cushioning
  • rocker bottom soles

Notes: Doctors can help you find orthotics that will more evenly distribute your weight across the bottoms of your feet.

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Polio

Polio is a viral infectious disease. It attacks the nervous system, which in turn, can lead to certain muscle groups becoming paralyzed. Foot deformities and conditions commonly associated with polio include flat feet, high arches, hammertoe, bunions, and claw toe. Please refer to these specific conditions for more information.

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Psoriasis

Psoriasis is a chronic autoimmune disease that affects the skin, nails, and joints. It causes scales to form on the skin (known as psoriatic plaques) and can cause pain in the joints. Psoriasis is most common on the elbows and knees, but it also can affect the hands and feet. In addition to psoriatic plaques, psoriasis on the feet can include blisters, cracking, and swelling.

Avoid shoes with:

  • synthetic materials such as plastic that cause the feet to sweat
  • narrow or shallow toe boxes
  • pointed-toes

Look for shoes with:

  • breathable uppers that promote air circulation
  • wide and deep toe boxes
  • removable insoles for a flexible fit

Notes: It is also a good idea to avoid nylons or socks made of synthetic materials. The goal is to keep feet cool and dry.

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Trauma

This heading covers any kind of trauma to the foot, toes, or ankles. It includes breaks, bruises, or sprains; it also includes foot, toe, or ankle surgery.

Avoid shoes with:

  • little to no cushioning
  • little to no shock absorption
  • narrow or shallow toe boxes
  • pointed-toes
  • open toes or exposed heels

Look for shoes with:

Notes: If your foot undergoes any kind of trauma, it may be a good idea to go barefoot while the foot recovers. You want to avoid forcing your foot into a shoe too soon. Once you are ready to be on your feet again, look for shoes that provide excellent cushioning and can accommodate swelling. Athletic and orthopedic shoes tend to provide a good combination of support and protection.

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Go to CHAPTER 6 – How to Spot Counterfeits