What we wear on our feet is important. The cushion, the support, the width, the length, the enclosure; all of it matters. Our feet are used all day long. Making sure your shoes fit right is a simple way to take care of the feet that take you through your day. Sometimes over-the-counter footwear, even orthopedic footwear, just doesn’t do the trick, and we need to make modifications to keep our feet happy.
What’s the best way to tell if you need to modify your footwear? If you experience foot pain or discomfort in your current footwear, a BioPed Pedothist can determine which shoes are most suitable for your feet and even modify them to accommodate your foot condition.
Signs you may need footwear modifications:
Modifications to footwear are prudent for many reasons. In addition to removing pressure from painful areas and giving more appropriate support to those in need, traditional footwear sizes and fit may need to be adjusted for feet that are thicker, wider, or have bony prominences like bunions, bunionettes, or dorsum exostosis (a bump at the top of the foot). Footwear modifications may also be a solution for someone who needs additional support but is unable to financially afford custom-made orthotics.
Most common footwear modifications:
External modifications – permanent changes made to the outside of the shoe
Stretching – When a shoe feels too tight overall or in a specific spot, such as over a bunion or hammer toe, shoe stretching can be used to adjust the upper’s width. A full stretch or spot stretch (more targeted) takes approximately 48-72 hours, during which time the shoe remains on the stretcher to allow the upper material to adjust. Generally, this is effective for tight spots or general tightness caused by lack of depth or soft tissue movement during standing. Foot deformities and structural changes to the foot’s shape would require more drastic treatment, though they are much less common.
A lift or rocker sole – If you have a leg length discrepancy from a congenital disorder or a broken leg in childhood, adding sole height to the shoe of the shorter limb will improve your posture and gait. As well as adding a lift, make sure the sole is rockered, so moving through gait and toe off are easier, and pressure on the ball of the foot is reduced.
Toe slider – In the event of a shuffle gait or neurological deficiencies from a stroke or MS diagnosis a toe slider can increase the life of a shoe and reduce the occurrences of tripping and falls. This is done by heat moulding RCH 500, a plastic, to the area concerned around the toe to reduce friction.
Internal modifications – permanent and sometime impermanent modifications to the insole of the shoe
Internal metatarsal pads – Forefoot pain, also known as metatarsalgia, can be debilitating and is localized to the ball of the foot. Often this is due to a dropped transverse arch, which supports the metatarsal heads and the toes. By adding a small hill just behind those bones on the insole of the shoe, it supports that arch and relieves pressure and discomfort. This is done by adding a preformed metatarsal pad bilaterally (to both sides) to support the foot and offload the painful areas, improving comfort.
Internal heel lift – This is an impermanent modification, a wedge that fits under the insole. This can be used to treat conditions such as leg length discrepancy or achilles pain so long as the correction height can fit comfortably in the shoe without raising the heel too high. The EVA wedge is typically no higher than 6mm and can range in density depending on the cushion requirements of the patient.
Excavations – Excavating under areas of high pressure, for example under a corn or callus, can relieve pressure by offloading the painful area and most times, prevent these calluses or corns from returning as aggressively. These excavations can then be padded with a layer of PPT for cushioning in the event that we are adding comfort for an arthritic joint, or a bony bump.
When is it time to consider custom shoes?
If you have a congenital foot deformity such as clubfoot, or and advanced condition such as charcot foot, or have had a foot amputation that makes even modifications to over-the-counter footwear unsuitable, it may be an indication that custom shoes are in order. BioPed Footcare Clinicians can assess your footwear needs, perform modifications as needed and recommend custom footwear if the situation calls for it.
