book on orthopedic shoes by Wendy Tyrrell and Gwenda Carter
Notes
Preface
- footwear ignored as therapeutic strategy
- shoes blamed, what what to change to?
- keep going to clinics and wear what you want
- orthotists (Britain) and pedorthists (US) only act on referrals, especially from orthopedic surgeons
- diabetes foot complications
- US Therapeutic Shoe Bill in 1993
- retail footwear can be used for many
- stock orthopedic on special lasts
- modular orthopedic footwear
- fully bespoke
- before: any color, so long as black
- no textbook since 1950s
1
- people have different shoes for different purposes
- ladies court shoes cause problems
- rigid industrial footwear, for protection
- “Patagonia” from “patagones” (big feet)
- if large enough for foot when loaded, needs to be fastened during swing phase
- slip-ons have to be wedged on
- check that laces actually close and undo
- uppers must contain soft tissue around heel
- heel ideal: 2.5-4cm
- higher heel puts more weight on metatarsal heads
- change in center of gravity causes ankles plantarflex, knees bend, hips flex, lumbar spine may move
- heel counters should grip heel
- 2002 Brazil footwear comfort norms
- “Women particularly love shoes…”
- comfort corresponds to sensitivity
- feet have lower sensitivity than hands
- long heel measure for instep fastening
- 3% change in foot volume over day
- vigorous exercise can change up to 8%
- est. 85% of people in wrong-size shoes
- leather ideal for uppers
- comparative table of outsole materials on page 18
2
- constant theme: dissatisfaction with appearance of therapeutic footwear
- underestimate cost of shoes given
- Health Belief Model
3
- lasts
- volume: polythene
- “deeper in the midfoot region, clipped in along the top line and flared and extended in the toe” (versus the foot)
- “heel curves (comb)”
- photos and information from Spring Line
- CAD has trouble flattening
- last formes originally of leather
- “pump for me” and “pump line”
- grading
- water-jet cutting
4
- still labor-intensive, hence expensive
- [interesting uses of “foxings” in Figure 4.1]
- Oxford = Bal
- Gibson = Derby
- metal to puff
- mudguards
- appliques
- saddle/bar over vamp
- “heel pitch” as angle of heel
- heel pitch makes shoes seem shorter
- measure heel height at breast
- soffee
5
- principles of shoe fitting
- examine creases and wear on existing shoes
- overall length, heel-ball, ball-toe
- don’t hallux the longest toe
- extra style room in unused space
- lower heel requires more toe space needed due to full range of motion
- hypermobility requires more toe room
- children need growth room
- “ball pocket”
- flex angle
- widest part
- snug around heel
- heel movement from pronation
- wedge around infra-malleoli area
- malleoli irritation from quarters
- pocked: top edge of counter to heel eat
- too narrow causes pushing of quarters from insole, creating a ridge and calluses
- heel bumps
- if can’t lower heel, change shape
- cheap: no heel counters
- backstrap sandals cause intolerance of counters
- upper should hug instep as snugly as possible
- insteps: Oxford/Bal v. Gibson/Blucher
- normal foot expands about 5% over day, 7-8% after exercise, when warm or humid
- ball width: Weight bearing, temperature
- professionalism versus bad preferences
- short versus long vamp patterns
- gaping, grinning
- low Oxford or Bal should be able to slide foot forward and put pencil behind heel
- size sick: add 2 sizes, 2½ for hypermobile
- Ken Hall measuring gauge
- Robert Gardiner’s Illustrated Handbook of the Foot
- King Edward II decree
- Edwin Simpson system with proportional girth increases
6
7
- “It is absolutely essential that orthoses and footwear are considered as a single therapeutic entity.”
- “The shoe and the orthotic must complement each other and must function as a unit.”
- interface between foot and shoe
- add twice the orthotic height to girth
- orthotic must match heel pitch of the shoe
8
- prescription footwear
- “tortuous referral route”
- foot at end of circulatory paths
- minimal stiffeners, soft uppers, light shoes
- “Patients will evaluate the footwear in the light of self-image…”
9
- deep treat grooves for mud
- trips, slips, and falls
- cushion good or bad, depending
- higher heels
- more forefoot load
- less heel load
- average 2.5cm heel height for therapeutic
- higher heels
- reduce lumbar lordosis
- shorten strides
- historically orthopedic shoes modified the midsoles
- now mostly modifying outsoles
- cradles
- Solid Ankle Cushion Heel / Buffer Heel
- Rounded Heel
- Thomas Heel
- Flared Heels / Floats
- Buttress Heel
- Wedge
- Bars
- Rocker Soles
- Raises
- Pelvic Level for checking leg length
- calipers
10
- ready-made therapeutic footwear since the 1960s
- new orthotic procedures reduce need
- modular footwear: modify lasts
- measure waist girth just behind the metatarsals
- measure instep girth “distal to the tuberosity of navicular”
- toe depth measure for clawed, damaged toes
- last, pattern, and sole modifications
- usually one fitting, in rough states
- modifications after fitting can cost more
11
- bespoke = made on individual lasts
- can add up to 2mm to stock last girths, 6mm to depth
- British Standard 5943 for measurements
- standard heel height 1 inch
- plaster standing impressions
- watch gait, make notes on it
- evaluate hosiery
- record actual measurements, without allowances
- heel width measure
- can’t always place feet flat for tracing
- joint: around both joints (angled ball girth)
- measure leg lengths supine
- casting
- wrap in cling film
- mark true horizontal and vertical lines on the cast
- mark horizontal lines across the front, down the instep, before cutting open