what-when-how
In Depth Tutorials and Information
When adapting retail footwear for an elevation, it is important that the
shoe be a good it with a secure fastening, and snug around the rearfoot
to provide stability. The heel should be low and broad, again for stability.
If the required external elevation is over 5 cm, it should be added to a
boot rather than a shoe. The boot will provide more stability and the
weight of the raise will not pull the boot off the foot, as may happen with
a shoe. The type of sole must be suitable for outside adaptation. Some
soles cannot be filleted because of their honeycomb construction.
SACHs
Foot function and shock absorption can be improved using a solid ankle
cushion heel modification or SACH, in which a medial or lateral portion
of the heel unit is replaced by a wedge of less dense material. The rear
wedge of the heel then dissipates the shock at heel strike while the denser
anterior portion stabilizes or controls midstance. A lateral to medial SACH
may reduce hyperpronation in children. Calcaneal pain may be improved
with shock reduction as can rigid ankle deformities. A combination of a
rocker sole and a SACH can improve gait where there is minimal motion
in the joints as a result of joint fusion or arthritis.
Upper adaptations
Tongue pads can provide extra cushioning to the dorsum of the foot, and
can be used to decrease the girth of the shoe over the instep.
Clinical decision making for footwear choices
Although the footwear options have been described, clarification is
required as to which patients benefit from specialist footwear.
Who should be referred for specialist footwear?
Patients may benefit from specialist footwear if they suffer from:
1.
Functional or structural problems associated with systemic diseases,
for example a diabetic neuropathic foot, Charcot foot, rheumatoid
arthritis foot deformity.
2.
Structural problems caused by trauma, fractures and grafts.
3.
Structural problems caused by amputations or other surgical
procedures.
4.
Functional or structural problems of the lower limb which impact on
the foot, for example leg length difference due to Paget's disease, or
muscle wastage due to stroke.
