Orthopaedic Footwear

…GETTING IT RIGHT

Many of us squeeze our feet into shoes that are either too small, too narrow or both.

Why not take the test for yourself? Whilst standing, ask someone to draw around your feet one at a time. Then cut out the shape of your foot and put it into your shoe. What happens? Well the chances are it either won’t fit in at all or it will float. In other words, your shoes will either be too small for your feet or you have bought a bigger size to accommodate the width.

When trying shoes on in a shop, steer clear of the ones that are uncomfortable the minute you try them on. You should never have to ‘break in’ new shoes.

The best type of shoe is one with a fastening, a buckle, laces or Velcro strap. This is because the fastening helps to keep your heel in the back of the shoe. If your heel is held in the correct position in the shoe, then the rest of your foot will also be in the right place. Otherwise, your foot will slide forward, particularly with a higher heel and the shoe and your foot will not work together.

High heels are not ideal footwear, as they increase the pressure on the ball of your foot and can cause problems at the knee joint. For special occasions, they will not do any lasting damage, but for everyday wear, try not to exceed a heel height of 4cm preferably 2.5cm.

If you buy a larger size of shoe, just to accommodate the width of your foot, you will find that your foot will not sit correctly in the shoe and will slide forward, making the widest part of your foot sit in the wrong part of the shoe. A shoe is usually designed to flex at its widest point and if your foot can’t bend at that point, because your shoe does not fit well, it can lead to very painful joints and tired aching feet.

When shopping for shoes, the best time to try them on is in the late afternoon. This is because your feet swell as the day goes on.

If you are unlucky enough to have feet that simply will not fit into normal retail footwear all is not lost. There are a number of companies offering larger sizes and wider fittings than the general retail sector. When all else fails the only real option is to have shoes made. We have access to over thirty different manufacturesthat offer many different last sizes. Some only offer a fully bespoke service which involves making personal lasts from a defined series of measurements (BS 5943). This labour intensive process is very costly but is the only way to overcome severe deformity of the feet. Bespoke footwear can run into thousands of pounds for the first pair and many hundreds for subsequent pairs.

Semi-bespoke footwear manufacture involves the same series of measurements. This time we take a standard last and add to it to form a new last. Some even have the capability to use the front of one last joined to the back of another. This is still costly, but not as costly as the bespoke option.

The least cost route is called stock footwear. This is footwear made on one of a range of standard lasts, usually slim, standard, wide and deep, wide, deep etc. Each manufacturer hasits own series of lasts each with different measurements. Understanding who does what and having the last size specifications enables the footwear consultant to chose the least cost option.

As well as making shoes that fit your feet, a number of modifications can be carried out on footwear to improve its function, such as rocker soles for people with limited or no movement in the big toe, sockets for calipers, special bracing, stiffeners or soles to provide support, wedge soles, raises etc. Some of these modifications can also be carried out on retail footwear.

Some footwear problems solved

Heel slip
First of all, all footwear should slip a little at the heel. There are several ways of reducing heel slip including heel grips, tongue pads and lacing techniques.
Heel grips: These may be made of a number of materials and are normally adhered to the inside of the heel towards the top of the shoe. The heel grips, made from suede material, generally last much longer than gel types.
Tongue pads: These are D shaped pieces of surgical felt adhered to the inside of the tongue of the shoe and have the effect of reducing the distance between the tongue and the heel.

Lacing Techniques: Lace the shoes as normal until you get to the second hole from the top. Thread the lace up through the second hole then down through the top hole to form a loop. Do the same with the other lace. Thread the lace end across and under the loop you have formed with the opposite lace. Tie off normally.

Tight forefoot
The obvious answer is to buy shoes that are wide enough in the first place. However, with lace-up shoes it is possible to ease the forefoot by lacing the shoe loosely up to the second from top eyelet, wrap the laces round each other three times then continue with the lacing and tie off normally.

Loose forefoot
If your feet slop around in your shoes at the front try inserting a forefoot filler which is basically the front half of an insole. Occasionally two or more may be required to achieve a good fit.

Pain in the top of the foot
This is often caused by the criss-cross effects of the lacing. To avoid this, start from the bottom, lace normally to just beneath the discomfort, pass the laces up through the eyelet down through the next eyelet. Continue lacing and tie off as normal.

Localized pressure from hammer toes etc
Take your shoes to a cobbler to have the area stretched using stretching fluid and a ball & ring stretcher.