Shoes & Pedorthics: Therapy for the Feet


Although shoes come in fixed shapes and sizes, the feet that wear them don't. Besides coming in assorted shapes and sizes, feet lengthen and broaden naturally throughout adulthood. Feet also change size and shape with each movement – elongating, spreading out and contracting with every step. Consequently, feet experience enormous stress during the daily routine, even on ”quiet” days. Pedorthics can help relieve the pressures and contribute to better health.

Pedorthics (peh-DOR-thiks) is the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. Through pedorthics, shoes and foot orthoses can become therapeutic tools addressing a variety of common or complex foot problems in a conservative (non-surgical) way.

What Does "Foot Therapy” Do?

Like other types of therapy, foot therapy is generally intended to restore function, reduce pain, prevent further damage and/or improve mobility. Shoes, because they encase the foot, are automatically a significant element in foot care and treatment.

Shoes have two basic purposes: protection and performance. A credentialed pedorthist creates the therapeutic link between patient and footwear by working from a prescription to achieve the results the patient needs.

What Determines a Shoe's Ability to Protect and Perform?

There are six major factors, including:

  • Construction. Techniques – sliplasting, injection molding, welting, stitching, cementing, and so on – create differences in a shoe that don't "show” to the average person. Quality of construction is also a consideration.
  • Materials. The components of a shoe affect its firmness, flexibility, breathability, weight and functionality.
  • Heel height. When talking barefoot, the heel normally rises about 2 inches during each step; the front of the foot provides the push-off motion that propels the next step. In a flat-heeled shoe, the heel continues to rise naturally, and the foot gives a normal push-off. In a higher-heeled shoe, natural movement is altered. The initial effect is redistribution of weight; an enormous amount of pressure is redistributed onto the forefoot, affecting the ability of the toes to push off and changing a person's gait. With long-term usage, higher heels also have a ripple effect on the upper body: pressures on the feet create pressures on upper joints, muscles and tendons.
  • Shoe shape. The shoe's shape must match the foot shape. Otherwise, discomfort and eventually damage can result.
  • Foot characteristics. Feet lengthen, shorten, expand and contract during motion, thousands of times a day. They also get longer and broader as people get older. But while your feet change continuously, your shoes don't. That's what makes it important to get your feet measured each time you shop for shoes; it provides the salesperson with a "baseline” that allows him/her to match your foot's characteristics with shoes designed for those characteristics. Foot length, width, girth, arch height and natural padding are all factors. So is the activity for which you are buying the shoes.
  • Shoe fit. Shoe "sizes” are not standardized, which means a shoe labeled "Size 8” by Manufacturer A will be very different from ones that other manufacturers call "Size 8.” That's because shoes are built on models – and a model's dimensions are proprietary information, not an industry-wide standard. What is standard about size is the difference between a whole size and a half-size: one-third of an inch. Be prepared to shop for shoes within a small size range. If you wear a size 8 in one brand, you might need a 7 ½ or 8 ½ in another brand.

What Makes Shoes Therapeutic?

They have certain design and construction features that other shoes don't. First, a shoe suitable for therapeutic purposes generally requires greater-than-usual depth (interior space). A therapeutic shoe has to be roomier inside so that, if an orthosis is needed, the foot and the orthosis aren't competing for space. Therapeutic shoes also must meet certain criteria involving fabrics, closure, and size/width availability. Finally, since foot therapy often requires external or internal shoe modifications, structural strength is a factor.

Where Do People Get Therapeutic Shoes?

Many doctors refer patients who need therapeutic footwear to a credentialed pedorthist. A credentialed pedorthist is a specialist in using footwear to relieve pressures, redistribute weight, accommodate deformities, prevent injuries and preclude the worsening of damage to the foot. Working from a doctor's prescription, a credentialed pedorthist can modify or make shoes, fabricate appropriate foot orthoses, and fit them both to the patient in a way that allows the foot, the orthosis and the shoe to function smoothly as a unit.

For some people, shoes are a medical necessity. Whether a foot condition is temporary or permanent, shoes and other footwear devices should be part of the treatment plan.

Patients may be eligible through health insurance for partial or full reimbursement for footwear prescribed to accommodate or alleviate medical conditions.

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