Prescription Footwear Research Articles

The Therapeutic Shoe Bill: Medicare Coverage for Prescription Footwear for Diabetic Patients

This article describes the extent of coverage and the process of obtaining Medicare coverage for prescription footwear for patients with diabetes and reflects policies in effect as of April 1, 2004.

Meeting the challenge for foot health in rheumatic diseases

Background: National guidelines recommend that patients with rheumatic diseases should have access to podiatry services and evidence is emerging that podiatry interventions are effective in the management of foot problems in this patient group. Despite this recognition it is generally perceived that access to podiatry services appears to be varied or absent. Objectives: To identify the nature of foot health problems presenting in a rheumatology clinic and to ascertain the availability and suitability of foot care for these problems. Method: A convenience sample of 139 patients (100 female and 39 male) was recruited. An assessment of foot health, and footwear was carried out and patients completed the foot function index (FFI). Any unmet foot care needs were identified. Results: The majority of the 139 patients presented with symptomatic callus and toenail problems and over half with foot deformity. There was no clear difference between genders. There was evidence of the effects of foot pain caused by these problems but low prescription of foot orthoses and specialist footwear. Conclusion: Overall this study indicates that poor foot health and foot pain as being common in patients with rheumatic diseases. The lack of foot care could lead to reduction in mobility and in some cases serious complications. This paper recommends that a specialist and dedicated foot care service is provided for these patients.

Therapeutic footwear for people with diabetes.

In this review, the evidence for the role of footwear in causing, healing, and preventing foot ulceration in diabetic patients is discussed. The mechanisms of action of therapeutic footwear are elucidated, and an 'ideal' approach to footwear prescription is outlined. Finally, some future directions for 'intelligent' footwear are also presented.

The art of writing the footwear prescription

The art of writing the footwear prescription

Measurement of plantar pressure distribution in hemiplegic children: changes to adaptative gait patterns in accordance with deficiency

Objective. A comparison of plantar pressure distribution in hemiplegic children with a healthy control group was performed to illustrate the link between the changing dynamics during the stance phase and the degree of deficiency. Design. Twenty three healthy control subjects and two groups of six hemiplegic children with minor and major spasticity were tested. Background. In previous studies, it was shown that the musculoskeletal dysfunction due to spasticity disturbed the hemiplegic gait pattern, for example reduced walking speed and step length. However, plantar pressure measurements which would help to understand the pathological gait mechanisms have not been studied. Methods. The stance phase parameters measured included spatio-temporal data and the relative impulse measurements during consecutive gait cycles. The relative impulses under eight plantar areas were determined with an in-shoe plantar pressure measurement device. Results. Each group had a specific plantar pressure distribution profile that varied with the degree of deficiency. The most significant differences were found beneath the midfoot, the first metatarsal head and the hallux. Conclusion. The neuromuscular disorders and foot deformities due to the cerebral lesion modified the contact of the foot with the ground, and led to specific plantar pressure distribution profiles. The equinovarus, with clawed-toe deformity due to greater spasticity, seemed to be an important factor in disturbances of the terminal stance phase. However, the spastic hemiplegic subjects seemed to adopt a gait pattern required for optimal stability. Relevance From previous work, comparable data were available only for the hemiparetic adult patients. In-shoe pressure data from spastic hemiplegic children can provide detailed information specific to each region of contact for the support of diagnosis, a clinical decision or the prescription of appropriate footwear, braces or othoses. Both peak pressure and local impulse have proven to be valuable for the understanding of foot function, lower extremity dysfunctions and walking strategies.

Shoes in the cupboard

Studies show that patient dissatisfaction with prescribed footwear results in low usage and that the cause is the system that provides it. The aim of this study was to compare referrer and patient perceptions of a multidisciplinary footwear clinic (MDFC) and a traditional surgical appliance clinic (SAC). Referring consultants completed a questionnaire for every referral (28 referred to the MDFC and 27 to the SAC) during a six-month period. Structured interviews were designed to gather the data. The results showed that referrers to both groups indicated that they lacked the time and knowledge to give advice about retail footwear. The entire MDFC group but only 18 (66.6%) of patients in the SAC group had the opportunity for discussion about footwear before the prescription took place. Some 17 (62.9%) in the SAC group reported problems with the footwear but only 11 (40.7%) of this group were informed what to do if problems occurred. Both groups demonstrated an association between the patient's attitude, their perception of improvement in their feet and overall satisfaction. These factors seemed to have an impact on the usage of the prescription footwear with 13 (48.1%) of the SAC group using other footwear compared with 2 (7.2%) in the MDFC group. This study adds to the suggestions made in other studies that there is a need to review the SAC system and identifies key areas that influence patient satisfaction.

A case of true equinus: from boot to shoe

We describe a patient with congenital unilateral type 2 hemimelia of the fibula treated by ankle fusion with the foot in full equinus. A prosthetic alternative to prescription footwear transformed this patient's life after 76 years.

Nonsurgical management of the foot and ankle affected by rheumatoid arthritis.

Rheumatoid arthritis frequently affects foot and ankle function, leading to pain, difficulty with ambulation, and disability. The purpose of this article is to describe common foot and ankle deformities associated with rheumatoid arthritis and present state-of-the-art nonsurgical management strategies. Physical impairments thought to be commonly associated with limitations of function and practical interventions for alleviating those impairments or reducing the impact of the impairment on ambulation are identified. Examples of rehabilitation interventions discussed include prescription footwear, custom and premolded foot orthoses, hindfoot orthoses, ankle-foot orthoses, shoe modifications, therapeutic exercises, and patient education. Early and aggressive attempts at prevention, delay, or correction of foot and ankle pathomechanics related to rheumatoid arthritis may play a key role in helping patients maintain an active ambulatory lifestyle.

Medical opinions, beliefs and prescription of orthopaedic footwear: a survey of Dutch orthopaedists and rehabilitation practitioners.

To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners. In this study 85 orthopaedists and 96 rehabilitation practitioners filled out a questionnaire measuring perceived desirability of prescribing orthopaedic footwear in specific medical conditions, the perceived advantages of orthopaedic footwear, the perceived disadvantages of orthopaedic footwear, the attitude to orthopaedic footwear and satisfaction with the co-operation with the pedorthist. Clinicians were asked to estimate their referral rate of orthopaedic footwear. Orthopaedists and rehabilitation practitioners agree that the prescription of orthopaedic footwear should be considered in the case of rheumatoid arthritis, amputation of the foot and diabetic foot and not be considered in the case of sprain and back pain. In the case of hallux valgi, dermatological problems and clavus (severe corn) a reticent prescription policy seems to be the optimal choice. In the other medical conditions studied no unequivocal prescription policy could be derived. Respondents who prescribed orthopaedic footwear more than the median (more than 50 prescriptions per year) were more often rehabilitation practitioner, perceived more advantages of prescription footwear, perceived less disadvantages of prescription footwear and were more satisfied about the co-operation with the pedorthist. In some medical conditions orthopaedists and rehabilitation practitioners agree about the optimal use of orthopaedic footwear. In some other medical conditions orthopaedists and rehabilitation practitioners are divided about the use of orthopaedic footwear. Reported rate of prescription was not related to desirability of prescription, but was related to beliefs such as perceived advantages, perceived disadvantages and satisfaction with co-operation with the pedorthist, underlining the importance of cognitive factors in prescription style.

Prescription footwear for arthritis of the foot and ankle.

The Board Certified Pedorthist can be a valuable member of the team of healthcare professionals involved in the treatment of arthritis of the foot and ankle. In addition to providing prescription footwear, the pedorthist can assist in educating the patient, postoperative care, and long term monitoring of the patient's progress. The objectives in the pedorthic care of arthritis of the foot and ankle are to reduce shock and shear; to relieve excessive pressure from sensitive or painful areas; to accommodate, correct, and support deformities; and to control or limit painful motion of joints. Specific types of prescription footwear used to accomplish these objectives include shoes, external shoe modifications, and custom made foot orthoses.

Principles underlying the organization of gait initiation and stepping

Many studies have attempted to better elucidate the effect of foot orthoses on gait dynamics. To our knowledge, most previous studies exclude the first few steps of gait and begin analysis at steady state walking. These unanalyzed steps of gait may contain important information about the dynamic and complex processes required to achieve equilibrium for a given gait velocity. The purpose of this study was to quantify gait initiation and determine how many steps were required to reach steady state walking under three footwear conditions: barefoot, habitual shoes, and habitual shoes with a prefabricated foot orthoses. Fifteen healthy subjects walked 50 m at habitual speed in each condition. Wearing habitual shoes with the prefabricated orthoses enabled subjects to reach steady state walking in fewer steps (3.5 steps ± 2.0) compared to the barefoot condition (5.2 steps ± 3.0; p = 0.02) as well as compared to the habitual shoes condition (4.7 steps ± 1.6; p = 0.05). Interestingly, the subjects’ dynamic medial–lateral balance was significantly improved (22%, p < 0.05) by using foot orthoses compared to other footwear conditions. These findings suggest that foot orthoses may help individuals reach steady state more quickly and with a better dynamic balance in the medial–lateral direction, independent of foot type. The findings of this pilot study may open new avenues for objectively assessing the impact of prescription footwear on dynamic balance and spatio-temporal parameters of gait. Further work to better assess the impact of foot orthoses on gait initiation in patients suffering from gait and instability pathologies may be warranted.

A method for the investigation of the effects of outsole modifications in therapeutic footwear.

Experiments to determine the effects of therapeutic shoe outsole modifications frequently require the examination of many different configurations and typically use in-shoe pressure measurement to determine the optimal design. A method is presented here to allow the foot-shoe interface to remain undisturbed as different outsole designs are used in the same patient. A standard extra-depth (or super extra-depth) shoe is modified to house three receptacles for quarter-turn fasteners in a carbon fiber plate. The fasteners pass through the outsole unit and secure it firmly to the plate. Results from a typical experiment are presented to illustrate the effectiveness of the approach. It is possible that a large clinic could use this approach in complex cases to assist with optimal footwear prescription.

Therapeutic footwear for patients with diabetes

The proper prescription and utilization of therapeutic footwear is crucial to successful prevention of diabetic foot complications. The author reviews shoe alternatives' characteristics and proper fit. The concept of foot risk categories is explained and appropriate shoe selections are discussed.

The extra-depth toe box: a rational approach.

The conservative management of foot deformities often requires the use of a modified shoe. A higher toe box is one of the most common variations required when the abnormality is located in region of the forefoot. High toe boxes are available in a variety of footgear, including athletic sneakers, comfort shoes, and prescription footwear. A rational approach to accommodating a deformed forefoot would be to first measure the maximum height of the abnormal toes in a weightbearing position. Then, by referring to a table listing shoes and available toe box space, the physician could match the foot with a shoe. The purpose of this study was to collect and tabulate measurements of toe box height for a variety of shoes. Impressions were taken from various shoes using a moldable plastic material. Toe box height was then measured and recorded. Results were tabulated for various types of men's and women's shoes. The depth of shoes at the point 5 cm from the tip of the toe was about 44 mm for most styles. The sagittal profile (i.e., vertical height available) of extra-depth shoes, comfort shoes, and athletic shoes was similar.

Indications and Prescriptions for Orthoses in Sports

The use of orthoses, in conjunction with appropriate shoes and external shoe modifications, is an important part of the overall treatment program for foot and ankle injuries in sports. Prescription footwear can also be a significant factor in injury prevention. Similarly, the CPed is an important member of the team involved in treating and preventing foot and ankle injuries in sports. By providing footwear, patient education, and follow-up assistance, the CPed can make a valuable contribution to a comprehensive program of treatment and injury prevention.

Defining How the Prescription Footwear Association and the Board for Certification in Pedorthics Can Help the Medical Profession

Dorland's Medical Dictionary defines pedorthics as the art concerned with the design, manufacture, fit, and modification of shoes and related foot appliances as prescribed for the amelioration of painful or disabling conditions of the foot and limb.

Ulceration, unsteadiness, and uncertainty: The biomechanical consequences of diabetes mellitus

Diabetes mellitus, which results from a failure of the endocrine system to control blood glucose levels within normal limits, affects approximately 15% of the population over the age of 65 in developed countries. Between 20–50% of people with diabetes for more than 10 years will experience symmetrical distal sensory neuropathy resulting in a progressive, distal to proximal, loss of sensation in the lower extremities. The most common consequence is plantar ulceration that too often results in partial or total amputation of the foot. While neuropathy is a major permissive factor, plantar ulcers occur at locations of high plantar pressures. The measurement of pressure using tools developed and refined in the field of biomechanics has been shown to be a valuable asset to the managemetn of the foot at risk for ulceration. In particular, the use of in-shoe measuring techniques has the potential to revolutionize the prescription of therapeutic footwear. Biomechanical techniques have also helped to evaluate other consequences of diabetic neuropathy on the foot such as callus formation, foot deformity, limited joint mobility and bony abnormalities. The reduction of afferent information from the lower extremities implies a lack of active feedback thought to be necessary for the control of human movements such as posture and gait. Our results show that diabetic neuropathy results in a significant increase in sway during standing that is not compensated for by other sensory systems. The study of the sagittal plane movements of the same individuals walking on a treadmill showed little effect on the kinematic control of gait when compared to age matched nonneuropathic control groups. This may indicate the dominance of efferent input over afferent feedback during gait. We believe that the study of the biomechanical consequences of diabetes can act as a model for many other diseases that have yet to come under the scrutiny of a multidisciplinary team.

The high incidence of mismated feet in the population.

All Americans, and most likely all individuals in all societies, have mismated feet; that is, the two feet of probably no individual are exactly alike in size, shape, or proportions. This conclusion was based on the findings of a demographic foot-measurement survey embracing 6800 adults (4000 females, 2800 males), conducted in 1981-1982 by the Prescription Footwear Association. The findings may explain why the ideal or expectation of "perfect" shoe fit is virtually impossible, although they do not suggest that adequate or satisfactory shoe fit is not attainable in most instances involving so-called "normal" feet. They also indicate that a mild degree of "breaking in" is required with most new footwear, although never necessitating any distress. This article presents the methodology of the survey and foot measurements, along with the found data and their significance regarding the traditional processes of search of "proper" shoe fit and the obvious need for higher levels of professional shoe-fitting skills and service. The article also analyzes and discusses some little known or seldom considered complexities of shoe fit and the foot-shoe relationship that surfaces from this study, for example, the role of shoe design, shoe-sizing systems, consumer shoe-buying attitudes, and shoe materials, the four variable phases of shoe fit (static, weightbearing, functional, and thermal), and the availability of shoe sizes in stores.