Orthopedic Shoes and Footwear Modifications
What makes a pair of shoes “orthopedic” and how are these types of shoes different from regular shoes?
Orthopedic footwear is a general term for shoes that are manufactured with certain characteristics and features that support the mechanics and structure of the foot. This usually includes a good rigid midsole and outsole, firm heel counter, removeable insole to accommodate custom orthotics, and are available in a variety of widths and shapes to fit various foot types.
Unfortunately, over the years, most private health insurance companies have stopped covering off-the-shelf (OTS) orthopedic footwear where the patient could select a pair of shoes from certain insurance approved “orthopedic” shoe brands. Many insurance plans were abused as orthopedic shoes were over-prescribed and involved in many insurance fraud cases.
As a result, most insurance companies today will only cover the costs to Modify Orthopedic Footwear, or the second option would help cover the cost of Custom-Made Orthopedic Footwear, which can cost anywhere from $1200-3000 depending on the type of shoe and materials used. Most insurance plans will not cover the full costs of a custom-made shoe, so a good shoe modification is a cheaper alternative and can provide just as good benefits. Depending on the type of shoe modification and materials used, it will usually cost anywhere from $50-300 per shoe.
Orthopedic shoe modifications can be performed on most footwear, whether they are your work boots, walking shoes, running shoes, dress shoes, and sandals. They may also be combined with your custom-made foot orthotics. You should always consult a Podiatrist or Pedorthist to see whether or not the shoe and shoe-modification is appropriate for your feet.
Here are some examples of some footwear modifications:
Heel-To-Toe Rocker Sole: this modification helps with a natural heel-to-toe gait and helps with propulsion at toe-off. This modification will help replace lost motion at the ankle joint, and would be useful for patients with ankle arthritis and those who have ankle fusion surgery.
Forefoot Rocker Sole: this modification helps to unload the forefoot by reducing first ray dorsiflexion and pressure during toe-off. This is very useful for patients with arthritic conditions of the big toe such as Hallux Limitus, Hallux Rigidus, patients who have toe fusions, bunion surgery, or forefoot ulcers.
Shoe Stretch: a simple modification where the shoe material is stretched in areas where there is a bony prominence that is rubbing against it. A metal ball and socket clamp is placed in the area needed to be stretched and is generally left on for a day or more. This is useful for patients with bunions, bunionettes, and hammertoe to help alleviate pressure against those joints.
Balloon Patch: this modification is similar to the shoe stretch modification in alleviating pressure points. To accommodate the areas of pressure, a hole is cut in the shoe over the bony prominence and a soft patch is fastened over the hole.
Closure Modification: this modification adds materials such as Velcro strapping or buckles to the upper of the shoe to help make it easier for patients to put on their footwear. For example, those with physical disabilities, vision impairment, and mobility issues, where tying shoe laces may be difficult or impossible.
SACH Heel: stands for “solid ankle cushion heel”, where the heel area of the sole of the shoe is removed and replaced with a softer compressible material. Conditions: heel spurs, plantar fasciitis, low back pain, and help cushion arthritic joints.
External Shoe Lift/Extension: this modification is done for patients with structural leg length differences where one leg is longer or shorter than the other. Extra material is added to the outer sole of the shoe with the shorter leg. This can be useful for those with scoliosis, leg, back, hip, and shoulder pain.
Medial or Lateral Buttress Pad: this is an external shoe modification designed to provide additional support and control by adding denser material along the side of the shoe. Medial buttress pads can help treat pronation-related disorders such as Tibialis Posterior Tendoniitis and plantar fasciitis. Lateral buttress pads can help treat supination-related disorders such as peroneal tendinopathies, Charco-Marie-Tooth Diseases, lateral ankle instability and people prone to inversion ankle sprains.
Medial or Lateral Wedges/Posting: this is an external shoe modification where dense wedges are added to just the bottom of the sole of the shoe. This is like buttress pads where medial wedges can help pronation-related disorders, and lateral wedges can help supination-related disorders.
If you think you may benefit from orthopedic shoes and footwear modifications, please make an appointment to see if these will help you get back on your feet!