Shoes and Foot Management OfftheShelf Shoes for Management

Shoes and Foot Management Off-the-Shelf Shoes for Management of Foot Pathology. To take full advantage of the learning opportunities presented in this resource, view the presentation in “Slide Show” mode. Click on the “Slide Show” tab in your Microsoft Power. Point tool bar, then click on the “From the Beginning” tab. As an alternative, you may press the F 5 key as a shortcut to begin the presentation.

Extra Depth Shoes. • Purpose: – Designed to relieve excessive foot pressure • Hammertoes • Bunions • Extreme foot shapes. • Construction Features: – Seamless or limited seams at forefoot and interior – Deeper toe box: 3/16 inch to ½ inch – Accommodative materials

Extra Depth Shoes. • Extra-depth shoe standards: – – Minimum of 3 widths Minimum of 3/16 inch of extra-depth Limited seams at the toe Closed toe • Other factors for high quality: – – – Genuine leather upper Foam-padded collar Long medial counter High toe box Steel shank Adaptable sole for modifications, such as lifts, rocker bottoms, etc.

Orthopedic Footwear Definition. • Shoes, shoe modifications or shoe additions which are used to: – Correct, accommodate or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot – Support a weak or deformed structure of the ankle or foot – Form an integral part of a brace. • Minimum orthopedic shoe specifications consist of: – – – – – • Blucher or Balmoral construction Leather construction or synthetic material of equality Welt construction with a cement attached outsole or sewn on outsole Upper portion properly fitted as to length and width No unit sole Bottom sized to the last Closure appropriate to foot condition (Velcro strap or lace closure preferred) Full range of widths, not just narrow, medium, wide Extended medial counter and firm heel counter. Sneakers and athletic shoes are not considered orthopedic shoes by the Medicaid Program and therefore are not Medicaid reimbursable.

Orthopedic Footwear. Key Terms – Blucher Shoe • Lace-up shoe • One piece vamp – Balmoral (Bal/Oxford) Shoe • Lace-up shoe • Typically with side seam – Welt Construction • Strip of material sewn to upper • Sole is sewn or attached to welt • Allows for sole repair and modification – Counter • Reinforcement between lining and upper • Stabilizes heel in early stance • May also be external to shoe (heel cap)

Shoe Coding: Modifications. • Elevations – L 3300 – Lift, elevation, heel, tapered to metatarsals, per inch – L 3310 – Lift, elevation, heel and sole, neoprene, per inch – L 3332 – Lift, elevation, inside shoe, tapered, up to one-half inch • Heel Modifications – L 3350 – Heel wedge – L 3390 – Outflare wedge • Other Modifications – L 3580 – Orthopedic shoe addition, convert instep to Velcro closure – L 3649 – Orthopedic shoe, modification, addition or transfer, not otherwise specified

Foot and Shoe Measurement. Brannock Device – Available for age/gender • Men’s – Sizes 4 to 16 – Width sizes 3 A to 3 E • Women’s – Sizes 3 to 13 – Width sizes 4 A to 2 E • Junior – Infant 0 to child’s size 5 (approximately age 10) – Key Measurements • Heel-to-toe length • Arch length (heel to 1 st metatarsal head) • Width of foot – Shoe Sizing • Correct size is larger of two length measurements

Using the Brannock Device. Foot Length – Move all adjustments to their largest settings – With the patient standing, place the foot in the correct side of the device with the heel firmly against the heel cup – Press the longest toe lightly and read the foot length

Using the Brannock Device. Arch Length – Slide the pointer until it is centered on the first metatarsal head and record the arch length Foot Width – Slide the width bar until it firmly contacts the lateral side of the foot – Locate the shoe size as determined by the larger of the two measurements (foot length versus arch length) – Read the width that corresponds to the appropriate shoe size

Foot and Shoe Measurement. • Shoe Sizing Schemes – Shoe sizes are related to the length of the “last, ” which is a footshaped template used for shoe fabrication. – The American size of the shoe is three times the heel-to-toe length of the foot (in inches) minus a constant. • The subtractive constant is 22 for men, 21 for women, 9. 75 for children up to size 13 ½. • Example: a man’s foot that is 10. 5” long requires an American shoe size 9. 5. – 3 x 10. 5 = 31. 5 – 22 = 9. 5. – Each half size increment is 1/6 of an inch (4. 23 millimeters). – Most countries in continental Europe and in Latin America follow some version of the French rule. • Shoe size is 1. 5 times the length of the last measured in centimeters, irrespective of gender or age.

U. S. Men’s Shoe Sizes. Size 6 = 9. 31 inches long. Widths: C Narrow: 3. 3 inches; D Medium/Standard: 3. 5 inches; E Wide: 3. 7 inches. Size 8. 5 = 10. 19 inches long. Widths: C Narrow: 3. 6 inches; D Medium/Standard: 3. 8 inches; E Wide: 4 inches. Size 6. 5 = 9. 5 inches long. Widths: C Narrow: 3. 3 inches; D Medium/Standard: 3. 6 inches; E Wide: 3. 8 inches. Size 9 = 10. 31 inches long. Widths: C Narrow: 3. 6 inches; D Medium/Standard: 3. 9 inches; E Wide: 4. 1 inches. Size 7 = 9. 69 inches long. Widths: C Narrow: 3. 4 inches; D Medium/Standard: 3. 6 inches; E Wide: 3. 8 inches. Size 9. 5 = 10. 5 inches long. Widths: C Narrow: 3. 7 inches; D Medium/Standard: 3. 9 inches; E Wide: 4. 1 inches. Size 7. 5 = 9. 81 inches long. Widths: C Narrow: 3. 4 inches; D Medium/Standard: 3. 7 inches; E Wide: 3. 9 inches. Size 10 = 10. 69 inches long. Widths: C Narrow: 3. 8 inches; D Medium/Standard: 4 inches; E Wide: 4. 2 inches. Size 8 = 10 inches long. Widths: C Narrow: 3. 5 inches; Size 10. 5 = 10. 81 inches long. Widths: C Narrow: 3. 8 D Medium/Standard: 3. 8 inches; E Wide: 3. 9 inches; D Medium/Standard: 4. 1 inches; E Wide: 4. 3 inches.

U. S. Men’s Shoe Sizes, continued. Size 11 = 11 inches long. Widths: C Narrow: 3. 9 inches; D Medium/Standard: 4. 1 inches; E Wide: 4. 3 inches. Size 13. 5 = 11. 81 inches long. Widths: C Narrow: 4. 2 inches; D Medium/Standard: 4. 4 inches; E Wide: 4. 8 inches. Size 11. 5 = 11. 19 inches long. Widths: C Narrow: 3. 9 inches; D Medium/Standard: 4. 2 inches; E Wide: 4. 4 inches. Size 14 = 12 inches long. Widths: C Narrow: 4. 2 inches; D Medium/Standard: 4. 5 inches; E Wide: 4. 9 inches. Size 12 = 11. 31 inches long. Widths: C Narrow: 4 inches; D Medium/Standard: 4. 3 inches; E Wide: 4. 4 inches. Size 12. 5 = 11. 5 inches long. Widths: C Narrow: 4. 1 inches; D Medium/Standard: 4. 3 inches; E Wide: 4. 5 inches. Size 13 = 11. 69 inches long. Widths: C Narrow: 4. 1 inches; D Medium/Standard: 4. 4 inches; E Wide: 4. 6 inches. Size 14. 5 = 12. 19 inches long. Widths: C Narrow: 4. 3 inches; D Medium/Standard: 4. 6 inches; E Wide: 4. 9 inches. Size 15 = 12. 31 inches long. Widths: C Narrow: 4. 3 inches; D Medium/Standard: 4. 6 inches; E Wide: 5 inches.

U. S. Women’s Shoe Sizes. Size 5 = 8 11/16 inches long. Widths: Narrow: 2. 81 inches; Average: 3. 19 inches; Wide: 3. 56 inches; Extra Wide: 3. 94 inches. Size 7. 5 = 9 ½ inches long. Widths: Narrow: 3. 13 inches; Average: 3. 5 inches; Wide: 3. 88 inches; Extra Wide: 4. 25 inches. Size 5. 5 = 8 13/16 inches long. Widths: Narrow: 2. 88 inches; Average: 3. 25 inches; Wide: 3. 63 inches; Extra Wide: 4 inches. Size 8 = 9 11/16 inches long. Widths: Narrow: 3. 19 inches; Average: 3. 56 inches; Wide: 3. 94 inches; Extra Wide: 4. 31 inches. Size 6 = 9 inches long. Widths: Narrow: 2. 94 inches; Size 8. 5 = 9 13/16 inches long. Widths: Narrow: 3. 25 Average: 3. 31 inches; Wide: 3. 69 inches; Extra Wide: inches; Average: 3. 63 inches; Wide: 4 inches; Extra 4. 06 inches. Wide: 4. 38 inches. Size 6. 5 = 9 3/16 inches long. Widths: Narrow: 3 inches; Average: 3. 38 inches; Wide: 3. 75 inches; Extra Wide: 4. 13 inches. Size 9 = 10 inches long; Widths: Narrow: 3. 31 inches; Average: 3. 69 inches; Wide: 4. 06 inches; Extra Wide: 4. 44 inches. Size 7= 9 5/16 inches long. Widths: Narrow: 3. 06 inches; Average: 3. 44 inches; Wide: 3. 81 inches; Extra Wide: 4. 19 inches. Size 9. 5 = 10 3/16 inches long; Widths: Narrow: 3. 38 inches; Average: 3. 75 inches; Wide: 4. 13 inches; Extra Wide: 4. 5 inches.

U. S. Women’s Shoe Sizes, continued. Size 10 = 10 5/16 inches long. Widths: Narrow: 3. 44 inches; Average: 3. 81 inches; Wide: 4. 19 inches; Extra Wide: 4. 56 inches. Size 12. 5 = 11 3/16 inches long. Widths: Narrow: 3. 75 inches; Average: 4. 13 inches; Wide: 4. 5 inches; Extra Wide: 4. 88 inches. Size 10. 5 = 10 ½ inches long. Widths: Narrow: 3. 5 inches; Average: 3. 88 inches; Wide: 4. 25 inches; Extra Wide: 4. 63 inches. Size 13 = 11 5/16 inches long. Widths: Narrow: 3. 81 inches; Average: 4. 19 inches; Wide: 4. 56 inches; Extra Wide: 4. 94 inches. Size 11 = 10 11/16 inches long; Widths: Narrow: 3. 56 Size 13. 5 = 11 ½ inches long. Widths: Narrow: 3. 88 inches; Average: 3. 94 inches: Wide: 4. 31 inches; Average: 4. 25 inches; Wide: 4. 63 inches; Extra Wide: 4. 69 inches. Wide: 5 inches. Size 11. 5 = 10 13/16 inches long; Widths: Narrow: 3. 63 inches; Average: 4 inches; Wide: 4. 38 inches; Extra Wide: 4. 75 inches. Size 12 = 11 inches long; Widths: Narrow: 3. 69 inches; Average: 4. 06 inches; Wide: 4. 44 inches; Extra Wide: 4. 81 inches. Size 14 = 11 11/16 inches long. Widths: Narrow: 3. 94 inches; Average: 4. 31 inches; Wide: 4. 69 inches; Extra Wide: 5. 06 inches.

Shoe Donning. • Loosen all laces and straps • Remove wrinkles from socks – Make certain any seams are appropriately located to prevent abrasion • Assist patient with donning of shoe – Use a shoe horn as needed, particularly if patient has limited torso flexibility/ROM (range of motion) • Tighten laces or straps as appropriate – Tight enough to prevent excessive motion and maintain foot and ankle support – Loose enough to prevent skin and circulation impairment

Shoe Fitting: Assessment of Fit. Static Assessment (Standing) – Overall length • Should have thumb width between end of toes and end of shoe leather – Heel fit • Counter contoured to match heel shape • Loose enough to allow appropriate heel slip without abrasion – Arch fit • Length supports entire arch • Height provides adequate support while allowing foot flexibility – Metatarsal heads • Adequate width to prevent impingement • Close enough fit to prevent excessive anterior foot translation – Toe fit • Toe box allows for spreading of toes during weight-bearing • Toes do not contact distal end of shoe

Shoe Fitting: Assessment of Fit. While patient walking, check: – Foot and shoe interaction • Anterior foot translation • Heel slip • M-L (medial-lateral) foot stability – Shoe and ground interaction • Heel and sole compression • Force path • Toe clearance – Patient balance

Shoes and Foot Management. This workforce product was funded by a grant awarded by the U. S. Department of Labor’s Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U. S. Department of Labor. The U. S. Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Produced 2015. HOPE Careers Consortium is a partnership of five institutions of higher education that is building exciting new programs that will provide valuable career education and training in the Orthotics, Prosthetics, and Pedorthics (O&P) sector. The five institutions are: Baker College—Flint, Michigan; Century College—White Bear Lake, Minnesota; Oklahoma State University Institute of Technology—Okmulgee, Oklahoma; Spokane Falls Community College—Spokane, Washington; and St. Petersburg College—St. Petersburg, Florida. Although the authoring institution of this educational resource has made every effort to ensure that the information presented is correct, the institution assumes no liability to any party for any loss, damage, or disruption caused by errors or omissions. This work by Oklahoma State University Institute of Technology (OSUIT) is licensed under the Creative Commons Attribution 4. 0 International License. To view a copy of this license, click on the following link: Creative Commons Licenses 4. 0.