A Solution For Split-Size Shoes
Eugenio Lamberty *
John Milani *
Despite the almost daily occurrence of new concepts and improvements in Orthotics, many problems remain to be solved. A significant number of these problems result from congenital factors or acquired diseases during childhood. The severely deformed leg and foot have been of major concern, particularly when the deformed foot has been significantly shorter in length than the sound foot (Fig. 1).
In some cases the feet may vary in shoe size by as much as three or four sizes (Fig. 2). This becomes quite expensive for the patient, who must either purchase two pairs of shoes to fit each foot properly or custom-made shoes. To reduce this financial burden and yet greatly improve cosmesis, a method of fabrication had to be found whereby the patient would be required to purchase only one pair of ordinary shoes that would be the size of the normal foot.
A shoe filler (Fig. 3), conceived, designed and developed by the authors through the Veterans Administration Prosthetics Center, has solved this problem. This device is placed in the shoe (Fig. 4) to take up the excess space of the shortened foot. Then the shoe insert portion of the orthosis is placed into the filler and shoe (Fig. 5). This results in a highly-cosmetic arrangement (Fig. 6) that is also financially beneficial to the patient.
Method of Fabrication
To construct the shoe filler, proceed as follows:
Secure a SACH foot that will fit the size shoe to be worn by the patient. Ensure that the plantar surface of the SACH foot is flat, to prevent the shoe insert portion of the orthosis from rocking. An immediate post-op foot can be used.
Vacuum mold the SACH foot with 1/4-inch low density polyethylene. Polyethylene is ideal since it provides good strength and flexibility.
When the plastic has cooled, remove it from the SACH foot and initially trim it so that it does not protrude beyond the borders of the shoe. Refer to Fig. 3.
Use standard methods and techniques to fabricate the orthosis.
Place the orthosis on the patient. Then place the orthosis on the patient into the shoe and shoe filler while ensuring that the shoe filler does not hinder this process.
Further trim the shoe filler along its medial and lateral sides, behind what would normally be the metatarsal heads of the sound foot. This allows the normal toe break of the shoe to function properly and thereby ensure unrestricted motions of the ankle and foot.
Notes
To prevent the orthosis from slipping forward in the filler, the filler should curve around slightly, onto the dorsum of the foot. Refer to Fig. 3. This trim, together with a properly laced shoe or a shoe laced with micro straps, should provide the required counterforce to prevent the orthosis from slipping forward in the filler. It is further noted that one patient, who had worn the new orthotic system for one month, required foam padding that was placed anteriorly into the filler to prevent the orthosis from slipping.
Summary
The design and development of a shoe filler when bracing the shortened foot is cosmetically appealing and financially beneficial to the patient who is consequently required to purchase only a single pair of ordinary shoes. In addition, fabricating the filler is a relatively simple procedure for the orthotist.
Acknowledgements
The authors would like to express their appreciation to Max Nacht, Technical Writer-Editor, VAPC, for his cooperation and assistance in preparing this article; and to Charles Berman and Anthony Morales, Photographers, VAPC, for their fine photographic work.
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