As Podiatrists, we spend a lot of time and energy on modifying biomechanics by changing things inside the shoe via orthotics, padding, foams etc etc. One of the most overlooked elements of changing the mechanics of gait in my humble opinion is by changing or modifying the shoe itself.
This is something Podiatrists don’t necessarily learn how to do at university and would typically outsource to pedorthists, bootmakers, cobblers etc and probably for this reason it is generally not done as much as it could be.
I have most of my experience doing this in adding a piece to the shoe to “even” up a length discrepancy. Typically Podiatrists will do this by adding in a length of eva inside the shoe, but you are limited how much this can be done and still fit the foot inside with it. A simple solution is by adding it externally.
A good bootmaker can easily (and cheaply cut a solid eva outer sole in half, add in an extra piece at the desired height and glue it all back together. The end result is a shoe that sits x amount higher than the other shoe, that looks near identical and that doesn't affect the feel within the shoe.
Rocker Soles are another super simple footwear modification that can be incredibly effective at offloading the forefoot.
A relatively simple concept, a strip of EVA form is added after cutting through the shoe's midsole. The foam added is thickest at the proximal area underneath the heel/midfoot and is tapered down to the thinnest part under the toe.
This creates a natural “rocker” at the propulsion phase of gait. It reduces the need for big toe dorsiflexion as the person pushes off and results in a massive decrease in the forces acting upon the forefoot (in this case the big toe).
Here it was used to offload a chronic ulceration under the big toe. Before we used it, the wound would continually break down when we moved to “normal” shoes, depsite using custom orthos, specific shoes, socks etc.
It’s a great tool because of how effective it is and patients love it as it allows them to wear a “normal’ looking shoe and not be stuck in post op/wound shoes.
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