Shoe Modifications

There are two bones in the lower leg and 26 bones in the foot that create many joints.

There are many muscles, tendons, ligaments and nerves in the foot and ankle.

There are two ankle joints:

• Talocrural joint
• Subtalar joint

The foot can be broken into three parts:

• Rearfoot/hindfoot
• Midfoot
• Forefoot

Arches of the foot:

• Medial longitudinal arch
• Lateral longitudinal arch
• Transverse metatarsal arch

• Provide ankle and foot stability in stance. 
  
• Control biomechanical alignment of the foot and ankle in locomotion (pronation, supination)
  
• Aid in adaption to surfaces
  
• Redistribute pressures on the foot
  
• Resist external forces on the foot and ankle
  
• Limit excessive movements in the foot and ankle
  
• Protect the foot and ankle
  
• Provide shock absorption  
• Produce a more energy efficient gait pattern
  

 A Certified Orthotist will assess the ankle and foot and take a 3-D cast/mould of the foot and ankle if needed.  This can be performed with the patient in a prone position or in a seated position.  The Certified Orthotist will ensure the foot and ankle are in a corrected position and the subtalar joint will be in neutral.

Certified Orthotists can accomplish corrections to the foot with intrinsic and extrinsic modifications.  Intrinsic modifications are changes made to the positive mould of the foot and ankle.  Extrinsic modifications are accommodative padding and wedging added to the shoe. Examples of accommodative padding:

Examples of accommodative padding:

• Metatarsal pad
• 2-5 bar
• Metatarsal head cutout
• Morton’s extension
• Heel cushion
• Forefoot extension
• Scaphoid pad
• Malleolar padding
• Shoe raise
  
• Rocker bottom
  
• Buttress

There are a variety of shoe modification designs. The Certified Orthotist will determine which design is best for treatment based on individual needs and goals. 

Shoe modifications work best when used within a neutral shoe with an appropriate heel counter.  Shoe modifications cannot be switched between shoes.  

Living with Shoe Modifications (follow up)

The corrections provided by the shoe modifications may take some time to get used of the corrections.  The shoe modifications should not be painful; however, it is not uncommon to feel some initial discomfort.  The break-in period should not last more than two weeks. If you experience rubbing or blisters, please book an appointment with your Certified Orthotist for immediate attention.  If you are experiencing pain after two weeks please book a follow up appointment with your Certified Orthotist.

It is always recomended to book a follow up appointment with your Certified Orthotist if you experience any changes in condition (pain, growth).  The Certified Orthotist can determine what changes need to be made or make recommendations for alternative treatment.  Shoe modifications can often be modified or refurbished.  The Certified Orthotist can reassess determine the course of treatment with you.

Alberta Aids to Daily Living (AADL) does provide funding for custom shoe modifications for Alberta Residents with valid Alberta Healthcare.  AADL will pay 100% for the cost for Alberta Residents over the age of 65.  AADL will pay 75% of the cost for Alberta Residents under the age of 65.  A prescription from a physician is required. There is coverage for persons with low income.

• WCB may provide coverage with a copy of a prescription from a physician.
• NIHB may provide coverage with a copy of a prescription from a physician. 
• Private insurance may pay for a portion of the cost of your shoe modifications.  It is important to consult your insurance company to determine the coverage that they provide. 
• Many insurance companies require a physician's prescription for shoe modifications benefits.  Some insurance companies may request a biomechanical analysis from the Certified Orthotist.  There may be an added cost for the Certified Orthotist to provide this report.