Orthopaedic Footwear Modifications

Type	Description
Heel Cushions / Horshu Pads	Offload pressure at heels Accommodate calcaneal spurs
Scaphoid Pads / Arch Pads	Arch support used for lifting the inside arch of the foot when a custom-made orthosis is not feasible
Metatarsal Pads / Anatomic Metatarsal Bars	Offloads pressure at the metatarsals and supports the transverse arch
Elevations / Lifts for LLD	Used for functional and anatomical leg length discrepancies (LLD).  Keep note -- please do not treat LLDs if the discrepancy is not creating a problem - the body has already compensated. Less than 5/8" rarely causes problems in normal walking, however can significantly effect sports or running.  Severe hip or back pain or recurrent injuries on one side of the body generally only results in 80% of the problems on that same side.  When ordering elevations for LLD, please begin to add the lift gradually to find a comfort level.  A full lift may not be achieved if the patient cannot tolerate the correction.
Elevations / Lifts for other reasons	Elevations may be used for problematic Achilles tendons (such as repairs or ruptures). The raise is placed at the heel and extended forward, tapered, towards the ball of the foot.    Mild lifts, internal or external, can also be used for mild pump bump, tight Achilles tendons, malleoli irritations, etc.
Excavations	Offloading extremely high levels of pressure; particularly used in the forefoot area; used in the heel center can be excavated for pressure relief and filled with silicone gel or poron and then covered with an orthosis that will mold to the excavation area
Closure Modifications	Closures, such as Hook & Loop (Velcro) buckles, lacing, etc., can be modified by the addition (or subtraction) of leather and fabric to allow the use of footwear by an individual not able to use the original closure due to bony deformity or dysfunction.
SACH Heels	Shock absorption (reduction to spine) Posterior SACH will move heel lever forward and improve calf pain and foot slap
Medial Wedges Lateral Wedges	Wedges are used to stabilize or shift the weight from one area to another.  Most are placed externally, however there are slight wedges which can be placed inside the footwear, medially or laterally.    The most common wedges used are:  1. Thomas heel to reduce pronation (an extended Thomas heel can add support to a flexible longitudinal arch and weak foot) 2. Inner heel wedge to rise and support a weak ankle or spread knock knees (a wedge which extends and raises the arch using a scaphoid and/or extended counter can also help relieve an inrolling foot) 3. Inner sole wedge and heel extension for severe pronation reduction  4. Triangular wedges for pronation/supination and to promote the patient to toe-in or toe-out if opposite gait problems exist   Many, many others... can be discussed with our pedorthic staff.
Forefoot Rocker Soles	Designed to load the weight-bearing area of the foot proximal to the metatarsal heads so there is less time spent on them.  This footwear modification allows for a more stable midstance and reduces shock during toe-off.  Indications include hallux rigidus, post-op (such as surgical fusion of the MPJ or IPJ), extreme metatarsalgia, offloading of a healing ulcer, relief from callous on distal portion of toes in hammertoe or claw toe deformities.
Mild Rocker Soles	Mild rockers provide metatarsal relief, reduce forces at the ankle and midfoot, and aid in propulsion.  Dr. Comfort orthopaedic footwear has already incorporated a mild rocker into their shoes, however we can increase the angle of the rocker to further assist gait if needed.  Indications include simple metatarsalgia, maintenance of a healed ulcer, pes cavus, minor ankle pain, toe amputation, painful flat foot, hallux limitus, etc.
Heel To Toe Rocker	A heel to toe rocker sole is the most common.  It replaces lost motion at the ankle and determines midstance time.  Moreover it reduces ground reaction forces on the heel and increases propulsion at toe-off. Indications include fusion or limited motion at the ankle, knee or hip; calcaneal fracture, ulcer, skin graft or muscle flap; severely painful arthritic ankle and/or foot; rigid claw or hammertoe deformities; pes cavus, midfoot amputations, etc.
Negative Heel Rocker	By unloading the midfoot and forefoot, this modification benefits distal toe ulcers from the heel weight-bearing. Indications include forefoot ulcers, prominent metatarsal heads, extreme callousing, and an ankle fixed in dorsiflexion. In order to proceed with this modification, the patient must be able to dorsiflex the foot and tolerate the effect of transferring weight-bearing from midfoot to hindfoot.
Carville Rocker	The Carville rocker is a severe angle rocker sole that will eliminate weight-bearing forces on the metatarsal heads.  Indications include extreme relief of ulcerated or high-risk metatarsal heads.  This is NOT indicated for problems at the distal ends of the toes as shock on toe-off is increased.  This rocker decreases stability, changes gait, and is not recommended for the patient with proprioception problems.
Double rocker	The double rocker will relieve a specific problem area or prominence on the plantar surface of the foot.  This rocker increases propulsion at toe off and reduces shock at heel strike.  It does, however, shorten midstance.  Indications include midfoot prominence maintenance, arthritic nodules on the plantar surface of the midfoot to deweight, Charcot joint, etc.
Rocker Bar	The rocker bar is a long metatarsal bar with a convex shape added to the sole bottom.  This modification transfers body weight during locomotion and shortens the gait cycle.  Indications include metatarsal or tarsal bone fractures, fused ankels, midfoot injuries, etc.
LOP Rocker Sole	The LOP (Line of Progression) rocker sole is used when a severe, rigid deformity prevents the foot from following a normal line of gait.  This type of rocker has an apex angle that allows the patient to "roll" into a comfortable line of progression.
Bunion Modifications	NOTE - first fit the patient with a shoe which may accommodate the bunion deformity such as the Dr. Comfort Brian, Annie, Douglas or Betty.  A "bunion shoe" may accommodate the deformity without modifications.   For the more severe deformities, there are two modifications we offer -- the bunion stretch using ball-and-ring for milder protrusions, and the balloon patch which adds excess material to the area for very severe bunions.
Midfoot Spread	This is only used for chronic conditions such as Charcot midfoot deformity.  Casting of the patient's foot is essential to produce this modification.
Buttresses / Flares	Buttresses and flares are utilized to stabilize the subtalar joint and thus the lower extremity.  Flares (medial or lateral) involve widening the base of the midsole and outsole to provide additional support medially or laterally.  Buttresses are placed on the midsole, outsole and the upper to bolster midfoot support. They are used in severe pronation/supination cases.
Other	Many other footwear modifications are available.  Please inquire for further information.