A pedorthist will fit you for the footwear that may help you walk or perhaps avoid an amputation.

You’ve got a prescription for therapeutic shoes in hand. Your next stop?

Many people go to pedorthists to be fitted with therapeutic shoes. Board-certified pedorthists are trained in foot anatomy, and the construction of shoes, shoe modifications, and foot orthotics (inserts). Like a pharmacist, a pedorthist fills the prescription for therapeutic shoes that was written for you by your podiatrist (foot doctor).

(Pedorthists do most of the dispensing of therapeutic shoes in this country. Podiatrists and orthotists, whose specialty is orthopedic braces, are neck-and-neck for second. Some prosthetists, whose specialty is artificial limbs, also fit shoes.)

About half of pedorthists work in orthopedic shoe stores, and half work in foot clinics or orthotic-prosthetic facilities. Either way, you’ll want to call for an appointment. If your feet tend to swell during the day, make an afternoon appointment.

It will take about 30 minutes for the pedorthist to measure and fit your feet. Ordinarily, the pedorthist won’t charge you for his or her time, just for the shoes and inserts you get.

About 85 percent of people can be fit with off-the-shelf shoes. The pedorthist might have the shoes you need in stock or will order them. Listed below are some examples of different types of special shoes:

COMBINATION LASTS

Let’s say your feet are narrow at the heels. If you get shoes that fit your heels, your toes will be crowded, which can lead to corns, blisters, and even ulcers. Yet if you get storebought shoes that allow enough room in the toes, the backs of the shoes will slip with every step – which may lead to blisters and sores.

Combination lasts are the solution for you. Such shoes are narrower at the heel but still allow generous room in the toe region.

DEPTH INLAY SHOES

Do you have toenails that are very thick – as thick as they are wide, even? Do you have a hammertoe – a toe that’s bent and sticks up above its neighbors? Regular shoes will put pressure on your toes or thick nails and may lead to, yes, you guessed it: blisters and then ulcers.

Depth inlay shoes, which have more height in the toe area, would work well for you. They are normally combination-lasted as well.

SPECIAL FOOTWEAR CAN HAVE THESE OTHER FEATURES

  • seamless, moldable uppers to avoid friction or pressure points over sensitive or irritated toes
  • lower heels to reduce pressure on the front of your foot
  • lace or Velcro closures that keep the shoe well secured to your foot, preventing the friction that can cause a blister

Off-the-shelf shoes may need some adjustment to fit your needs. The uppers may need to be stretched to accommodate prominent toes, wedges and flares can be added to the soles for better stability, and rocker soles or metatarsal bars added to reduce pressure to certain areas of the foot. Shoes with laces can be converted to Velcro closure if the functioning of your hands is impaired. Lifts are added to the inside or outside of the shoes if your legs are different lengths.

You may need inserts for the shoes. These are also called foot orthoses. (An arch support is one kind of orthosis.) Inserts can be made of foam, leather, or plastic. Softer designs are recommended for those with diabetes to provide shock absorption and to accommodate any abnormalities of the feet, such as calluses or prominent areas.

Medicare requires that an insert be molded to your foot or a model of your foot to ensure the best results, and that’s standard practice in the industry. It usually takes about a week to get the finished inserts.

If your feet can’t fit into standard footwear, as is the case for about 15 percent of people, the pedorthist can fit you for custom-made shoes. These take three to six weeks to make.

Nice And Roomy

When you first put on your new therapeutic shoes, they might feel too loose. They aren’t. The shoes you’ve been wearing were probably too small. My typical customer comes in wearing shoes that are two sizes too narrow and too short.

There are two reasons for this. One, most of us get fixed on the size we wore when we were 20. Yet many people’s feet get bigger as they grow older. It’s not uncommon for a customer to declare, “I wear a 7B,” but to walk out with a pair of 9Ds.

Two, many people with diabetes have neuropathy (nerve damage) in their feet. Because of decreased sensation in their feet, shoes that are the right size feel too big to them, so they wear shoes that are too small.

Wear your new shoes two hours on and two hours off for three days. This allows your feet to get accustomed to the shoes. Then start wearing them all day. In the evening, check your feet for red spots. If any redness lasts more than 30 minutes to an hour after you’ve taken off the shoes, tell your pedorthist. He or she will probably want to make further adjustments to the shoes.

Your pedorthist will want to see you again after you’ve worn the shoes and inserts for six months. If the inserts are compressed, you’ll be fitted for new ones.

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