THERAPEUTIC FOOTWEAR

Therapeutic footwear refers to specially designed shoes or shoe inserts that support or accommodate specific medical or physical conditions of the feet, ankles, or lower limbs. These are often prescribed by healthcare providers for patients with certain chronic conditions like diabetes, arthritis, or foot deformities.

Purpose of Therapeutic Footwear
Therapeutic footwear is intended to:

Relieve pressure on sensitive areas of the foot
Improve mobility and balance
Prevent foot injuries or ulcers (especially in diabetic patients)
Correct or accommodate foot deformities (e.g., bunions, hammertoes)
Support the foot in cases of poor circulation or nerve damage

Types of Therapeutic Footwear

Extra-depth shoes – Provide additional room for foot deformities or custom orthotics.
Custom-molded shoes – Made from a mold of the patient’s foot to accommodate severe deformities or abnormalities.
Orthopedic shoes – Designed to support or correct alignment issues.
Diabetic shoes (also called therapeutic shoes for diabetics) – Reduce risk of skin breakdown and ulcers due to neuropathy or poor circulation.

Who Needs Therapeutic Footwear?
Common patient groups include those with:

Diabetes (especially with neuropathy or foot ulcers)
Arthritis
Foot deformities
Cerebral palsy
Post-surgery foot recovery
Stroke survivors with foot drop or other gait issues

Insurance & Medicare Coverage
In the U.S., Medicare Part B covers one pair of therapeutic shoes and inserts per year for people with diabetes who qualify, under certain conditions and with a prescription from a physician and fitting by a qualified provider.

Diabetic foot complications

Diabetes can cause a range of foot problems, many of which can become serious if not properly managed. These issues often stem from two main complications of diabetes:

Peripheral neuropathy (nerve damage)
Peripheral arterial disease (PAD) (poor blood circulation)

Common Diabetic Foot Problems

1. Diabetic Neuropathy

Nerve damage reduces feeling in the feet, so you may not notice injuries, cuts, or pressure sores.
Can lead to burning, tingling, numbness, or complete loss of sensation.
Causes foot deformities (e.g., hammertoes, Charcot foot).

2. Poor Circulation (PAD)

Reduced blood flow means wounds heal slowly.
Increases risk of infection and ulcers.

3. Foot Ulcers

Open sores, often on the ball of the foot or bottom of the big toe.
Can easily become infected and may not heal without proper care.

4. Infections

Small cuts or blisters can lead to serious infections.
Diabetics are more prone to fungal and bacterial foot infections.

5. Calluses and Corns

Build-up of hard skin caused by pressure or friction.
If not managed, can break down and lead to ulcers.

6. Blisters

May go unnoticed due to reduced sensation.
Can become infected if not protected.

7. Dry, Cracked Skin

Can cause fissures (deep cracks), which may allow bacteria to enter.

8. Foot Deformities

Muscle imbalances from neuropathy may cause:
Hammertoes
Bunions
Collapsed arches
Charcot foot (a severe condition causing weakening of bones and joint collapse)

9. Amputation

Due to infections or ulcers that do not heal, diabetic foot problems are the leading cause of non-traumatic lower-limb amputations.

Foot Care Tips for People with Diabetes

Inspect feet daily for cuts, blisters, swelling, or color changes.
Keep feet clean and dry, especially between toes.
Moisturize daily, but not between toes.
Trim nails carefully or have them trimmed by a podiatrist.
Never walk barefoot – even indoors.
Wear properly fitting therapeutic shoes or inserts.
Control blood sugar levels to slow progression of neuropathy and vascular disease.
See a podiatrist regularly for foot exams.

Arthritic foot complications

Arthritis can cause many foot and ankle problems, leading to pain, stiffness, swelling, and difficulty walking. Since the foot has 33 joints, it’s especially vulnerable to arthritis-related damage.

Common Foot Problems Caused by Arthritis
1. Foot Pain and Stiffness

Caused by inflammation and joint damage.
Often worse in the morning or after periods of inactivity.

2. Swollen Joints

Especially in the toes, midfoot, and ankles.
Can make shoes tight or uncomfortable.

3. Joint Deformities
Over time, arthritis can cause:

Bunions (big toe angling toward the second toe)
Hammertoes (toes bend abnormally)
Flatfoot (collapsed arch)
Claw toes or mallet toes
Hallux rigidus (stiff big toe joint)

4. Nodules or Bony Bumps

Common in rheumatoid arthritis – soft or hard lumps may form under the skin near joints.

5. Heel Pain

Arthritis can cause inflammation of the plantar fascia or the Achilles tendon, resulting in heel pain.

6. Difficulty Walking or Standing

Due to pain, joint instability, or misalignment.
Gait may change to compensate for pain, leading to further problems.

Types of Arthritis That Affect the Feet

Osteoarthritis (Wear-and-tear arthritis; affects joints like the big toe, midfoot, and ankle).
Rheumatoid arthritis (RA) (Autoimmune condition; often affects both feet symmetrically, causing joint erosion and deformities).
Psoriatic arthritis (Can cause swelling of toes (“sausage toes”) and heel pain).
Gout (Causes sudden attacks of severe pain, redness, and swelling—often in the big toe).
Ankylosing spondylitis (Inflammatory arthritis that may affect the heels (enthesitis).

Treatment Options
Conservative (Non-surgical)

Orthotics or therapeutic shoes
Braces or splints
Pain relievers and anti-inflammatory medications (NSAIDs)
Steroid injections into painful joints
Physical therapy
Moist heat or ice therapy

Surgical (for severe cases)

Joint fusion (arthrodesis)
Joint replacement (rare in the foot but possible)
Bunionectomy, osteotomy, or toe realignment surgeries

Self-Care Tips

Wear supportive, well-fitting shoes (no high heels or tight toe boxes).
Avoid standing for long periods or walking barefoot.
Do gentle stretching and strengthening exercises.
Maintain a healthy weight to reduce pressure on the feet.
Regularly see a podiatrist or orthopedic foot specialist.

Foot deformities

Common foot deformities are structural abnormalities that affect the shape, alignment, or function of the foot. They can be congenital (present at birth) or acquired over time due to aging, arthritis, diabetes, injury, or improper footwear.

Most Common Foot Deformities
1. Bunions (Hallux Valgus)

Bony bump at the base of the big toe
Big toe points toward the second toe
Caused by genetics, arthritis, or tight shoes
2. Hammertoes
Middle joint of a toe bends downward, forming a hammer-like shape
Common in 2nd, 3rd, or 4th toes
Can be flexible or rigid

3. Claw Toes

Toes bend upward at the joint closest to the foot and downward at the middle and end joints
Can cause painful corns or ulcers

4. Mallet Toes

Bend occurs only at the joint closest to the tip of the toe
Often affects the 2nd toe
Can lead to pressure sores or calluses on the tip

5. Flat Feet (Pes Planus)

Loss of the arch of the foot; entire foot touches the ground
May be flexible (arch appears when standing on tiptoes) or rigid
Can cause pain in heels, arches, ankles, or knees

6. High Arches (Pes Cavus)

Arch is abnormally high
Can lead to instability, ankle sprains, or pressure on the heel and ball of the foot
Often associated with neurological conditions

7. Charcot Foot

Seen in people with diabetic neuropathy
Bones weaken and collapse, leading to foot deformity
Can become swollen, red, and warm; often mistaken for infection

8. Hallux Rigidus

Stiffness and pain in the big toe due to arthritis or joint degeneration
Makes walking and bending the toe difficult

9. Tailor’s Bunion (Bunionette)

Similar to a bunion but occurs at the base of the 5th (pinky) toe

10. Toe Overlap or Underlap

One toe crosses over or under another toe
Can cause friction, corns, and footwear discomfort

11. Equinus Deformity

Limited upward bending (dorsiflexion) of the ankle
Causes abnormal walking patterns

12. Clubfoot (Talipes Equinovarus)

Congenital deformity where foot twists downward and inward
Requires early medical or surgical treatment

Risks and Complications
If left untreated, foot deformities may lead to:

Chronic pain
Calluses or ulcers
Gait and balance issues
Difficulty wearing regular shoes
Skin breakdown and infections (especially in diabetics)

Treatment Options

Custom orthotics or shoe inserts
Therapeutic footwear
Foot exercises and physical therapy
Padding and taping
Surgical correction (for severe or unresponsive deformities)

Cerebral palsy foot complications

Cerebral palsy (CP) often affects the muscles and motor control of the lower limbs, leading to various foot complications. These foot problems can significantly impact a person's mobility, gait, and quality of life.

What Causes Foot Complications in CP?
Cerebral palsy is caused by a non-progressive brain injury or abnormal brain development, which affects movement, coordination, muscle tone, and posture. These impairments can lead to muscle imbalance, spasticity, and joint deformities—especially in the feet.

Common Foot Complications in Cerebral Palsy
1. Equinus Deformity (Toe Walking)

Tight calf muscles or Achilles tendon pulls the foot downward (plantar flexion).
Common in spastic CP.
Leads to toe walking and balance issues.

2. Pes Planus (Flat Foot)

Arch of the foot is flattened.
Often due to weak or unbalanced foot muscles.
May cause pain, fatigue, and instability.

3. Pes Cavus (High Arch)

Arch is abnormally high due to uneven muscle pull.
Can result in pressure sores, instability, and foot pain.

4. Varus or Valgus Deformities

Varus: Foot turns inward.
Valgus: Foot turns outward.
Affects walking and shoe fit; may lead to joint misalignment.

5. Hallux Valgus (Bunion)

Big toe deviates laterally toward the second toe.
May occur due to muscle imbalance and joint instability.

6. Clawed or Hammertoes

Toes curl or bend due to uneven muscle tension.
Can cause pressure points, corns, and difficulty wearing shoes.

7. Foot Drop

Inability to lift the front part of the foot.
Often due to weakness or poor control of dorsiflexor muscles.
Causes dragging of the toes during walking.

8. Contractures

Permanent tightening of muscles and tendons around the foot and ankle.
Can severely restrict movement and require surgical intervention.

🚶‍♂️ Effects on Mobility

Abnormal gait (e.g., toe walking, crouch gait, scissoring)
Poor balance and frequent falls
Difficulty using standard footwear or braces
Increased energy use while walking

Treatment and Management

Non-Surgical

Physical therapy to stretch and strengthen muscles
Orthotics (AFOs, SMOs) to support and align the foot/ankle
Botox injections to reduce spasticity
Serial casting for contracture prevention or correction
Specialized footwear (therapeutic or custom-molded)

Surgical

Tendon lengthening or transfer
Corrective bone surgeries (e.g., osteotomy)
Foot and ankle fusion in severe cases

Special Considerations for Children

Early intervention is key to prevent deformity progression.
Foot problems may worsen during growth spurts.
Ongoing multidisciplinary care (neurologist, orthopedist, PT, orthotist) is often needed.

Post-surgery foot recovery

Post-surgery foot recovery is a critical phase to ensure healing, restore function, and prevent complications after a foot or ankle operation. Recovery time and care steps vary depending on the type of surgery, but general principles apply to most procedures.

Common Foot Surgeries Requiring Recovery

Bunionectomy (bunion removal)
Hammertoe correction
Tendon repair (e.g., Achilles tendon)
Flatfoot or high-arch correction
Foot or ankle fracture fixation
Plantar fasciitis surgery
Joint fusion (arthrodesis)
Neuroma removal
Charcot foot reconstruction (common in diabetics)

Phases of Foot Surgery Recovery
1. Immediate Postoperative Phase (Days 1–7)

Rest, Ice, Compression, Elevation (RICE)
Keep foot elevated above heart level to reduce swelling.
Use prescribed pain medication or anti-inflammatory drugs.
Non-weight-bearing: Use crutches, walker, or knee scooter.

2. Early Recovery Phase (Week 2–6)

Sutures/staples are usually removed in 10–14 days.
Swelling and bruising improve gradually.
Begin partial weight-bearing (if allowed).
Wear a post-op shoe, cast, or CAM boot.
Physical therapy may begin (especially after tendon or joint surgery).

3. Intermediate Phase (6–12 weeks)

Transition from boot/cast to supportive shoes or orthotics.
Gradual return to walking and normal activities.
Increase range of motion, strength, and balance training.
Swelling may persist.

4. Long-Term Recovery (3–12 months)

Full healing of bones and soft tissue may take several months.
Resume regular shoes, sports, or work gradually.
Possible long-term use of custom orthotics or therapeutic footwear.

Possible Complications to Watch For

Infection (redness, heat, pus, fever)
Poor wound healing
Nerve damage (numbness, tingling)
Blood clots (DVT)
Persistent swelling or pain
Nonunion or failure of bones to heal
Stiffness or reduced motion

Tips for a Successful Recovery

Follow your surgeon’s instructions carefully.
Don’t skip follow-up appointments.
Avoid smoking—it impairs healing.
Eat a nutritious, high-protein diet to support tissue repair.
Perform home exercises or PT as directed.
Don’t rush weight-bearing unless cleared.

Transition to Normal Footwear

Choose supportive, cushioned shoes with a wide toe box.
Avoid high heels or narrow shoes for at least 6–12 months.
Consider custom orthotics to prevent recurrence (e.g., bunions, flatfoot).

Stroke foot complications

After a stroke, many individuals experience foot and leg complications due to brain injury that affects muscle control, coordination, balance, and sensation. These issues can lead to impaired walking, increased fall risk, and reduced independence.

Why Foot Problems Happen After Stroke

A stroke can damage parts of the brain that control movement and sensation. This often results in:
Muscle weakness or paralysis (usually on one side)
Spasticity (involuntary muscle stiffness)
Poor coordination or balance
Sensory deficits (numbness or hypersensitivity)

Common Foot Complications After Stroke
1. Foot Drop (Most Common)

Inability to lift the front of the foot (dorsiflexion)
Toes drag on the ground during walking
Caused by weakness in ankle and toe muscles or disrupted nerve signals

2. Spasticity or Muscle Stiffness

Calf muscles (gastrocnemius and soleus) may become tight
Leads to toe walking, foot inversion (turning inward), or cramping

3. Equinus Deformity

Persistent downward pointing of the foot (plantarflexion)
Makes standing and walking difficult

4. Claw Toes or Hammertoes

Overactive toe muscles cause abnormal bending of toes
Leads to pressure sores, pain, and shoe-fitting problems

5. Ankle Instability

Weakness in ankle stabilizers increases the risk of sprains or falls

6. Swelling and Poor Circulation

Limited movement causes fluid build-up (especially in the paralyzed limb)

7. Loss of Sensation

Numbness or altered sensation in the foot increases risk of injury and skin breakdown

How These Affect Mobility

Difficulty lifting foot during gait (foot drag)
Poor balance and uneven stride
Slower, cautious walking
Higher risk of tripping and falling

Management & Treatment Options
🔹 Bracing

Ankle-Foot Orthosis (AFO) – most common device for foot drop
Keeps the foot at 90 degrees for safer walking

🔹 Physical Therapy

Gait training, balance exercises
Strengthening weak muscles
Stretching spastic or tight muscles

🔹 Functional Electrical Stimulation (FES)

Device sends small electrical pulses to activate foot muscles during walking

🔹 Botox Injections

Used to reduce spasticity in overactive muscles

🔹 Occupational Therapy

Helps patients adapt to daily tasks using assistive devices

🔹 Custom Footwear or Orthotics

Improve alignment, comfort, and pressure distribution

🔹 Surgery (in severe cases)

Tendon lengthening or muscle release procedures

Foot Care After Stroke

Check for pressure sores, cuts, or signs of injury (especially if sensation is reduced)
Keep feet clean and dry
Wear proper shoes—avoid slippers, flip-flops, or barefoot walking
Use therapeutic or orthopedic footwear if needed