The document discusses various shoe modifications that can be made externally and internally to address foot issues. Externally, modifications include different types of heels (e.g. orthopedic, wedge), soles (e.g. rocker bars, metatarsal bars), and combinations. The purpose is to restore foot balance and distribute weight across the foot. Internally, modifications involve inserts (e.g. steel shank, navicular pad) to transfer forces, reduce friction, and accommodate deformities.

1. EXTERNAL SHOE
MODIFICATIONS

2. INTRODUCTION
EXTERNAL SHOE MODIFICATIONS
● Orthopaedic heel (Thomas)
● Thomas heel wedge
● Medial sole and/or heel wedge
● Medial shank filler
● Valgus strap
INTERNAL SHOE MODIFICATIONS
● Steel shank in shoe
● Cookie insole and insert
● Navicular (scaphoid) pad
● Longitudinal arch support
● Long counter on medial side
The purpose of shoe modifications is to restore, in so far as possible, foot balance in standing
and walking. The goal is to achieve a pressure pattern on the sole of the foot in which the
weight is distributed between the first and fifth metatarsal heads and the apex of the
plantar surface of the heel.
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3. WHY SHOE MODIFICATIONS
• Transfer forces from sensitive to tolerant areas
• Reduce friction and shear on sensitive areas
• Modify weight transfer patterns
• Correct flexible deformities
• Accommodate fixed deformities
• Limit motion of painful, inflamed or unstable
joints

4. EXTERNAL SHOE
MODIFICATIONS
1. Heel Modifications

5. Orthopaedic heel (Thomas)
● Type of extended heel
● A wedge with an extended anterior
medial border used to support the
longitudinal arch and correct for
flexible pes valgus (pronated foot)
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6. Cushion heel
● Wedge of shock-absorbing material that is
added between the heel and the sole of a
shoe.
● Provides the maximum amount of shock
absorption and attenuation on heel strike.
● Indicated for patients after ankle fusions or
following a calcaneal fracture.
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7. Flares
● An extension, either medially or
laterally, of the sole that provides
stabilization.
● The flare can be added at the
heel only, or it can run the entire
length of the shoe.
● A flare is not designed to correct
deformity, only to control side-to-
side motion.
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8. Flares
● A medial flare is used to resist
hind foot eversion
● A lateral flare is used to resist
inversion.
● Both flares are used to provide
heel stability.
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9. Wedges
● A wedge is used to help correct
flexible deformities of the hindfoot
and/or forefoot.
● Medial wedge is used to promote
hind foot inversion.
● Lateral wedge is used to promote
hind foot eversion.
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10. Heel elevation
● To compensate for an acquired or congenital
limb-length discrepancy.
● Offsets the limb-length discrepancy created by
an AFO, cast, or walker boot.
● Can be applied either under the heel only or
under the whole bottom of the foot.
● A heel-only elevation is appropriate for
accommodating a fixed equinus position or
alleviating strain on the Achilles tendon.
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11. EXTERNAL SHOE
MODIFICATIONS
1. Sole Modifications

12. Rocker bar
● Most commonly prescribed shoe
modifications.
● Basic function is to rock the foot from heel
strike to toe-off without requiring the shoe to
bend.
● Eases forward propulsion.
● Offload areas of high plantar pressure, reduce
bending forces, and replace or restore lost
motion due to injury or deformity.

13. Mild rocker sole
● Most basic, popular, and widely used
of all rocker soles.
● Characterized by a mild rocker angle
at both the heel and toe.
● Increases forward propulsion
● Mitigates the pain associated with
early hallux rigidus.
● This type of rocker is a common
feature of walking and running shoes.

14. Heel-to-toe rocker sole
● It is designed to significantly aid in
propulsion at toe-off. Has the shortest
midstance.
● Used for a patient who has undergone
an ankle or triple arthrodesis.
● Contraindicated in patients who are
experiencing balance and/or
proprioception

15. Toe-only rocker sole
● Has a significant rocker angle at the
toe, with only a very mild rocker angle
at the heel.
● Provides a stable midstance.
● Indications include hallux rigidus and
metatarsal head ulcers associated
with diabetic neuropathy.
● Suitable for patients with balance
and/or proprioception problems.

16. Severe-angle rocker sole
● Carville rocker
● Has a severe rocker angle at the toe
and no heel rock.
● Eliminates weight-bearing forces on
the forefoot.
● Contraindicated for patients that are
experiencing balance and/or
proprioception deficits.

17. Negative heel rocker sole
● Has a mild heel rocker angle and a
significant toe rocker angle.
● Places the patient’s heel at the same
height as, or lower than, the ball of the
foot in stance phase.
● Inability to attain the necessary ankle
dorsiflexion will cause discomfort and
imbalance and may actually increase
pressure on the problem area(s)

18. Double rocker sole
● Is essentially a mild rocker sole from
which the middle section of sole has
been removed.
● Indicated in Charcot midfoot or a
prominent base of fifth metatarsal
head in a cavus foot.
● Does not increase plantar pressure at
the midfoot as with all other types of
rocker soles.

19. Metatarsal Bar
● Is a flat leather bar placed
across the sole posterior to
metatarsal head.
● It is used to relieve the
pressure from the metatarsal
heads.
● The picture on the right
illustrates the metatarsal bar
in the lateral & plantar view
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20. Sole Wedge
● This alters mediolateral
metatarsal alignment
● A medial wedge is used
to promote forefoot
supination.
● A lateral wedge is used to
provide pronation.
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21. Sole Flare
● A medial flare is used to resist
eversion.
● A lateral flare is used to resist
inversion.
● Both flares promote great
stability.
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22. Steel sole bar
● Inserted between the inner
and outer soles
● Prevents motion of the
anterior portion of the sole
● Reduces stress on the
phalanges and metatarsals
in the presence of fractures.
● Used with a rocker bar to
assisst rollover
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23. EXTERNAL SHOE
MODIFICATIONS
1. Combination Heel and Sole

24. Combination of sole and heel
modifications
● Shoe lifts and wedges can be combined in
both the heel & sole
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25. Thanks!
Any questions?
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26. 26
Team Presentation
26
Muhammad
Mubarak Janjua
‫جی‬‫ميں‬‫تها‬‫اے‬‫س‬ُ‫ا‬ ‫حشر‬‫سے‬
‫اب‬‫نہ‬‫بوليں‬‫گے‬‫کبهي‬
‫بے‬‫وفا‬‫سامنے‬‫تو‬ ‫آيا‬‫پيار‬‫آ‬‫ہي‬
‫گيا‬
Hafiz Attiq Ur
Rehman
‫کچه‬‫طرح‬ ‫اس‬‫سے‬‫تيرا‬
‫ہجرمناتا‬‫ہوں‬
‫ہنستا‬‫ہوں‬،‫بہت‬‫ہنستا‬‫ہوں‬،
‫ہنستا‬‫ہی‬‫جاتا‬‫ہوں‬
Ahsan Abbas
‫تيرے‬‫بنا‬‫زندگی‬‫سے‬‫کوئی‬
‫شکواہ‬‫تو‬‫نہيں‬
‫تيرے‬‫بنا‬‫زندگی‬‫بهی‬‫ليکن‬
‫زندگی‬‫تو‬‫نہيں‬
Aqsa Anwar
‫ستاروں‬‫سے‬‫آگے‬‫جہاں‬‫اور‬
‫بهی‬‫ہيں‬
‫ابهی‬‫عشق‬‫کے‬‫امتحاں‬‫اور‬
‫بهی‬‫ہيں‬