This document discusses various modifications that can be made to footwear to accommodate medical conditions and pathologies. It describes modifications that can be made to the inner sole, heel, toe box, and other parts of the shoe. Common modifications include metatarsal pads, inner arch supports, heel wedges, rocker bottom heels, and toe sliders. The modifications are intended to improve function, accommodate leg length discrepancies, arthritis, neurological conditions, and support medical issues like plantar fasciitis.

1. NAME-MINAL FIZA
BPT 3rd
year
Footwear modification
Footwearmodifications are changesoradaptationsmade tofootweartoimprove functionandto
accommodate specificpathologiessuchasa Leg LengthDiscrepancy,Ankle Arthrodesis(fusion),
Severe Arthritis,Neurological conditionsandDiabeticcomplications.
PARTS OF FOOT WEAR
• UPPER- COVERS THE DORSAL ASPECTOF FEET
• SOLE – LIES UNDER THE PLANTARSURFACEOF FEET
• HEEL – LIES UNDER THE ANATOMICHEEL
• LINING/REINFORCEMENT
FOOTWEAR MODIFICATION
• INNERSOLE MODIFICATION

2. • HEEL MODIFICATION
• TOE BOX
INNER SOLE MODIFICATION
• METATARSALPAD/BAR
• INNERARCH SUPPORT
 Charcot Modification(combinationof three modifications:splitsole,excavation,androcker
sole)
• CORK-INSOLE
• SPONGEINSOLE- – EXCAVATEDHEEL (U SHAPEDCUSHION)
– FOAMRUBBER INSOLE
– HEEL RAISE
• CONDITIONS- –CALCANEALSPUR,PLANTARFASCITIS,POSTCALCANEALBURSITIS,FOOTULCERS.
OTHER MODIFICATIONS
• METATARSALBAR- PESCAVUS
Pescavus footoccurs inabout 8% to 15% of the population,butitdoesnotgetnearlyas
much attentioninthe medical literature asdoesitscounterpart,pesplanus. Sixtypercent
of individualswithcavusfeetdevelopfootpain.
Addinga metatarsal baror a metatarsal padwill shiftplantarpressuresmore proximally,
away fromthe metatarsal heads.Leavingthe anterioredge of the orthosisatfull
thickness(insteadof bevelled) producesarocker-type effect,whichshortensthe time the
metatarsal headsbearweight.A forefootextensionof softdurable material attenuates
the pressure peaksunderthe metatarsal heads.
• METATARSAL PAD- FOREFOOTPAIN
Metatarsal supportpads workby reducingthe pressure onthe ball of your
footby supportingthe metatarsal bone justbehindthe ball of yourfoot.By
distributingsome of the pressuretothe shaftsof the bones,the pads
diminishthe pressureonthe ballsof yourfeet.

3. • CORKINSOLE
- Corkis a relatively softmaterial thatisdenselycompactedforshoe use.
However,whensubjectedtothe weightandheatappliedthoughnormal
wear, cork insolesmoldthemselvestothe wearer'sfoot.Thiscreatesacustom
fitthat conformsto the wearer'snatural shape,offeringahighdegree of
comfort.
• MEDIAL ARCH SUPPORT-
Medial arch supportsare designedtoprovide structural supporttoflatfeetandfallenarches.They
can helpinthe followingways.
1. Theycan reduce paincausedby inflammationorextreme stressonthe
plantarfascia.
2. Theycan reduce strainon the feet.
3. Provide properbalance andsupport.
HEEL MODIFICATION
1. THOMAS HEEL- EXTENSION OFMEDIAL HEEL BREAST. MAINTAINSMEDIAL
LONGITUDINALARCH
• REVERSE THOMAS HEEL- SUPPORTS LATERALLONGITUDINALARCH.
2. HEEL WEDGE- GENU VARUMDEFORMITY: LATERAL WEDGE
GENU VALGUM DEFORMOITY: MEDIAL WEDGE

4. 3. ROCKER BOTTOM HEEL- FACILITATINGPLANTARFLEXION ANDFACILITATES
GAIT IN SWING PHASE.BENEFITS- ANKLEFUSION,ANKLESPRAIN,
METATARSALGIA.
4. HEEL FLARE-
•A medial flare isusedtoresisthindfoot eversion
• A lateral flare isusedto resistinversion
• Boththe flaresare usedtoprovide heel stability.
HEEL MODIFICATION- – HEEL PAD: Heel pads are generallyconstructedof
polyvinylchloride,silicone,leather,polyethylenefoamslike Plastizote,and
thermoplastics.The firstline of relief fortreatingplantarfasciitis, heel
cushions provide extrashockabsorptioninthe heelarea.Theyhelpabsorb
the shock of heel strike inwalkingandrunning.
SACH Heel (solidankle cushioned heel) – A softcompressible material
wedge replacesaportionof the back of the heel base.Reducesshockat
heel strike andcompensatesfordiminishedankle motion.
TOE MODIFICATIONS-
METAL SHANK – The shankisa componentpartof all supportive
footwearandisa rigidmaterial placedintothe midsole tostiffenthe base
of the shoe andprovide torsional stability.Whilethere mightbe the very
rare occasionthat thisiswarrantedas a modificationtoashoe,the
necessityof thismodificationwoulddeemthe shoe inappropriate.
Stretch Toe Box – Billedasashoe modification,thisimpliesthe toe box istoonarrow,short,or
shallowandtherefore mightbe inappropriateforthe patient.Occasionally,aspecificstretchis

5. neededtoaccommodate aspecifictoe orforefootjointdeformitytomake roomforthat enlarged
area witha specificspotstretchorball-and-ringstretcher.
ShufflePlate/ Toe Slider – Additionof a smooth,low-friction,non-treaded
material tothe forefootof the shoe.Useful whenthe patientisunableto
fullyliftthe forefoot,orusesashuffle gait – especiallyincarpeted
environments(similartowhatis usedbydancerswhorequire the comfortof
a supportive shoe,butwithoutthe tread).
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