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Speciality shoes for people with lower limb disorders

A strong walker in spite of a handicap

Selecting the right shoes is not all that easy for some people, but what if you have a handicap? Advanced osteoarthritis, ankylosis, artificial joints or a prosthesis are just a few examples. Prostheses for example are high-tech constructs. They are individually adapted and meanwhile make a normal gait pattern possible. Assuming the shoes are tailored to the prosthesis. This applies correspondingly when one is affected by any of the aforementioned handicaps. Speciality shoes for these fields of application are intended to improve safety, and ought to be both functional and comfortable when walking and standing. This improves mobility.

The right fit

Shoes have to fit properly whether one has a handicap or not. For speciality shoes, it is therefore especially important that they can be equipped with insoles in order to compensate for deficits. Here attention must be paid to ensuring that wearer comfort is not negatively affected by the insoles. The right length of the shoe is important as well. Frequently shoes are purchased in too big a size because they are not wide enough. This can be problematic since shoes that are too long increase risks such as spraining, slipping or stumbling. An optimal fit also depends on using the right last in the production process. The last should be based on the natural foot shape so the shoes do not pinch and are neither too big nor too small. By the way, manufacturers of prosthetic feet also use the last for orientation.

Criteria for a harmonious gait pattern

A controlled rollover is important for a harmonious gait pattern. This can for example be accomplished with a metatarsus support and a wider sole.

Good, effective shock absorption is one of the key features of a speciality shoe. This can be readily implemented with a slanted heel section with integrated damping element. Offsetting the roll for the ball of the foot slightly to the rear with a pronounced toe pitch not only supports the rollover but also reduces the risk of stumbling. The toe pitch is the distance between the toe-cap and floor when the shoe is standing on a level surface.

Stepping down safely

While one normally feels small irregularities or slippery surfaces while walking, this perception is restricted with a prosthetic leg. Technical assistance by the shoe is required here so the foot can step down safely. The sole should therefore have a special tread. Ideally its material composition can already improve the slip resistance and ensure the required grip on smooth, wet surfaces. This by the way is a characteristic appreciated by anyone with less than 100% walking performance.

Lightweight and comfortable

Mobility compared to the healthy foot may be limited depending on the handicap. Personal mobility as such may also be less than optimal, so this can be compensated by speciality shoes. They should therefore be designed so they are easy and comfortable to put on and take off. A large opening to put the shoe on, a loop on the tongue or also a one-hand closure make it much easier to put on and take off. If the shoe is particularly lightweight, this is also advantageous, because the centrifugal forces on swing-through are higher the more a shoe weighs. A weight of less than 500 grams is ideal (for size 42).

The right material

The shoe needs to be made of high quality materials. These include vegetable tanned leather with sufficient water vapour permeability and breathable textiles that guarantee a balanced climate inside the shoe as well as comfortable wearing behaviour, even with continuous use. After all, your feet should simply feel comfortable. So pay attention to breathable materials.

All of the aforementioned characteristics of a speciality shoe can contribute to relieving strain on the joints and back. That reduces strain on the entire musculoskeletal system and helps prevent back pain. After all, the right shoe helps prevent non-physiological movements.

Checklist

• The prosthetic shoe should support correct pronation and reduce the risk of stumbling, while optimising the way the prosthetic leg swings. Ideally, this is achieved with a slightly recessed metatarsal bar and a pronounced toe pitch.
• The shoe should permit controlled pronation to warrant a harmonious gait. This can be achieved e.g. by supporting the middle foot and using a widened sole.
• Effective shock absorption is important, as is protecting the joints, implemented e.g. with a sloping heel section that has an integrated damping element.
• An optimum fit is assured if the shoe is adequately wide in the area of the forefoot without unnaturally pushing the big toe to one side. Generally one can say that the foot must be able to move in all directions without the loss of secure foot guidance. The natural shape of the foot must not be impaired or changed by the shoes.
• The use of insoles is important with speciality shoes. It must be possible to use them without impairing wearer comfort while securely holding the shoe on the foot.
• The shoe must have the right length. Often shoes that are too large are purchased because the width is not sufficient. In many cases the feet also have different lengths. Shoes that are too long increase risks such as slipping, spraining, stumbling and skin problems.
• Increased anti-slip protection gives the user greater stability on smooth, wet surfaces, ideally achieved with a special profile and choosing a special rubber mixture for the sole.
• It must be easy and comfortable to put the shoe on and take it off again. The shoe should preferably have a large opening, a loop on the tongue or a one-handed closure.
• The shoe must be made of top quality materials, e.g. vegetable-tanned leather with adequate water vapour permeability and permeable textiles to guarantee a balanced climate inside the shoe while making it pleasant to wear even for longer periods of time.
• A lightweight shoe reduces the centrifugal forces when swinging the prosthetic leg, and facilitates fatigue-free walking as far as possible. The individual shoe should therefore not be heavier than about 500 g (for German shoe size 42).
• Shock absorption for the forefoot relieves the pressure on the metatarsal head.

Minimum requirements

• Controlled pronation, reduced stumbling risk
• Optimised swinging of the prosthetic leg
• Shock absorption and protection for the joints
• Different lengths with sufficient width in the forefoot area
• Does not impair the natural shape of the foot
• Use of insoles is possible
• Optimal fit
• Anti-slip protection
• Easy to put on and take off
• Top quality materials
• Low weight

Also appropriate

• Shock absorption for the forefoot
• Available in various widths

Products in this sector with the AGR seal of approval

• Nunatak A 10 BOA
• Nunatak C 10 BOA
• Nunatak C 10 VELCRO
• Nunatak C 20

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