Footwear

Shoes serve many functions. They protect our feet. They cushion our body weight. They can make our feet feel comfortable or fashionable — hopefully both! Finding the proper shoes and making sure they fit are important for keeping your feet and your body happy. Poorly fitting shoes can be painful and cause foot problems like bunions, corns, calluses, hammertoes, plantar fasciitis, stress fractures, and more.

Every day, the average person spends several hours on their feet and takes several thousand steps. Walking puts pressure on your feet that's equivalent to one-and-a-half times your body weight. No wonder your feet hurt!

Actually, most foot problems can be blamed not on walking but on your shoes. Corns, for example, are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns usually are located on the top of the toes or on the side of the small toe. Soft corns may resemble open sores and develop between the toes as they rub against each other.

The Charcot Restraint Orthotic Walker, or CROW, is a rigid boot designed to accommodate and support a foot with Charcot neuroarthropathy (CN).

CROW consists of a fully enclosed ankle/foot orthotic with a rocker-bottom sole. It is a common treatment used to minimize further deformity and prevent ulcer development after acute CN has calmed down.

CN occurs when bones and joints in the foot fracture, break up or pop out of place with minimal or no known direct injury. In the United States, this deformity most commonly occurs in people with diabetes. The foot first enters an acute stage of swelling, warmth and redness, that can be mistaken for an infection. Broken bones and dislocations can occur, causing severe deformities of the foot and ankle. Some patients develop pain or ulcers when the affected foot becomes deformed. CN can affect the other foot or happen again in the same foot. The foot does not regain its normal shape. 

People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.

• Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds.
• Nerves: Those who have nerve problems can develop a blister and oftentimes not even know it is there until they take off their shoes.
• Immunity: Some individuals with diabetes have a diminished response of their immune system. Because of this, they can get an infection from a cut or blister more easily and have more difficulty treating it.
• Deformity: People who suffer from diabetes can have collapse of the arch of their foot or other deformities which makes the foot more difficult to place into off-the-shelf shoes because of the risk of blisters developing over areas of high pressure.

Proper footwear is therefore very important for people with diabetes. Your foot and ankle orthopaedic specialist can help you choose proper footwear and recommend shoe modifications to protect your feet.

Patients with diabetes are prone to major foot problems. This is because the foot expresses many of the underlying effects of diabetes, including neuropathy, vascular disease, and diminished response to infection.

As a result of the neuropathy, the foot can develop an ulcer. This happens for two reasons. The first is that the neuropathy causes paralysis of small muscles in the foot, which results in clawing of the toes. Clawing of the toes causes prominence of the metatarsal heads (bones closest to the toe) on the bottom of the foot as well as the knuckles on the dorsum (top) of the foot.

Most children learn to walk at about the time of their first birthday, although some learn months earlier or later. As your child begins to walk, you may have your first questions about what shoes he or she should wear. A growing child will need new shoes frequently, and more questions will arise.

You should ask yourself the following questions when selecting your child's shoes:

• How does the shoe fit?
• How is the shoe made?
• Is the type of shoe appropriate for your child's age? 

Orthotics, also called orthoses, are devices that are worn to relieve pain associated with foot and ankle deformities and help prevent or delay surgery. Most people think of shoe inserts or arch supports when they hear the word orthotics, but they can include devices such as foot pads, shoe inserts, ankle braces, and similar items. Treatment often can begin with less expensive off-the-shelf orthotics and progress to custom orthotics if the symptoms and diagnosis require it.