Fully use the sizing chart. It is always worthwhile filling in the boxes at the bottom of the chart to record the sizes. It will help in future to check if the patient's size has changed.
If ordering boots make sure that the ankle circumferences are noted as anything out with the regular sizes will need bespoke uppers to accommodate.
There are a variety of lasts on offer to accommodate all foot shapes.
Ladies/Gents styles difference against standard last.
Difference in size
Narrow heel and shallower forepart
When measuring for shoes take the measurements both standing and sitting, sometimes there can be a size difference in both length and width.
Trust your measurements, split sizes are available and if there are any doubts then rough fit the shoes. It takes an extra appointment but the result will be better.
Be sure that if a T-strap is required for ankle control that the side and height is stated so it optimally controls the patient.
Utilise the different upper materials on offer. Stretch leather is great for accommodating high toes, wide joints and mild swelling changes.
Neoprene is the best material for patients who have chronic swelling and can also be ordered with a toe puff to increase the depth at the toes.
Use the different lining materials on offer, bambus has natural anti-bacterial properties. Go guard has been specifically developed for the diabetic foot incorporating silver ions into the fabric to combat bacteria formation.
The colour of shoes in the catalogue can all be changed along with the stitching and panels.
Don't try to be too ambitious with modifications to uppers. If you are adding several major increases to areas then it may be worth considering bespoke footwear. The result will be better.
Not only can the uppers be modified but the stiffeners can also be changed. The heel counters can be double stiffened and extended both medially and laterally to give more stability.
If the tongue tends to fall to one side then consider a loop on the tongue or stitching the proximal edge to the upper.
The inlays which come with the shoes can also be modified. For example they can changed to pink poron, soft LAS poron insoles etc.
When measuring for Steprite footwear and a bespoke insole is being incorporated, be sure to consider the thickness of the insole. Steprite shoes come with 3, 3mm insoles which can be replaced with the TCI.
If ordering both custom TCIs and Steprite shoes be sure to link the two orders together so that the insoles are an intimate fit and be returned to the hospital together.
EVA soles are a recommendation if major sole modifications need to be added. They are lightweight and give the best cosmetic finish for the patient.
The new Thru Wedge sole unit for ladies incorporates a heel rocker and is very flexible. The PU construction also allows for easy modification and gives a good cosmetic finish.
If the patient is very active consider changing the soling material to hard wearing. This will extend the time between repairs however will increase the weight of the shoe.
General Hints and Tips
Try to keep it simple. Make sure that clear and concise instructions are given for the technical staff to follow ensuring that your handwriting is legible.
Utilise stock shoes. There are a variety of styles, both ladies and gents in a selection of sizes, which can be used for the less complicated feet.
Consider the contour last if the patient needs extra width in the toe box for accommodation of toes.
The style of the shoe is always important. Low opening styles, such as the Michigan and street style, allow an easier entry for people who wear AFO's.
Pay careful attention to the modifications you are requesting to uppers, certain sizes have limits on what can be done to them.
Take into consideration the seams and panel placements on the Steprite footwear. Don't be afraid, if you know that a particular style might cause a problem due to a seam, to tell the patient you will get a better result in the end.
If choosing Velcro and major modifications to the instep are also being utilised be sure to increase the strap length as well and always overcompensate, the straps come with 3 cut lines if required.
If the patient is diabetic and this box on the chart is selected modifications will automatically be made these include;
Rim toe puff
If there is any doubt on what can and can't be done regards to materials and modifications, phone the technicians they are more than happy to help.