Shoe modification and the use of orthoses in the treatment of foot and ankle pathology.

Shoe modification and foot orthoses can play an important role in the nonsurgical management of foot and ankle pathology. Therapeutic footwear may be used to treat patients with diabetes, arthritis, neurologic conditions, traumatic injuries, congenital deformities, and sports-related injuries. These modalities may improve patient gait and increase the level of ambulation. They also may be used to treat acute problems such as plantar fasciitis or metatarsalgia and as preventive tools in patients with diabetic neuropathy. Shoe selection is primarily based on the condition of the patient, the foot shape and type, and the patient's daily activities. Modifications include flares, which provide stability; extended shanks to reduce bending stresses; rocker soles to rock the foot from heel strike to toe-off; and relasting, or reshaping, shoes to accommodate deformities. The four main types of custom orthoses are the accommodative, which cushions and protects the foot; the semi-rigid, which cushions and protects as well as provides support, control, and weight redistribution; the rigid, which offers arch support; and the partial foot prosthesis, which addresses partial amputations and helps protect the foot.