Orthopedic Boots

Orthopedic Boot

My first pair of 100% orthopedic shoes. I’m not an orthopedic shoemaker, but many of the shoemakers I studied from in the Netherlands are. Why call these orthopedic? I’ve made lots of shoes for people who wear “orthotic inserts.” These boots different. They are a textbook case of how to handle hallux valgus – your basic big bunion and also dealing with foot and ankle instability. The blueprint shows how different the feet are.

On the right foot, there is a significant bunion on the first metatarsal joint (big toe). There is also a bunionette on the little toe ball joint of the right foot. She has had some plantar fasciitis, pain and tenderness on the bottom of the foot. Not a lot of mobility in MT1, the big toe.

The left foot has no such issues, but due to a stroke, my client lost some facility with her left leg creating balance issues and instability with the left ankle and foot. Looking at the print of the left foot, those issues are not visible. The left foot is also a full size longer than the right, and two widths narrower in the standard sense. Her issues have nothing to do with her left foot per se, and yet everything to do with it. Getting to know the client, seeing and feeling the feet first hand is an essential part of making custom shoes. In this regard, the knowledge I got from in person contact is critical to the success of working with her.

For an orthopedic shoemaker, dealing with hallux valgus is really no big deal. Basic beginner stuff. Their daily work is typically with clients that have much more complicated conditions. I have an understanding of these issues, but since I’m not a trained orthopedic specialist. I referred her to one. She said “No.” She really wanted me to make them. I told her that I would take a crack at it, no guarantees.

What to do? I referred to my copy of “Orthopedisch maatschoeisel in de medische praktijk” (1991), by Dr. Klaas Postema. This hand me down from my colleague Rene van den Berg, was the standard textbook that he and many of the shoemakers I met in the Netherlands studied in school. I read through that and Dr. Postema’s latest book, “Pedorthic footwear – assessment and treatment” published (in English!) in 2018. I also thought back on all the discussions I’ve had and shoes I’ve seen at Mischa Bergshoeff’s shop in Gouda. You can look at his work and see how amazing it is and have no idea of what sort of feet go in those shoes.

There is a prescription for hallux valgus, a sort of shoemaking recipe, in the books. Depending on the mobility of the foot, you can squeeze it a bit around the tarsals and that will actually straighten out the bend in MT1 slightly. This should ease the stress of toe-off in walking and possibly give more flex to MT1. Extra room is needed for the bunion and bunionette, but the foot will slip forward to fill that space unless you keep it firmly in the rear 2/3 of the shoe. It’s important to keep the rearfoot firm and secure. It’s a tight fit, but should not be uncomfortably tight. To help keep the ankle and foot in position, the upper is about a hand’s width above the ankles (malleolus). There is a firm heel counter and a rocker bar to assist in toe-off. I made a padded contoured footbed liner with metatarsal bump to helps restore the transverse arch.

Like any recipe, you need to season to taste. Most people don’t want to go to “orthopedic specialists” because they are most famous for making ugly shoes and boots. The difficulty of clinically handling the many foot pathologies orthopedic shoemakers encounter is already extreme. On top of making the most appropriate shoes possible, people also demand they look great. Sometimes there is a real disconnect between the shape and functionality of the client’s feet and what the client wants to see when they look at the shoes. As a custom shoemaker, it’s my job to balance those things. For an orthopedic shoe, it’s no different, just more difficult.

These shoes are EU 39-9(L) and 38-10(R). I wanted to use a Vibram Gumlite unit sole because it’s cushy to walk on and a good all-weather material. Vibram, however, typically only makes huge soles available to the distributors in the US like only men with giant feet need their soles. It’s very hard to get the right size unit sole for a custom shoe, but once the shoe is size 41 or less, you really have to start hacking to make it fit. When I made the trial shoes, I simply made sure the sole covered the shoe. As you can see from the tread pattern, this is not nice. Would anyone even notice? I noticed and I didn’t like it. At the very least, the shoes have to satisfy me.

I had to shorten these to get a passable agreement of the heel and forefoot. If you look closely, you’ll see the word “Gumlite” is gone from the final version. I made a straight cut and then sanded a 1 cm skive for the 39 and 1.5 cm skive for the 38. Previously, I have cut these along the curve of the heel and made an overlap. This time I wanted to try something new. The cut along the curve of the heel looks more finished, but the increased contact area and a transition before the edge of the heel on the straight cut and skive should keep the heel more solidly bonded, at least in theory.

Who doesn’t  love a hidden feature? There is one for the wearer and one for shoemakers. For the wearer, there is an embossed inside lace stay. This allows me to use more rust colored thread for not-totally-gratuitous ornamental stitching to sew it in. The embossed stays can only be seen when the shoes are open.

When they are open, look at the back of those speedhooks! Have you ever seen such a clean finish? Thanks many times over to Mischa for this method of setting speed hooks. I want to thank all the shoemakers who helped reach the point where I am able to make shoes like these, and thanks to Dr. Postema. I couldn’t have done it without you.

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