03/11/2019    Paul Kesselman, DPM

RE: Custom Shoes for Patients with Gout (A. James Fischer, DPM)

I have used Hersco in LIC, NY for more than twenty
years for patients with severe Charcot foot
deformities. They also manufacture custom foot
orthotics and AFOs. They are reasonably priced and
their management and customer service team are
superb. Mr. Kennedy is a CPed and has had many
articles appearing in several publications on a
regular basis. I would definitely reach out to Mr.
Kennedy and review the case prior to submitting an
order.

Some simple tips from thirty five+ years of
ordering custom shoes for patients: Be sure to
take a good plaster cast with the patient in a
semi weight bearing position on pillows or foam
and with knee and ankle at 90 degrees (when
possible) and mark all the seriously deformed
areas.

Plaster is far superior over any other impression
method as in my opinion, it will be the best way
to capture the multi-dimensional deformity. Trace
the foot in both a semi weight bearing and fully
weight bearing position (as per their
instructions). Lastly, send some photos of the
patient's feet to Mr. Kennedy for his review.

As far as the construction of the shoe: The
patient's weight and other musculoskelteal issues
will determine the weight type construction of the
shoe.

The inside of the shoe may need to be lined with
plastizote or other open cell materials if any of
the deformities require additional accommodation.
A Spandex vamp and toe box might be best if the
patient experiences edematous changes during the
day.

As for a closure system, you must evaluate the
patients upper limb and spinal dexterity. A tandem
lace or Velcro closure might be best.

Think about whether a rocker sole is necessary or
appropriate for this patient. Some types of
rockers may increase the patient's fall risk.
Think about the type of custom insert or orthotic
is required to off load the patient.

If the deformities are unilateral, does the
patient want the shoes to appear the same
(mirrored) from the outside or do they want one
shoe to look normal (asymptomatic side) and the
other to look like a shoe accommodating a
deformity. Remember there is just so much the mfg
can disguise the deformities. Color: If you are
making one shoe, stick to a dark neutral color as
it's easier to keep clean.

Split heel: If the heel is seriously deformed, a
split heel with a Velcro closure might assist the
patient's entry into the shoe.

Paul Kesselman, DPM, Woodside, NY

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