External Shoe Modifications

Types and Applications.



External Modifications to shoes correct body balance by restoring foot balance during standing and walking. The adult foot should distribute weight between the first and fifth metatarsal heads and heel as illustrated above.



Common Types:



 SACH Heel (Solid Ankle Cushion Heel)


The Solid Ankle Cushion Heel is a posterior portion replaced by the softer rubberized SACH material. SACH heels reduce shock heel strike and compensate for the absence of ankle motion.



Lateral SACH Heel


The lateral SACH heels are sometimes used with adolescents to help bring the subtalar joint into a neutral position when their feet hyper-pronate.



Thomas Heel


The Thomas Heel is manufactured with an anterior medial extension of one half inch longer then the standard heel. The Purpose of the Thomas Heel is to give added support under the sustentaculum tali and the medial longitudnal arch.



Lateral Thomas Heel


A Lateral thomas heel will support the cuboid area and will tend to rotate the foot externally i.e., abduct the foot. If Additional support is needed then a wedge can be insert


Heel and sole wedges (medial) may be prescribed when the medial aspect of the foot bears too much weight (pronation or depression of the medial longitudnal arch)




Lateral heel wedge with anterior extension


This modification gives added support and transfers weight medially and off the fifth metatarsal shaft, and especially off the fifth metatarsal head itself.



Lateral Heel Wedge


Lateral heel wedges can be inserted into the shoe or externally added, but the most important aspect is they must be placed under the heel base.



Lateral Sole Wedge


this modification is created when weight needs to be supported or redistributed from the lateral to medial side of the shoe. It can also be used for treating knee strains, bow legs, tibial torsion and any other varus feet.



Pigeon Toe Wedge


This wedge is a lateral sole wedge assisting the foot to toe out instead of toeing in



Medial Toe Wedge


This is used to encourage toeing-in and is commonly used with a medial heel wedge.



Genu Varum Modification(bowlegs)


When working with a supinated foot (foot rolls out) use an outer sole and heel wedge to force the knees in. A long counter and arch cookie will prevent arch collapse. If the shoe needs additional strength, the wedge may be extended the full length of the shoe.




Genu Varum Modification(bowlegs) with pronation


In case of bowlegs accompanied by pronation, reinforce the counters to gain additional control.



Genu Valgum Modification (knock knee) modification


The application of inside heel and sole wedging help direct knees outward and apart. A long counter and medial arch cookie can be used if the shoe needs additional support.



Genu Valgum Modification (knock knee) heavy duty modification



if needed, the wedge may be extended the full length of the shoe.





the use of a Thomas heel, an inner heel wedge, a long extended medial counter, and an arch is a common application to correct this problem




Spinner Wedges


Spinner wedges are lateral metatarsal wedges designed for control of "pigeon toes."

This wedge is often made with a reverse thomas heel to control toeing in and keep the foot from pushing the lateral side of the shoe.