Permanent Footwear Modifications

Permanent Upper Modifications

  • Balloon Patch: A patch of material is fastened over a hole made in the upper to accommodate a bony prominence.
  • Closure Modification: Permanent, external modification of the upper of the shoe by the addition of leather and fabric. Examples include the addition of hook-and-loop (Velcro) straps or buckles, or a closure system including both hook-and-loop and lacing (lace stitch Velcro).
  • Stretching: Stretching the upper of the shoe using a standard shoe stretcher or a ball-and-ring stretcher.

Permanent Upper, Midsole, and Outsole Modification

  • Buttress: Material (typically EVA) is fastened to the upper and sole on the inside or outside of the shoe creating a “wall” that bolsters support of the foot and widens the base of support to help control abnormal motion.

Permanent Midsole and Outsole Modifications

  • Charcot Modification: Splitting and widening the sole of the shoe, possible excavations inside the shoe, and the addition of a rocker sole.
  • Excavation: A hole is drilled out of the midsole of the shoe from the inside to create a well for a soft tissue lesion, bony prominence, or sensitive area.
  • Flare: Material is added to the side of the sole to broaden the base of support on the inside (medial) or outside (lateral) portion of the shoe. The flare should be widest where it meets the ground.
  • Metatarsal Bars: A permanent, external modification to the midsole in which a “bar” of material is added beneath the ball of the foot to change the flex point of the shoe. Similar to a rocker sole, but with less adjustability and specificity of treatment.
  • Resole: The original sole is removed and replaced with a new sole.
  • Rocker Sole: An addition of material and/or grinding modification made to the bottom of the shoe designed to address range-of-motion limitations, offload an area on the bottom of the foot, or improve function and gait patterns.
  • SACH Heel (solid ankle cushion heel): A soft compressible material wedge replaces a portion of the back of the heel base.
  • Shoe Lift: Extra material is added to the midsole or outsole of one or both shoes to raise by a prescribed height.
  • Shuffle Plate/Toe Slider: Addition of a smooth, low-friction, non-treaded material to the forefoot of the shoe.
  • Split Sole: Cut is made through the midsole and outsole of the shoe which is then spread. Additional material is inserted to maintain the split and the required broadened base of support.
  • Thomas Heel: An anterior medial extension of the standard heel on the inside to add rearfoot or midfoot support medially.
  • Wedge: A wedge is fixed to the shoe midsole to direct weight away from the modified side.

Some modifications are not appropriate for all types of footwear and options should be discussed carefully with a trained Canadian Certified Pedorthist.
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Only someone specially trained in footwear modification should perform this function. A pedorthist is best positioned to assess the performance of the modification and make additional alterations if required. A poorly executed modification could cause a patient additional discomfort and possibly harm.
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Download – Footwear Modifications, Permanent and Non-Permanent as a PDF
Video: Modified Shoes