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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Describe the types of shoes, shoe modifications, and foot orthoses and their functions.

  2. Describe the components of shoes, shoe modifications, and foot orthoses.

  3. Describe the proper fit of shoes, shoe modifications, and foot orthoses.

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Physical Therapy students are expected to:

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  1. Determine the need for specialized shoes, shoe modifications, or foot orthoses for a client.

    1. Evaluate relevant client examination findings to diagnose impairments that may be improved by specialized shoes, shoe modifications, or foot orthoses.

  2. Develop appropriate goals for specialized shoes, shoe modifications, or foot orthoses.

  3. Describe the biomechanical methods employed in therapeutic shoes, shoe modifications, or foot orthoses to achieve the goals.

  4. Develop and execute a search strategy to identify research evidence for the uses and effectiveness of therapeutic shoes, shoe modifications, and foot orthoses.

  5. Recommend shoes, shoe modifications, or foot orthoses as part of a plan of care for individuals with impairments of the foot.

  6. Evaluate shoes, shoes with modifications, and foot orthoses for fit, function, comfort, and cosmesis.

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CASE STUDIES

Tim Higgins is a 24-year-old man with bilateral foot pain during any sustained walking or standing longer than 30 min. He was diagnosed as a teenager with flexible flat feet, which made it impossible for him to play high school sports. He recently graduated from college and is employed as a civil engineer, which requires him to do considerable walking over all types of outdoor terrain to monitor work sites and projects. Despite wearing expensive, supportive boots with arch support inserts, Tim's foot pain has gotten worse, is now present all the time, and is making it difficult to get through his workdays. Examination findings are presented in Box 13.1.

Michael Ferris is a 55-year-old man with a diagnosis of non-insulin-dependent type II diabetes mellitus, who is a chief financial officer for a large insurance company. He lives in Philadelphia and commutes by train daily to New York City to work and thus spends much time sitting and eating fast food in busy train stations. At a company-required annual physical examination, it was discovered that he has developed diabetic neuropathy bilaterally. Selected examination findings are presented in Box 13.2.

Janice Simmons is a 63-year-old woman who sustained a left transtibial amputation for gangrene of her left foot. Her case is described in Chapters 4, 5, 6, and 7. She has been walking independently with a prosthesis for about 6 months and returns to Vascular Clinic for a recheck. She is wearing extra-depth shoes. Results of her vascular evaluation are outlined in Box 13.3.

Case Study Activities

All Students:

  1. Describe the biomechanical principles that explain how the footwear or orthosis will improve client function.

  2. Describe how a specialized shoe, shoe modification, or foot orthosis affects each person's gait.

  3. If a foot orthosis is recommended, describe the shoes that the client should ...

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