ASK THE PEDORTHIST

by Seamus Kennedy, CPed

Reprinted from InMotion magazine, Volume 15, Issue 3, May/June 2005, published by the Amputee Coalition of America (website: www.amputee-coalition.org). Reprinted with permission.

1. What is a pedorthist?

By strict definition, pedorthics is the design, manufacture, modification and/or fit of footwear, including shoes, orthotics and foot devices, to prevent or alleviate foot problems caused by disease, congenital defect, overuse or injury.

That comes across as a bit of a mouthful! Basically, pedorthists are highly trained professionals in the design, fit and function of shoes and orthotics. They are experts in external below-the-ankle care. I would also like to add that they practice both the “science and art” of making feet comfortable. Proper shoes and orthotics should not only fit your feet but also your lifestyle.

2. What kind of training is required to become a pedorthist?

The Board for Certification in Pedorthics (BCP) is the body that regulates who becomes a certified pedorthist (CPed). For detailed information on the steps involved in becoming certified, you should visit the organization’s Web site at www.cpeds.org.

Briefly, to become a certified pedorthist, one needs to complete a four-step process:

1. Obtain some college credits in ancillary courses, such as anatomy, physiology or biomechanics.
2. Complete a minimum of 120 hours of pedorthic education in a program reviewed and approved by the BCP. Many approved courses are given throughout the country several times a year.
3. Gain some practical hands-on work experience in pedorthics.
4. Study the appropriate materials and books about pedorthics and shoe-fitting, and pass the certification exam, which is held twice a year.

The BCP recognizes this is a lot of work for some applicants, so it is now developing a tiered program for potential certified pedorthists that uses three levels to categorize their experience on the way to becoming fully certified.

3. I have diabetes. Why should I wear special shoes? Why can’t I just buy my shoes form a local department store like everyone else?

Diabetes is a serious disease the affects approximately 18.2 million Americans. Unfortunately, a lot of complications are also associated with diabetes, including disruption of the vascular system, which can impair many areas of the body, such as the legs and feet. As a result, people with diabetes should pay special attention to their feet.

Of the 18.2 million Americans with diabetes, about 25 percent will develop foot problems related to the disease. These foot problems often develop from a combination of causes, including poor circulation, which impairs the healing process, and lack of sensation to pain, heat or cold. With lack of feeling in their feet, people with diabetes can develop minor cuts, blisters or pressure sores and not be aware a wound is developing. If these minor injuries are not noticed and are left untreated, serious complications like skin ulcerations may arise and could eventually lead to the need for amputation.

It is very important, therefore, for those with diabetes to prevent all foot-related injuries. One of the best ways to do this is to wear proper-fitting and correctly constructed shoes. Wearing tight-fitting or inappropriate shoes greatly increases the chances that a serious foot complication will develop. In addition, it is recommended those with diabetes inspect their feet daily to watch for potential problems.

4. Since I have diabetes, do my shoes need to be specially fitted by a pedorthist? I can tell if my shoes fit, can’t I?

If you have diabetes, and especially if you have any loss of sensation in your feet, you should have your shoes fitted by a pedorthist. A pedorthist will be able to measure your feet correctly and choose a shoe with the correct last, or model shape, for your foot type. Good, protective shoes will also have soft lining materials and an absence of seams at critical locations inside the shoe.

Two common misconceptions regarding shoe fit are that you can know your shoe size and that you can feel when a shoe is right for you. Let a pedorthist measure your feet. Often your shoe size may have changed, especially if you have gotten older or heavier (like most of us). Shoe fit also depends on the last model used to make the actual shoe shape. The pedorthist will know the best shape for your foot. Unfortunately, many people with diabetes have poor feeling in their feet so they are inclined to buy shoes that are too tight and too small. This can lead to the very serious complications discussed in the answer to Question 3.

5. Are pedorthists able to help partial-foot amputees? If so, how?

Pedorthists are able to help partial-foot amputees in the following ways:

1. They can select the appropriate footwear that properly fits and supports the remainder of the foot.
2. They can often design a toe filler that mimics the shape of the old foot. This filler can be incorporated into the shoes as part of a custom foot orthotic so the foot will appear normal from the outside and so that the shoe’s toe box will not collapse.
3. They can add rocker soles, wide flares or wedges to many shoes to help improve an amputee’s gait and stability.

6. Aren’t therapeutic shoes and foot orthoses expensive? How can I pay for them?

Expensive is a relative term. People with diabetes, who are at risk for ulcers and amputations, must protect their feet at all costs. Allowing an infection to begin can lead to deadly consequences for their overall long-term health. Not everyone needs custom shoes and custom orthotics, but everyone should have proper-fitting and functioning footwear.

In the late 1980s, the government recognized the increased incidence of foot amputations in people with diabetes. As a result, it developed the Medicare Therapeutic Shoe Bill (TSB) to provide protective footwear and orthotics for people with diabetes who are at-risk for amputations. Ask your local pedorthist or podiatrist if you qualify for this program.

7. Is going to all this extra trouble to get the right type of shoes that fit properly really worth it?

Compromising the quality of your life for cost is too high a price for anybody to pay. For people with diabetes, an ounce of prevention is certainly better than a pound of cure! As pedorthists like to say, “Good health starts from the ground up.”

About the Author

Seamus Kennedy, CPed, is president and co-owner of Hersco Orthotic Labs in New York City. He received his degree in mechanical engineering from University College in Dublin, Ireland, in 1988, and became involved in the biomechanics field in 1995.