The Shoe Surfing Handmaid : A Tale of Woe. Finding the right shoe for your loved one.

Finding footwear for someone with swollen feet can be a challenge. You’d be forgiven for thinking that a quick trip to the mall or a stand alone big box shoe store and you’d be done in no time at all. After fighting Saturday afternoon mall traffic to get there, your stress ramps up even more as you express your frustration to the high-schooler working their Saturday job who knows little to nothing about fitting footwear and particularly about footwear for swollen feet. There’s nothing among the 2,000 plus pairs of shoes in the store that is going to work.

And so, you end up here. Back at home. On the internet. On your phone, your tablet or your laptop cruising the web as you casually watch tv.

Your elderly relative’s feet have started to swell. One early indicator of venous insufficiency is swollen feet. One side effect of chemo-therapy is that the lymphatic system is compromized and fluid pools in the foot. The doctor has diagnosed lymphedema but unfortunately, the doctor doesn’t know of a local shoe store they can direct you to either.

Now it’s your problem to resolve. Unwittingly, you’ve become a slave to the mission of finding the right shoe for your loved one - a Shoe Surfing Handmaid.

You’ve entered into the search bar “ shoes for swollen feet” or maybe “shoes for lymphedema” or maybe you’ve figured out that the only shoes that are going to work are “extra wide shoes” and you’d be correct.

The way to go when looking for accommodative footwear for swollen feet is to go wider and not longer. It may seem as if I’m stating the obvious, but often the decision taken is to go longer in size to get the additional width to accommodate the girth of the ‘edamatous’ or swollen foot. And usually it’s because most shoe stores don’t carry extra wide width shoes, even fewer carry extra extra wide width shoes, and practically none carry extra extra extra wide width shoes. It’s just too much inventory to carry.

The problem with going longer to get wider is that you end up with a pair of clown shoes and everyone knows what happens in clown shoes. You trip. Only when you’re elderly and you trip, it’s not usually a barrel of laughs and often results in another kind of trip ..one to the hospital.

So now that you’re here on Pedors.com what’s the next step to find the right shoe?

Pedors Shoes specializes in accommodating feet of all sizes. We offer over 35 unique sizes and in 5 widths representing more than 150 unique sizes. We have an “ off-the-shelf” shoe that is as close to a custom-made shoe as you can get without the expense of a custom shoe. It is more likely that we have a shoe for your foot than not. We just need to figure out what size you need.

Once we’ve determined your size, then you need to decide what type of shoe is going to best satisfy your need. Each product is designed to address a specific foot issue. The design will also take into consideration the ability of the wearer to put the shoe on and take it off. For example a shoe with a velcro shoe is easier for someone with limited range of motion or who has difficulty tying shoelaces.

Some shoes are designed specifically with an elderly person in mind.

Generally a light weight shoe is preferred. Heavy clunky footwear won’t wear well. If gait is compromised or if a walking frame is being used or a cane or a walking stick then soling should not be too “grippy” but at the same time should not be too slick either. Shoes for seniors should also feature a delayed heel strike and some toe spring. These features are important when evaluating appropriate shoes for nursing homes and other retirement living communities like assisted living and skilled nursing facilities. Patients in memory care environments are known as walkers who need protective footwear. Shoes that are easily put on with velcro closures help reduce the incidence of foot trauma in Alzheimer patients who are known for going barefoot.

So what are the design features in a shoe for someone with swollen feet, venous insufficiency or lymphedema?

1. First of all the shoe has to have enough volume or girth to accommodate the swelling on the dorsum of the foot.

2. Second, the shoe needs to be able to open up so that the foot can be easily placed on the footbed.

3. The shoe closure needs to be adjustable to accommodate any change in the volume of the foot over the course of the day.

4. The shoe should be lightweight. A heavy shoe is less likely to be worn and an unprotected foot is more likely to be traumatized.

5. The upper material should be soft and not restrictive. Ideally the material might offer some compression to help reduce swelling in the foot. A heat moldable material like Pedoprene can easily be modified to accommodate other forefoot deformities like a bunion or a hammertoe.

Is there a shoe that has been designed specifically for lymphedema?

The PedorsMAX 6E collection was designed specifically for people living with the challenge of finding footwear to accommodate lymphedema. The Classic MAX is a shoe for everyday use in and around the house like going to the store, out to dinner or church on Sunday. The MAX Slide is used around the house as a big accommodative slipper that is easy to slide into at night for a trip to the bathroom or kicked off when putting your feet up on the couch. The MAX Wrap Sandal is designed primarily for people with extremely swollen severe lymphedema, chronic venous insufficiency and for people who may have bandaged feet, wear compression garments or have their feet wrapped to help reduce swelling. The primary intent is to get some plantar surface protection for the foot when no other footwear can accommodate the foot. It is a solution for people who find they are walking around in socks because they can't find a footwear solution.

What other medical conditions require accommodative footwear.

Diabetes: Diabetics have to be particularly careful when choosing appropriate footwear. Peripheral neuropathy is often present in the diabetic foot. The degradation of the nerve endings in the lower extremities means that the daibetic foot becomes insensate and loses the ability to feel or sense when trauma may have occurred. So a small stone in a shoe that is undetected can lead to an ulcer and an ulcer to an amputation. Selecting a shoe that minimizes the risk of injury to the foot is critical. The shoe should accommodate the foot. The toe box should be wide enough and deep enough. There should be nothing inside the shoe that could rub or cause a blister like a prominent seam. Ideally the inside of the shoe should be seamless. The upper material should be soft and ideally pliable and if possible heat moldable. The shoe should have a removable insole so that there is enough room to accommodate a diabetic insert. A diabetic insert that is molded to the plantar surface of the foot reduces the shear forces and friction on the sole of the foot. By molding to the bottom of the foot the insert also helps to reduce pressure points that can also lead to callusses.

Arthritis

For those folks suffering with rheuamatoid arthrits in their feet, the challenge is easing the pain or stiffness in the toe joints and the ligaments in the foot. It’s common especially after after exercise, walking, running or even just standing to experience persistent aching or soreness. The inflammation associated with rheumatoid  arthritis can cause bone erosion and joint deformity. And this is where an appropriate rheumatoid arthritis shoe that can accommodate the deformity can make a huge difference.

Exercise and, by extension appropriate footwear, is particularly important for osteoarthritis patients. In his excellent book “ Osteoarthritis of the Knee, Prevention, Treatment, Cure” Dr. Wolfgang Franz presents in his Kaiserslautern Knee Concept. The concept details how the cartilge tissue receives the supply of nutrients from the synovial fluid that surrounds it. These nutrients however have to be kneaded into the cartilage in a similar way as to how flour is kneaded into the dough when making bread. The best way to get the cartilage the nutrients it requires is through plenty of exercise which is critically important for healthy knees.

A shoe that can accommodate a toe deformity, bunion or hallux valgus can make a huge difference not only to comfort levels, but also with regards to the amount of physical activity, overall well being and in the long term, independence and quality of life.

How are shoe widths catagorized? How do I know what width to go with?

There are two generally recognized indicators for shoe width, alphanumerics and a general descriptor.

A = Narrow

B/C = Medium

D/E = Wide

2E/3E = Extra wide

4E/5E = Extra Extra wide

6E/7E = Extra, Extra, Extra wide

At the end of the day, it’s a bit of a leap of faith. If you can’t find a specialty shoe store or ideally a Pedorthic retailer near you - you’re left with having to order from an online source. Be sure the vendor offers free shipping, free returns and free exchanges. You may get lucky and get the size right the first time but if for whatever reason the size is not right the shoe will need to be exchanged.

The Tale of Woe turns into a Tale of Joy when the right shoe is finally on the swollen foot. For so many folks something that is normally regarded as such a simple everyday task of putting your shoes on each morning is such a challenge. Without shoes it’s considerably harder to walk outside. Without shoes there is a much greater risk of trauma to the foot. Without shoes it’s much harder to exercise aerobically. Without exercise it is much harder to manage your health and increase longevity, improve quality of life and live independently. A pair of shoes, for many, can restore a degree of dignity.