Assessment for Medical Shoes Provision
A comprehensive foot evaluation is essential for determining the need for specialized therapeutic footwear, including inspection of skin integrity, assessment of foot deformities, neurological testing (10-g monofilament plus at least one other sensory test), and vascular assessment of pedal pulses. 1
Initial Assessment Components
History Taking
- Prior history of foot ulceration or amputation 1
- History of Charcot foot or vascular surgery 1
- Smoking status 1
- Presence of retinopathy and renal disease 1
- Current symptoms of neuropathy (pain, burning, numbness) 1
- Vascular symptoms (leg fatigue, claudication) 1
- Daily activities and footwear needs 2
Physical Examination
Skin and Structure Assessment
- General inspection of skin integrity 1
- Assessment of foot deformities (hammertoes, prominent metatarsal heads, bunions) 1
- Presence of calluses, erythema, or warmth indicating increased plantar pressure 1
- Signs of previous ulceration 1
Neurological Assessment
- 10-g monofilament testing (mandatory) 1
- At least one additional sensory test from: 1
- Pinprick sensation
- Temperature sensation
- Vibration sensation using 128-Hz tuning fork
- Ankle reflexes
Loss of protective sensation (LOPS) is indicated by absent monofilament sensation, while at least two normal tests (with no abnormal test) rules out LOPS. 1
Vascular Assessment
- Inspection and palpation of pedal pulses 1
- Assessment of capillary refill time 1
- Evaluation for rubor on dependency and pallor on elevation 1
- Venous filling time 1
For patients with symptoms of claudication or decreased/absent pedal pulses, ankle-brachial index testing should be performed. 1
Criteria for Medical Shoe Recommendation
Medical shoes are specifically indicated for high-risk patients with:
- Severe neuropathy with loss of protective sensation 1
- Foot deformities (hammertoes, prominent metatarsal heads, bunions) 1
- History of ulcers 1
- Callous formation 1
- Poor peripheral circulation 1
- History of amputation 1
Footwear Assessment Parameters
When evaluating current footwear or determining needs for new medical shoes, assessment should include:
- Fit: Should be 1-2 cm longer than the foot with width equal to the foot at metatarsal phalangeal joints 1
- General structure: Evaluation of heel rigidity, sole hardness, and shoe flexibility 3
- Motion control properties: Stability features and support 3
- Cushioning: Ability to absorb shock and redistribute pressure 2
- Wear patterns: Indication of gait abnormalities or pressure points 3
Special Considerations
- For patients with neuropathy or increased plantar pressures: Well-fitted walking shoes or athletic shoes that cushion and redistribute pressure 1
- For patients with bony deformities: Extra wide or deep shoes 1
- For patients with extreme deformities (e.g., Charcot foot): Custom-molded shoes 1
Common Pitfalls to Avoid
- Failing to perform a complete foot assessment before recommending footwear
- Not considering patient's daily activities and compliance factors 4
- Overlooking the importance of patient education about proper footwear selection 1
- Neglecting to schedule follow-up assessment after footwear provision 4
- Focusing only on foot problems without considering overall mobility needs 5
Proper assessment for medical shoes requires a systematic approach that evaluates neurological, vascular, and structural aspects of the foot to determine the appropriate level of specialized footwear intervention, with the ultimate goal of preventing ulceration, amputation, and improving quality of life.