Foot Shells

[kapteenkoukku]

I was at my prosthetist recently and I commented on my Variflex foot's shell that it makes difficult to find shoes which function with the artificial foot and at the same time the shoe feels comfortable for the flesh foot. It is too low in profile which means that shoe laces close altogether yet the shoe may not even fit tight and on the flesh foot it is wide open. Another thing is that these foot shells are too narrow which adds to the problem. This means that one has to buy shoes that are too tight on the flesh foot.

usera.ImageCave.com/Jukka/Leg/Foot Shell.JPG

I cannot understand why they have to make the shell so close fitting to the foot inside, it is just a shell anyway, why it cannot be wider and higher. I do not think that if it being wider and higher it would compromise the function as foot shells are thin and light.

My prosthetist said that they are all that way and it is indeed a problem, but could not state any reason why all foot shells are like that. To me it signals that there is no reason to have too narrow and low foot shell versus the lenght.

Only decently "shoe-fitting" feet are SACHS feet and Otto Bock has this foot that is moulded around the mechanism which means it is solid and no foot shell at all, it is a foot.

I wonder whether it is possible to go foot shell shopping to buy a shell that does not come from the manufacturer of the foot but could be more fitting to the shoe.

I hate shoe shopping because it takes five years to find shoes that fit on both sides if at all.

Attachments:

[allenuk]

That is a pretty rough looking prosthetic foot!

I've got a 'standard' Blatchford's foot - but at least it has toes and a separated big toe. I'll photograph it later.

One idea, though: I had to have made-to-measure shoes because of problems with my real foot, and while I was at it I got them to make the OTHER shoe to the right size of my plastic foot (didn't cost any more). Again, photos later. Very expensive in the UK but I would have guessed far less so where you are. Result: good fit for both feet, and I don't care whether close inspection would give someone else a laugh.

Prior to that I had tried buying a size 9 for my real foot and a size 8 for the other - that worked too, although I had to adjust the height a little (just a thick insole).
Drawback: you end up with 2 shoes that you don't want, but if you're talking basic (i.e. not 'designer') shoes, it's not that expensive a route.


Allen.

[ann58]

Now me, for instance....I need a narrow prosthetic foot & over here where I live {they seem to be hard to find}

[tedatrowercpo]

I think it boils down to the fact that you can fit a narrow foot into a wide shoe but not the other way around and the manufacturers don't want the expense of creating and stocking different widths. As Ann has mentioned for some these molds are still too wide.

And no, the footshells are not interchangeable as the interior is molded to accommodate the for for which they are intended. There would be very little to gain if you could swap them because they do indeed all have roughly the same profile with regard to width,

[allenuk]

Funnily enough, after banging on about how good my shoes are, they aren't.

My prosthetist was trying to fit an Echelon foot the other day, getting nowhere, and finally focussed his attention on my shoe. Rather than the usual 'trainer' that most of us wear, mine had a curved sole (a 'rocker' in the trade), which was throwing the Echelon completely. Once I had changed to a pair of trainers, all went better.

Not, alas, for my mis-named 'good' foot, which NEEDS a hand-made extra-wide deep-toebox shoe... with a rocker sole. However, at least I now know what I need, which is basically a different type of shoe for each foot.

How's the Echelon? Not as good as it should be, as apparently my weight has galloped up towards the upper limit for Echelons. I am not 125kg yet, but only a couple of kg away, so I now have even more incentive to lose a bit.

And I DO like food so much!


Allen.

[ann-]

May 28, 2010 7:42:36 GMT -7 ann58 said:

Now me, for instance....I need a narrow prosthetic foot & over here where I live {they seem to be hard to find}

I have just had a new pair of legs made .... (am bilateral) they gave me two very narrow looking feeting (no toes) single axis, I think .... and I just can't walk on them properly. I think, mechanically, they are meant to be the same as what I am already using ....the kind I have at the moment have toes and are slightly wider ....so am wondering how much the narrowness of pros feet affects balance etc. etc.
Having said that the sockets aren't right either so are being re-made and hopefully will go back to my old feet (actually only had toes for the last year or so and kind of want to hold on to them, LOL)

Ann

[ann58]

Jun 2, 2010 5:18:41 GMT -7 ann- said:

May 28, 2010 7:42:36 GMT -7 ann58 said:

Now me, for instance....I need a narrow prosthetic foot & over here where I live {they seem to be hard to find}

I have just had a new pair of legs made .... (am bilateral) they gave me two very narrow looking feeting (no toes) single axis, I think .... and I just can't walk on them properly. I think, mechanically, they are meant to be the same as what I am already using ....the kind I have at the moment have toes and are slightly wider ....so am wondering how much the narrowness of pros feet affects balance etc. etc.
Having said that the sockets aren't right either so are being re-made and hopefully will go back to my old feet (actually only had toes for the last year or so and kind of want to hold on to them, LOL)

Ann

I have never heard of feet w/no toes.

[ann-]

I have never heard of feet w/no toes.[/quote]


I thought they were a thing of the past as well. Not sure if its the feet or the sockets or both, but really found it difficult to balance which is unusual, so that pair are being remade and I think the feet will be changing too.

[kapteenkoukku]

Jun 1, 2010 14:40:47 GMT -7 tedatrowercpo said:

I think it boils down to the fact that you can fit a narrow foot into a wide shoe but not the other way around and the manufacturers don't want the expense of creating and stocking different widths. As Ann has mentioned for some these molds are still too wide.

And no, the footshells are not interchangeable as the interior is molded to accommodate the for for which they are intended. There would be very little to gain if you could swap them because they do indeed all have roughly the same profile with regard to width,

That means I have to keep buying shoes that my flesh foot has the toes right up to the front and squeezing. I have jogging shoes like that but it is ok because they are soft. Only leather shoe which is wide enough in front is Birkenstock, they allow the toes right up to the front and you can still wiggle the toes, but very expensive. I have them but the sole wears away very fast; I can buy a new sole and get a gobbler to stitch it on but when I order the sole through local Birkenstock dealer it takes at least three (3) months to deliver. That is why I bought two (2) pairs so that when I am waiting for sole delivery for one pair I am wearing off the other. But now both pairs are very worn of on the top, the leather is all cracked, and they do not sell the same model anymore. The sole is also very expensive, cost twice the amount the normally priced shoe costs. And even with the Birkenstock, the profile of the foot is too low for tying the shoe laces.

What is the point of making expensive sophisticated feet that have very good function, but only shoe that one can wear is jogging shoe because of fit.

I just bought a pair of Birkenstock sandals, but I cannot use them until I can get the arch of the sandal that I use for my artificial foot flattened. My prosthetist said they can grind the arch flat for me and glue a new suede leather lining to cover the cork inner sole. I love Birkenstock for my flesh foot because they are so comfortable. I have very small foot for my size and weight so there is a lot of pressure on my foot and I do not want any more problem for that already collapsed arch I have, I need something to support it from below.

Shoe shopping for an amputee is a costly affair and spending a lot of money does not necessarily solve the problems as long as the artificial feet are not made to be at least a little close to the shape of a real foot. Is it really so expensive for manufacturers to make decent foot shells, I think they have an attitude problem.

[bluedogz]

I may be wrong, since I'm from the arm world... but could you not just shop for shoes that fit your 'real' foot (knowing they'll be too big for the pros), then add thick socks to the pros till the shoe stays on?

[kapteenkoukku]

Jun 6, 2010 4:10:32 GMT -7 bluedogz said:

I may be wrong, since I'm from the arm world... but could you not just shop for shoes that fit your 'real' foot (knowing they'll be too big for the pros), then add thick socks to the pros till the shoe stays on?

That I call fire fighting.

Why cannot manufacturers provide complete products and not leave them half way. We are not taken seriously, but become some sort of lower caste after amputation.

[ann-]

Jun 6, 2010 4:16:26 GMT -7 kapteenkoukku said:

Jun 6, 2010 4:10:32 GMT -7 bluedogz said:

I may be wrong, since I'm from the arm world... but could you not just shop for shoes that fit your 'real' foot (knowing they'll be too big for the pros), then add thick socks to the pros till the shoe stays on?

That I call fire fighting.

Why cannot manufacturers provide complete products and not leave them half way. We are not taken seriously, but become some sort of lower caste after amputation.

I don't understand why its become so difficult ... years ago you always bought the shoe and handed it over before the prosthesis was made, so that the prosthetic foot supplied fitted the shoe. Nowadays I hear many single amps saying the prosthetic foot given doesn't match their own other foot ... why should this be?
To be honest, I don't often get asked to supply a pair of shoes before I have legs made these days ... though do usually get asked what size shoes I take..

[ann58]

Jun 6, 2010 4:10:32 GMT -7 bluedogz said:

I may be wrong, since I'm from the arm world... but could you not just shop for shoes that fit your 'real' foot (knowing they'll be too big for the pros), then add thick socks to the pros till the shoe stays on?

'bluedogz' think about what you are saying....what lady wants to wear a shoe full of socks....would look awful.....besides we wear different styles of shoes...sandals....pretties {you know}

[cherylm]

My situation has been changing...when I first became an amputee, my prosthetic foot was ordered a half-size smaller than my other foot, on the advice of my CPO. ("It's easier to get a shoe on or off the prosthetic foot if there's a little more 'wiggle room' there.") In the years that have followed, my so-called "good" foot has slowly been losing its arch and "growing" as it flattened out. I've gone from a size 9 to a size 11...and for most of that time, my prosthetic foot was still the original size 8 1/2 that they ordered in the beginning.

What they did with me was to keep me in the same size shoes on both feet...on the prosthetic foot, they used padding to take up all the extra space between foot size and shoe size. About a year ago, when I got my second full prosthesis (with new foot), they "upsized" my prosthetic foot...although I'm still slightly smaller on that side than I am on the "meat" side.

My new prosthetic foot has reasonably realistic-looking molded toes...but it does not have a split big toe, which I kind of miss!

[allenuk]

Jun 6, 2010 4:10:32 GMT -7 bluedogz said:

I may be wrong, since I'm from the arm world... but could you not just shop for shoes that fit your 'real' foot (knowing they'll be too big for the pros), then add thick socks to the pros till the shoe stays on?

Bluedogz: that is PRECISELY what I do most of the time! Mind you, I'm no lady (or gentleman either for that matter).

I have been known to wear different shoes; one that suits my plastic foot, one that suits the other one. I was always (ask my friends) odd, apparently, and since old age has mercifully overtaken me, no longer give a flying whatsit! But I do appreciate that some people are bothered about appearance, and should be catered for - shoes (according to my prosthetist, who trained originally as an orthoticist) are a vital part of a prosthetic set-up, and are too often overlooked.


Allen.

[oneblueleg]

I've been an amputee for 26 years and never had any problems with foot sizes. I understand that the artificial foot cannot be the same shape as the real foot when loaded as it wouldn't then fit in the shoe. As the ankle invariable doesn't articulate and a hard foam will not allow the give required, it just can't be.
If this was all an amputee had to worry about wouldn't life be great!

[kapteenkoukku]

Jul 21, 2010 4:23:07 GMT -7 oneblueleg said:

I've been an amputee for 26 years and never had any problems with foot sizes. I understand that the artificial foot cannot be the same shape as the real foot when loaded as it wouldn't then fit in the shoe. As the ankle invariable doesn't articulate and a hard foam will not allow the give required, it just can't be.
If this was all an amputee had to worry about wouldn't life be great!

I have been an amputee since 21/5/2001 i.e. nine (9) years plus and I do have a problem with foot sizes. To me the acceptance of half-finished design and prosthetic product as an amputee is same as accepting self of being categorised as an outcast in society who has to hide him/ herself from the better folks' eyes and not to demand any betterment in artificial limbs we use. If we all accept ourselves of being outcasts then a pegleg would be good enough for such people. It works well enough for moving from place A to place B and there is no worry whether shoe fits or not.

Yes, the foot at the ankle maybe stiff to push into the shoe but those feet with foot shell are soft and they give way in certain positions when squeezed. Only SACHS foot and certain Otto Bock's more advanced designs are solid. So why the foot shell has to be snug fit around the carbon fibre foot? Why it cannot be hollow inside in places it is extended to make more natural foot that fits into shoe the same way as the real foot of same size. I am sure it is possible. This is not rocket science.

So what are the things that an amputee has to worry about? To me the number one worry is the socket fit, suspension and skin interface, number two is the alignment of the whole limb and everything else come after that. If at the bottom end there is something more advanced than just a peg tip then it has to be complete in all aspect including ability to wear a shoe.

My observation here in Singapore is that I seldom see amputees wearing other than sports shoes. That is because the shoelaces are tied from almost toetip hence the shoe is more snug on the foot. Well, that is ok if one is not in working life or has a job where no formal wear is required. I have spent hundreds of dollars for shoes that fit my real foot, but thrown them away because they just do not fit my artificial foot and I have unnatural and bad gait as a result. So why to try to develop natural gait from the advanced design of artificial cabon fibre feet if the whole thing is destroyed by a poor foot shell?

That is my problem and that is what I worry about amongst other things. And I feel I have right to raise this issue without anyone downplaying the problem.

[oneblueleg]

I reserve the right to have an opinion too and I repeat, I don't have any of these issues. That's just as valid as you saying you do.
If making a foot how you want is so easy, as it's not rocket science as you say, why do you suppose that no one has done it? Surely it would make sense for manufacturers to make what the customer wants? Why would they spend so much on developing the function of the foot and not bother with the foot shell? I suggest it's because it's not as easy as you might think.
It is important by the way, that the footshell is in close proximity to the carbon springs, the footshell plays a role in the function of the foot, so it's not just a cosmetic device. It is perfectly true that if the footshell were the size of your real foot when loaded, it would not fit into a shoe, that's an inescapable fact.

I have a right to say these things without anyone downplaying my arguments ;D

[allenuk]

No, it's not that simple.

I had a pair of orthotic shoes made to cope with problems on my 'good' foot, and while I was doing this I got them to make what I THOUGHT would be a good shoe for my plastic foot, following the slim shape and size of the plastic one.

It looked a bit odd (one bigger than the other) but that didn't bother me.

But then the clinical lead at Stanmore shook his head and said that the narrower shoe wasn't helping my prosthetic leg - he would rather have the bother of stuffing a larger shoe with packing materials to take up the space, and thus for me to end up with a bigger 'platform' to stand on.

So, I have reverted to 15 quid trainers, and he was of course right! They ARE better for the prosthetic leg. Anyway, he spent 10 minutes making a rubberised 'extension' to the plastic foot, so that it was broader and higher - purely so that the trainer shoe would fit better. And it's worked well since.

A

[ann-]

Jun 6, 2010 12:34:10 GMT -7 ann- said:

Jun 6, 2010 4:16:26 GMT -7 kapteenkoukku said:

That I call fire fighting.

Why cannot manufacturers provide complete products and not leave them half way. We are not taken seriously, but become some sort of lower caste after amputation.

I don't understand why its become so difficult ... years ago you always bought the shoe and handed it over before the prosthesis was made, so that the prosthetic foot supplied fitted the shoe. Nowadays I hear many single amps saying the prosthetic foot given doesn't match their own other foot ... why should this be?
To be honest, I don't often get asked to supply a pair of shoes before I have legs made these days ... though do usually get asked what size shoes I take..

LoL .... since my last posting.... I have my new pair of legs remade and have new feet. Although they are supposed to be the same size as my other pair of feet, they don't fit my shoes ..... so am beginning to see the problems people are talking about. I have about half to inch gap at the end of the shoe, which I have had to pad out with tissues and am having to put the strap across the front on the tightest hole to keep them on .... one of them is also making a very loud gruanching noise as I walk ... so not the best. Though I see advantages in the type they have given me as it definitely works my muscles more.

But am better understanding now what you guys are saying.

[ann58]

ann, I also just had a new leg made...everything is fine {I think} I always have my prosthesis foot made one size smaller than the good one. So far it always work out great...try it.

[ann-]

Jul 27, 2010 11:15:21 GMT -7 ann58 said:

ann, I also just had a new leg made...everything is fine {I think} I always have my prosthesis foot made one size smaller than the good one. So far it always work out great...try it.

I am bilateral, and had a new pair made ... so don't have 'a good one' so to speak .... I just get asked for my shoe size. So I have just taken delivery of a new 'pair' of legs and got both new type of feet which I have had for just under week now and finding the new feet ok to walk with, just don't fit my shoes,and one noisey but apart from that all fine.... should get it sorted next week.

[kapteenkoukku]

Jul 26, 2010 3:05:46 GMT -7 oneblueleg said:

I reserve the right to have an opinion too and I repeat, I don't have any of these issues.

It is important by the way, that the footshell is in close proximity to the carbon springs, the footshell plays a role in the function of the foot, so it's not just a cosmetic device. It is perfectly true that if the footshell were the size of your real foot when loaded, it would not fit into a shoe, that's an inescapable fact.

I have a right to say these things without anyone downplaying my arguments ;D

Yes, you have rigth to your opinions and arguments like everybody here, no-one has suggested otherwise.

However you appear rather blunt and undiplomatic in expressing your opinions and arguments by saying that "if shoe fitting was the only problem that an amputee has wouldn't the life be great". Saying things in that manner signals disrespect to other amputees' concerns and seems that the intention is to criticise and belittle people who think shoe fitting is a problem and that if you do not have a problem with it then no-one should have a problem with it and if someone has he is an idiot. It is much the same as saying that people who like to have a cosmesis around the leg to make it look closer to real leg have unnecessary concerns.

Of course the footshell has to fit around the carbon fibre part but both can be designed to to fit to one-another if there is will. As Ted Trower put it, it is easier to have the footshells too small for wide footed people than having too wide footshells for narrow footed people. I am not a R&D person but I can think of adding flexible stiffeners internally into the footshell if the footshell is larger (wider & higher) than the carbon part. That would make it to fit snug around the carbon, be flexible (give way) when donning the shoe and at the same time stay in shape to fill up the shoe. Ships and aircraft are built that way, if they just had a shell they would brake. Ships' hulls are flexible so are aircraft bodies.

I still maintain that it is not impossible to develop more functional prosthetic feet. Innovation does not stop at inventions today in hand. Innovation is driven from identification of problems in hand and here we have one; it is just the lack of will to see and accept the problem that is slowing the innovation. Manufacturers' first concern is money and sense and although they do R&D, they may not be the ones whose ideas turn to breakthroughs or advancement in technology.

I have one observation; I have used Otto Bock Dynamic Plus that has a solid cosmesis moulded around the carbon fibre spring in the centre and also SACHS foot and both fill up the shoe much better than my Variflex with its crappy footshell. Also, I have pair of Crocs that I bought before I got my Variflex foot. I was able to use them with Otto Bock foot but now I cannot wear because there is too much empty space in the shoe with Variflex footshell. So I repeat: Is it worth to try to improve the gait with carbon fibre inner part of the foot when ill-fitting shoe puts you back right where you were with a simple SACHS foot, or maybe to even worse gait.

A person who has a narrow foot is maybe fine with these narrow and low footshells and is lucky to be that way but there are also people who have wider feet who should not be ignored, to be fair to all.

[ann-]

Jul 27, 2010 0:00:03 GMT -7 ann- said:

Jun 6, 2010 12:34:10 GMT -7 ann- said:

I don't understand why its become so difficult ... years ago you always bought the shoe and handed it over before the prosthesis was made, so that the prosthestic foot supplied fitted the shoe. Nowadays I hear many single amps saying the prosthetic foot given doesn't match their own other foot ... why should this be?
To be honest, I don't often get asked to supply a pair of shoes before I have legs made these days ... though do usually get asked what size shoes I take..

LoL .... since my last posting.... I have my new pair of legs remade and have new feet. Although they are supposed to be the same size as my other pair of feet, they don't fit my shoes ..... so am beginning to see the problems people are talking about. I have about half to inch gap at the end of the shoe, which I have had to pad out with tissues and am having to put the strap across the front on the tightest hole to keep them on .... one of them is also making a very loud gruanching noise as I walk ... so not the best. Though I see advantages in the type they have given me as it definitely works my muscles more.

But am better understanding now what you guys are saying.

An update on my feet ... have had an appointment today and very pleased to say they have sorted out the horrible 'gruanching noise' they were making... the prostheses have also been set back more ... seem to be fitting shoe a bit better, not sure if they have done anything, but said when I have the covers fitted on, which we hope to do in a few weeks if all is well, they will take up a bit more space in the shoe ...so am getting back on track with the new feet ....these have ankle movement which is the first time in 40 odd years for me so taking a bit of getting used to.

[ann58]

Ann, I'm glad they are getting you fixed up....and YES variflex ankles do take some practice. Did they send your feet back for a smaller size? You said they didn't fit your shoes.