Whether the origin of “If the shoe fits, wear it” comes from Cinderella, the saying can be traced over two centuries. At those times, shoes were exclusively for feet. Today, thanks to certain medical technologies, people with mobile impairments can choose shoes that fit. Unfortunately, if you are wearing a brace for leg and ankle support, many shoes intended for feet alone do not fit. If they do initially, they wear out rapidly. There are new support braces for children and adults that benefit many incurable conditions. Finding a standard shoe to fit a foot with a brace is often very complicated. You don’t have to wait for a fairy. Knowledge, research, experience and a medical professional motion support team can help.
When the cobbler cobbled his first shoe, it was intended for one foot in each shoe. They may not have been comfortable but they were sturdy and protective from rough terrain. For years, any form of brace, prosthetic or orthotic placed in the shoe with a foot would stretch the leather and the shoe-last would not last.
Shoes and sneakers do not adapt or wear well with braces also inserted with your foot. In addition, many brace users can’t jump over puddles or maneuver easily around them. Walking on smooth surfaces is almost or more challenging than hiking in the woods. A recent class of more supportive hiking boots may help people who rely on braces for degrees of mobility. Low-cut models with flexible midsoles are excellent for day hiking. Materials impact a boot’s weight, breathability, durability and water resistance. These may offer stiffer but comfortable ankle support. They may be the comfort match for brace wearers or those seeking more support than ordinary shoes provide. Low-cut hiking shoes are available virtually everywhere shoes are sold. If the shoes fit, they will wear well with or without a brace.
Wearing a shoe with an AFO or Ankle Foot Orthosis, a new term for a supportive brace, means you’re using the shoe beyond its expected intent. Most shoes will not withstand this use.
An AFO is a form of brace that supports and aids a common joint action called dorsiflexion. Dorsiflexion of the foot is sometimes referred to as dorsiflexion of the ankle. Flexing the ankle joint so that the underside of the foot rotates upwards. That is, the upper surfaces of the toes (including the toe nails) move towards the shin bones at the front of the lower-leg. Many are born with diseases that disallow those muscles (or associated nerves) to function normally. An AFO is added to the foot and lower leg. Both are inserted in a shoe.
Can you necessarily go to any shoe store or order online for a pair of shoes to fit a brace or AFO? Many will find it a stupefying task. You might have to opt for orthopedic or custom shoes that, for many, are not insured and beyond affordability. Furthermore, these custom shoe designers are usually podiatrists or orthopedists. They are often ignorant of what AFO is and how it works.
Many AFO manufacturers recommend and warranty each AFO foot brace for use with sneakers. Most sneakers are soft and these can stretch rapidly to the point of instability. Yet there is more to this dynamic. Weight and foot-size are two significant variables that can quickly damage ordinary shoes. Few AFO manufacturers are aware or recommend low-cut hiking shoes.
Among the best patients for an AFO are children that are low in weight. Children want to be mobile and AFO is a form of brace that helps support ankle and lower leg muscles that are necessary.
The ToeOFF KiddieGAIT is among the more popular AFO braces that many pediatric therapists prescribe. This brace offers dynamic technologies that help children rise and move from wheelchairs and walk.
The Allard KiddieGATE is a dynamic AFO and is very different than the brace you might have seen, such as the ones Forest Gump wore in the movie. Those are static braces. Static AFOs are devices that hold joints in constant position and are made of rigid materials.
Dynamic AFOs have varying types including hinged, articulating, static progressive or inhibitory. The dynamic components may be based on materials, mechanical joints, exertion of forces on joints, freedom of joint motion, or inhibitory influences to properly guide foot motion to simulate a normal gait.
David Zwicker, New York orthotist with Prothotics labs, indicates that dynamic AFO devices are helping children find mobility in varying degrees, based on their conditions. There are many more to choose from. Zwicker, among many other caring orthotists, understand that mobility is very precious to people at any age. Orthotists strive to use and explore technologies that help find the best and most comfortable fit to deliver the best mobility possible. In some cases, physical therapy aids in using the AFO devices more effectively.
Lighter body weights do allow a brace and foot to fit more sturdily in shoes and sneakers. Low-cut hiking shoes may add a little more stability while allowing other muscles to stretch and perform properly.
Adults with an AFO, on the other hand, over 175 pounds, bear more pressure that compromises the fit and durability of most shoes and sneakers. As adults age, calf to ankle muscles become more limited across genders and more complaints rise of walking issues. Over the course of ages 40 through 80, compromised dorsiflexion increases although sometimes related to other joint muscular problems.
Then there are adult-onset nerve and muscle diseases that wear nerves and/or muscles more rapidly, such as multiple sclerosis and muscular dystrophy.
Passive adults over 60 experience normal muscle wear and require additional support from shoes. You find New Balance sneakers more prevalent on normal aging feet, without braces. Some wear over-the-counter orthotics for
There’s a drop-off of how aging people might treat drop-foot dorsiflexion. They use canes, walkers, and power scooters. Many are unaware of what an AFO brace is, Very few are stubborn enough to want to stand and walk. That may be why fewer elect a brace and fewer than that choose an AFO.
Heavier bodies, larger feet, heavier feet, and an AFO can stretch almost any ordinary shoe, including leather or synthetic New Balance sneakers.
Hiking shoes are more rigid but an AFO foot brace doesn’t comfortably fit in a boot. It can fit in hiking shoes just at the ankle, and not tied to the top.
Brands like Oboz Footwear, The North Face, and Merrell make low-cut hiking shoes that are more likely to properly support an adult foot with a dynamic AFO brace in a shoe, while allowing dynamic natural foot movement in accordance with the brace.
AFO users have very case specific support needs. Avoid shoes that offer special supports for normal people. Some offer 3–5mm thick inserts are sandwiched between a boot’s midsole and outsole to add load-bearing stiffness to the midsole. They vary in length; some cover the entire length of the midsole, while others only cover half. There are also Plate supports –
thin, semiflexible inserts are positioned between the midsole and the outsole, and below the shank (if included). They protect ordinary feet from getting bruised by roots or uneven rocks. Most AFO wearers are more likely to be concerned about walking smooth hills or slightly bumpy surfaces. This is why use of a cane is helpful to avoid accidents.
Hiking shoe brands are not on many AFO brace manufacturer recommended lists and, in some cases, may nullify a replacement warranty. Consult with your prescribing health practitioner.
If you are an adult who wants to retain upright mobility and a choose a brace for support, then a low-cut hiking shoe is a lightweight alternative to flimsy sneakers. Remember that NO SHOE was designed for a foot and a brace and, as an adult, using a brace places you in a minority. Do not use a shoe for more than 3 consecutive days and switch to another. None of these shoes will last long under daily use. All will be more dependable than sneakers.
Nothing is better than stable, healthy muscles. An AFO helps people who can’t move as a helping aid. Ask a physiatrist for a recommendation. Ask you user to customize it for your comfort, Competent, professional orthotists like David Zwicker, can help you adapt and optimize a new pseudo-active lifestyle.
If the brace and shoe fit then wear it with AFO but make sure your shoe provides the support you need. A foot, an AFO device and a shoe must work in concordance. People with neuromuscular mobility problems need the assurance that fit and support must coexist for better mobility degrees, when nerves, muscles, or both can’t do the job.