This Information Sheet aims to provide information to help users find suitable footwear.
For up-to-date information on specific products and suppliers in Ireland, visit the ‘Products and Suppliers’ section of the Assist Ireland online database (www.assistireland.ie). The information in this resource can also be accessed using the telephone support service on 0761 079 200 during office hours.
The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.
FOOTWEAR FOR MINOR FOOT PROBLEMS
Look for footwear which has soft leather or textile uppers with the minimum of seams; the inside edge should be as straight as possible and the shoe should have a fastening so that the heel can be kept well back in the shoe. Once the big toe has started to rise over the next toe, deeper shoes are needed.
Replace the insole with a washable one and launder frequently. Change shoes often; leave shoes for at least 24 hours after being worn, and they should be aired properly. Footwear made of porous, breathable material such as leather, or materials that have been treated, such as Gore-Tex, may alleviate the problem. Check the composition of the shoe lining to make sure it is also breathable. Wellington boots are available in breathable material, contact clothing advice services for details.
FOOTWEAR FOR PEOPLE WITH DIABETES
People with Diabetes need to look after their feet very carefully; the Diabetes Federation of Ireland has information on their website (www.diabetes.ie) dealing with the way in which diabetes can affect the feet.
You need to choose footwear with great care to ensure that it does not rub anywhere, and that there is plenty of room for the toes, and that the foot sits well back in the shoe.
You should look for footwear that has seam free linings, fits properly, and has broad based heels.
FOOTWEAR FOR COLD FEET
People who have very little movement or poor circulation will have greater difficulty keeping their feet reasonably warm.
Moving the feet and legs frequently encourages the blood to flow more freely and keeps the limbs warmer. Try to ensure feet and ankles are warm before putting on footwear, as standard footwear
can only maintain the warmth of your feet, not create warmth.
- Thick-soled shoes and additional insoles help insulate feet from the cold.
- The more the foot is covered the warmer it will stay.
- Shoes should neither be too tight nor too loose - both can cause cold feet.
- Wearing two pairs of socks or stockings will help providing they do not make shoes too tight.
- Silk socks next to the skin are often warmer.
- Avoid sitting in draughts - fit draught excluders to all doors.
- Exercise feet and toes together to promote warmth. Make sure they are warm before you put on socks and shoes.
- Make sure shoes and socks are dry and warm before putting them on.
KEEPING FEET WARM
Keeping the body warm helps keep the feet warm. Warm still air, suitable clothing and exercise all help to maintain warmth.
Feet will stay warm if the environment is warm and free from draughts. People with chronically cold feet need a higher room temperature
Clothes trap and enclose a layer of still air around the body. If the body is already warm this air is heated which helps maintain body temperature.
Several layers of loose fitting light fabric provide more warmth than one layer because more air is trapped. The more layers of clothing people wear, the warmer they will be, as long as movement is not restricted.
Legs are more than one third of the total body surface area; by wearing warm trousers over a complete under layer of warm tights or long johns and socks more heat is preserved.
Exercise produces heat so it is important to keep the feet and legs moving where possible. Exercise includes making curls with the feet, moving them up and down, running on the spot, or any other movements the person is able to make as well as walking; this also helps to reduce swelling. The exercises still help even if initiated by someone else eg whenever footwear is changed.
Constantly cold feet may have poor sensation. The skin needs inspecting regularly for bruising, breaks or infection.
TYPES OF FOOTWEAR
Most slippers are made of warm materials. An effective lining, existing or added, increases warmth. Sheepskin has its own inbuilt lining but this will eventually wear flat. Separate sheepskin insoles are available. Slippers will stretch with use and need changing when they no longer fit well.
Some shoes are available lined with synthetic fur. Plain styles are warmer than those with a punched hole pattern.
Boots are available in a variety of styles and leg lengths. When choosing consider both the ease of putting on and the effort of taking off. Fitting is particularly important, check they are not too tight. If the boots are too heavy this will inhibit movement and encourage cold feet. High boots may eliminate draughty gaps but must fit properly at the calf. If low boots are chosen consider filling the space around the top with socks, leg warmers or tucked in trousers.
Socks, stockings and tights (hosiery)
Consider wearing two pairs of socks, one thick and one thin or socks over stockings. These must fit properly and fit within the shoes - neither too loose nor too tight. Consider warming hosiery before dressing.
Hosiery is available in a wide range of material and in different weights. Man-made fibres feel warmer when brushed. The thicker the fibre the warmer it is particularly when knitted. Wool is a good insulator but needs to be washed carefully and replaced when the fibres become matted.
Mountaineering or walking socks (available from sports shops) are often warmer than traditional socks. Slipper socks have extra-grip soles, cover the foot and reach the calf. They are worn instead of slippers and shoes. They are safer and warmer than ordinary hosiery worn without shoes, but may prove difficult to remove.
Very warm surrounding air is needed to warm cold feet. It is sometimes more effective and economical to have a specific heater for the feet, but someone who has circulation problems or reduced skin
sensation should take care as he/she may not detect overheating.
Electrically heated footwarmers
Electrically heated footwarmers are connected to a power point and should have a safety cut-out to prevent overheating. This is especially important for those people with poor circulation. Be aware, particularly for people with limited mobility, a footwarmer or its flex is easily tripped over. Particularly if the person has limited mobility.
Hot water bottles can give immediate local heat but need a cover to prevent burning the feet. Microwavable 'gel' hot bottles and natural wheat filled bottles are now available.
Electrically heated socks
Electrically heated socks are an expensive but effective way of keeping the feet warm particularly for people with circulation problems. The socks are powered by a battery, 12 volts or less, worn either at the waist or at the top of the sock.
Heat producing chemical packs
To gain extra warmth a heat producing chemical pack is inserted into the top of the sock. There are two types of pack: disposable and re-useable. The disposable consists of two chemical elements that combine to provide heat, which is given out for about eight hours. The re-useable pack is a gel sachet, which is immersed in hot water before use. It then releases heat over a period of time, usually for about four hours. These sachets are re-useable up to 50 times and are available from sports, camping or angling shops.
Keeping feet warm in bed
Keeping feet warm in bed is more of a problem for people, who wake early, cannot move about, or move about so much they 'loose' their bedclothes.
It is important to get into bed warm, for instance straight from a bath. Having a warm drink, putting on warm nightwear and getting into a warm bed in a warm bedroom also helps. Bed socks can help prevent cold feet. The all-in-one pyjama suit with 'built-in' feet for children is ideal. These suits are also available in adult sizes from specialist suppliers. All-in-one sleeping bag suits are also available.
Putting a dressing gown and slippers on as soon as you get up, whether during the night or in the morning helps maintain heat. Going to the toilet in the middle of the night without slippers and dressing gown could result in a chill and could be dangerous if you fell and assistance was not at hand.
Anyone whose feet get cold in the middle of the night should make sure the bedding is well tucked in.
Hot water bottles can pre-warm the bed but are only useful when first getting into bed, as they do not maintain their heat.
These are available as over or under blankets and help to maintain a comfortable body temperature throughout the night. Most have a thermostat and a timer and some are designed to be left on all night. Electric blankets are not recommended for anyone who has circulation problems, reduced skinsensation, is at risk of developing pressure sores, who has continence problems or in other situations when there is a risk of moisture coming into contact with the blanket. Check that the appliance has been safety checked by the manufacturer, that it is compatible with your electricity source, that any
thermostats are functioning, that it has been serviced as recommended by the manufacturer and that the mains connection does not pose a trip hazard to the user or other members of the family or carers.
FOOTWEAR FOR PEOPLE WITH ARTHRITIS
People with arthritis often have a great deal of trouble with their feet if bony changes take place, eg when the bones of the toes cross over, or the ends of bones lose all their fatty protection. The footwear to look for should have insoles with good shock absorption, thick but flexible soles to protect the feet from the ground underneath, plenty of depth to accommodate the toes, soft uppers of leather or fabric and lightweight soles and heels.
Trainers often fit this description well, and can be a sensible choice when the condition first makes itself felt.
Shoes with extra depth may be needed and perhaps even made-to-measure footwear.
Socks with extra padding over the sole of the foot will provide better cushioning, but make sure footwear does not then become too tight.
FOOTWEAR FOR OLDER PEOPLE
As people become less active regular sessions with a chiropodist are helpful for problems such as corns, hard skin and bunions and to ensure that nails are cut regularly.
Footwear should have a heel with a broad base, preferably with a fastening, supportive uppers and a non-slip sole; all these factors help people walk more safely.
FOOTWEAR FOR CHILDREN
Some children have specialist footwear needs. It is essential to ensure that specialist shoes are well fitted and replaced as the child grows. Ill-fitting shoes or shoes which are too small will further damage feet which already need extra care.
For children under 18 years of age, two pairs of orthopaedic boots or shoes are paid for annually to people with medical cards or on the long-term illness scheme. Children over 18 years qualify for one pair annually. These are supplied on prescription from your orthopaedic surgeon.
Orthopaedic footwear is available for private purchase. Manufacturers/suppliers will endeavour to ensure children are fitted properly although this sometimes adds to the expense.
Even if shoes are prescribed most children would like another pair. Sometimes boots available on the high street are suitable. If possible discuss the possibilities with a health professional. An organisation called The Children's Foot Health Register produces a booklet containing the contact details of ‘centres of excellence’ for shoe fitting for children in the United Kingdom and Ireland.
Few people offer made-to-measure or bespoke shoes for children. Children's feet are growing all the time and these shoes take a long time to make. Please contact the Assist Ireland support line or email email@example.com for a list of these firms.
FOOTWEAR FOR SWOLLEN FEET
Feet can become swollen either for short or long periods.
Short term swelling of the feet is either the result of an accident or an operation, or follows the end of a long bus or plane journey - travellers should choose adjustable footwear for comfort; swelling of the feet following injury will usually disappear following treatment.
Long term swelling of the feet often accompanies conditions such as heart disease or when people are seated for long periods. Any swelling often worsens towards the end of the day. The degree of swelling can be decreased by raising the feet during the afternoon - for the greatest benefit the feet must be higher than the hips.
It also helps if the feet are exercised regularly throughout the day - movement of the calf muscles encourages the return of blood to the heart and so helps to minimise the retention of water in the feet and legs. One good exercise is to put the heel on the floor and tap the toes up and down.
Shoes and socks/stockings should be put on before putting the feet on the ground and before feet have become swollen. Elastic stockings put on before getting up can reduce the amount of swelling.
People whose feet swell are particularly vulnerable to skin damage so their shoes need to give them good support, be well fitting and have a smooth lining.
Some people have found that firm knee-length boots can reduce the amount of swelling.
It is not advisable to wear slippers all the time - people tend to shuffle when in loose fitting slippers. Shuffling does not encourage and reduces the ankle and calf movement needed to return blood to the heart. This can lead to further swelling.
Never cut a shoe as it will fall off when the swelling goes down.
To help you to walk if your feet are swollen, footwear should have a heel with a broad base, preferably with a fastening, supportive uppers and slip-resistant sole.
Swollen feet require shoes with extra depth and possibly width.
- The shoes should open up as near to the toes as possible. The fastenings should be adjustable, eg laces, straps or Velcro. These should exert even pressure over the foot.
- When buying shoes, particular care should be taken with fitting; they should not be bought when the feet are at their most swollen. Some people may prefer to have morning and evening shoes, which should be bought at the appropriate times.
- Low cut, slip-on shoes stop any swelling from moving down to the toes.
Putting shoes onto swollen feet
- Put on first thing in the morning.
- Use a shoehorn.
- If possible check the position of the toes to ensure that they are not pushed into the wrong position when the foot swells.
- Adjust fastening to fit firmly and evenly over the foot.
Feet that are swollen at the end of the day
Look for shoes with: adjustable fastenings, eg laces, Velcro or buckles; elastic inserts; a vamp with a V-shape split; slightly deeper uppers with rounder toes. Fluid gravitates to the feet; high heels will make it worse.
Shoes and sports shoes
All shoes with laces are adjustable, but some are more adjustable than others depending on the length of the opening. All laced or Velcro fastened training and sports shoes are made in accordance with the Gibson design. Check the opening extends as far as the toes so that the width can be adjusted evenly. Fabric shoes may not give enough support, and may not 'give' like leather shoes.
Surgical/orthopaedic firms produce ready-made shoes with extra depth, which have a variety of insoles to cope with the fluctuations of swelling. Please contact the Assist Ireland telephone support line (1890 277 478) or email: firstname.lastname@example.org for a list of these suppliers.
Summer styles are frequently preferred by people whose feet swell, as they are often made of fabric, are light or stretchy, and have lots of gaps or holes. During cold weather the wearer should check the
condition of his/her skin and may need to wear warm socks or tights to protect against the cold. Many sandals have buckles or laces, which allow the shoe to be, enlarged easily – both round the ankle and over the front of the foot. Some straps or buckles are attached with elastic, and longer lengths can be sewn on.
Footwear designed for use over dressings, plaster-casts etc may provide a cheap solution to the problem of what to wear indoors. These products can be found in the products and suppliers section of the Assist Ireland site.
Socks, stockings and tights
Socks with no elastic in the tops may be easier to wear if legs are swollen. Some specialist suppliers stock socks for swollen feet. Stump socks made for amputees are sometimes suitable for swollen feet and are available from specialist suppliers.
Tubesocks avoid the problem of the heel, which may be in the wrong place if the foot is swollen, although sometimes the lack of shaping increases pressure at the front of the ankle. Most sports shops stock these.
Support tights and stockings may help by providing venous support and can be bought from high street stores. Advice should be sought from retail pharmacies or through the local health centre about the correct pressure needed. Compression hosiery also provides support. It is generally prescribed and
fitted by practitioners trained to offer guidance on the wearing of compression hosiery as the compression will vary at specific points along the leg. Getting these stocking on and off can be difficult,
if so, discuss the problem with a health care professional or with your nearest clothing advice service to find out about dressing techniques and equipment that may help.
Slippers are designed to be worn for short periods of time indoors, for instance in the evenings and after work.
If they are worn for longer periods they need to be chosen with great care. It is best to choose those which fully support the foot. These styles should have stiffeners in the toes and heels, and have fastenings such as lacing and Velcro.
- Slippers should be reviewed and renewed regularly – ie before they are worn or trodden down, before the soles and uppers have come apart and before the soles have become worn through.
- Slippers should fit properly. Unfortunately few are available in half sizes; an insole may help to ensure the correct fit.
- Soles should be firm rather than soft, with a low or flat heel.
- When wearing footwear without fastenings, people tend to shuffle to keep it on. This may lead to a greater risk of falls.
- Mules (backless slippers) are not recommended as they do not keep the feet warm and increase the risk of falls.
- Fleecy lined slippers can help to keep the feet warm; when the lining is flattened replace with a fleecy insole.
- Slippers which fit snugly round the ankles, keep warm air in.
FOOTWEAR FOR PEOPLE WHO ARE INDOORS FOR LONG PERIODS
Many slippers are not suitable for long-term wear. It is advisable to wear types of footwear, which give more support. These include fabric shoes, trainers, felt boots and sandals.
The best style of footwear for people who spend long periods indoors is one that:
- encloses the heel and comes as high up the foot as possible,
- has elastic gussets or fastenings such as zips, Velcro or laces,
- for swollen feet, has a low opening and an adjustable Velcro fastening.
FOOTWEAR FOR BANDAGED FEET
Some people wear slippers when their feet are heavily bandaged because it is the only footwear their feet can fit into. It is quite difficult to maintain mobility and walk safely if the slippers are only kept on with elastic or if the backs are trodden down. However, suitable temporary footwear is available. The hospital should supply it if the bandages are due to an operation. A range of temporary footwear can be found in the products and suppliers section of the Assist Ireland site.
FOOTWEAR FOR ODD SIZED FEET
Most people have feet, which are slightly different in size, usually under one size. People with odd-sized feet may have one foot at least two sizes longer and/or wider than the other.
Footwear should be fitted by staff who have been trained in measuring and fitting feet. This is particularly important if the customer has foot problems. Shops with trained staff will display a current certificate of membership of a trade association eg Children’s Foot Health Register - prominently. This organisation will send a list of their members if you send a sae (see Useful Addresses).
Alternatively, staff may have received training from their own company, which includes supervision in fitting shoes for at least six months.
Where there is one or two size difference in foot length the most suitable shoe styles are adjustable (laces or T-bar) and the size bought to fit the larger foot. A three-quarter or full size insole inserted into the shoe on the smaller foot can help to hold the foot in the correct position, well back in the shoe; on a lace-up style, adhesive chiropody felt stuck onto the underside of the tongue may help. A heel cup may improve fit for a slip-on shoe, which has a high vamp (comes well up the front).
If the feet vary more than two sizes in length it is not possible to adjust the shoes to fit. This is because the place where the foot bends will not coincide with bend in the shoe for both feet. Two different sized shoes are needed to make the pair.
‘Solemates’ is a voluntary organisation offering a partnership service for people with different sized or only one foot (see Useful Addresses).
The difference in length is less noticeable if the shoes are colour co-ordinated with whatever is worn above - socks, stockings, trousers or skirts. The person may feel self-conscious about odd sized shoes but the most important consideration in preventing future foot disorders is to wear shoes that fit.
OBTAINING DIFFERENT SIZED SHOES
From high street retailers
- Buying two pairs of different sizes some shops give a discount off the second pair. Ask the manager if this is possible.
- From stock - one pair of shoes is sold made up from two existing pairs either by the retailer or the manufacturer. If the shoes are made from different skins the shoes may differ in colour and texture. This is usually most successful in black.
- Special order - the retailer orders two differently sized shoes from the manufacturer who makes them up on the appropriate standard lasts using a single skin. This gives the resulting pair consistency of texture and colour.
From mail order companies
A number of small companies making shoes are able to supply odd-sized shoes by mail order. The customer draws a foot-plan of both feet in accordance with the firm's order form.
Some mail order companies supplying off-the-shelf footwear may sell shoes of two different sizes and single shoes. Contact your nearest clothing advice service for details.
Mail order is not recommended for children, they need the personal attention of a skilled fitter.
Made-to-measure bespoke footwear
For a child or adult who have feet that vary greatly in length, perhaps one foot is child size and the other adult, made-to-measure bespoke footwear may be the only answer.
The names of a few shoemakers who make footwear for children are available from Assist Ireland, please contact the Assist Ireland support line or email email@example.com.
The less expensive method for adults is for the footwear to be made on an adapted last. The main expense is for the last to be constructed and kept for each foot. The cost of the first pair will therefore probably be greater than it will for subsequent pairs.
How to utilise the unused shoes
An organisation called Solemates tries to match people who have feet of different sizes. This enables them to exchange spare shoes or arrange to go shopping together. There is a small membership fee.
Some manufacturers of children's ready-made orthopaedic footwear will supply odd sizes. These bootee styles are usually supplied for children who need straight lasted styles or ankle support.
However they are similar in style to those found in high street shops and may be acceptable to children whose only problem is their odd sized feet.
Fitting feet of different widths
A small difference in foot width may be accommodated by buying footwear with adjustable fastenings, ie laces, buckles or Velcro. The footwear should be bought to the larger width. Footwear made of very soft leather or of fabric will mould more easily.
An insole in the shoe of the narrower foot may help, although it may also decrease the depth of the shoe as well as its width. People who make hand made shoes, the uppers of which are cut out to normal commercial sizings, may be able to mould the upper to accommodate small differences.
Large differences will probably have to be dealt with by made-to-measure bespoke footwear.
FOOTWEAR FOR PEOPLE WITH SENSITIVE FEET
Adverse reactions to leather footwear are usually caused by either chrome used in the tanning process or by dyes. Over recent years, other ways of tanning leather are used so that it is a little easier to find shoes, which are less likely to produce such reactions.
If a reaction is noticed, the user can find out what caused it by having allergy tests. Once the cause is known, seek shoes with leathers, which are tanned in a different way. Always check the composition of the shoe linings too.
Fabric shoes are available; particularly for summer wear. Trainers, especially the cheaper ranges, often have fabric uppers. Fabric slippers are usually available all year but especially in the autumn. Check the fibre content of the fabric used.
Sometimes minor allergic problems are avoided if shoes are bought which are lined with cotton or by wearing cotton socks, stockings or tights.
Wellington boots are sometimes a problem for people who have an allergy to rubber. Some are available lined in cotton (note: usually the tops need turning down when they are worn). Breathable Wellington boots are also available.
Soles and insoles are made from many different materials, so it should not be too difficult to find out which to choose and which to avoid.
People with medical cards or on the long-term illness scheme can have footwear prescribed for them. A general practitioner, physiotherapist or consultant refers people needing such footwear to an orthopaedic surgeon. Patients who have been given a prescription will be provided with either ready made or made-to-measure footwear.
If the footwear has been prescribed to someone with a medical card or on the long-term illness scheme the cost of adaptations prescribed by an orthopaedic surgeon will be covered. Otherwise the adaptations may be undertaken and paid for privately. An orthotist - the person employed to carry out the prescription - will run a footwear clinic in the hospital. Orthopaedic shoemakers will also undertake this work privately, eg for people who want more shoes adapted.
Any shoe that needs adapting should be of reasonable quality and well made. To make some adaptations the shoe will have to be taken to pieces and re-made - a poorly constructed shoe may not be able to withstand this.
Certain styles of shoe are more suitable for adaptation than others. Ask your orthotist what qualities are required. Write them down and explain to the shoe shop assistant exactly what you need from the shoes. Make sure that the shop will refund your money if you return the shoes unworn and undamaged within a reasonable length of time.
The adaptations most usually prescribed are:
- shoe raises,
- calliper sockets,
- change of fastening.
Shoes suitable for the insertion of calliper sockets must have been made on an internal (concealed) insole. Check when buying. Shoes must also have a broad based and solid heel, eg wood, leather, micro-cellular which is at least 2.5cm high.
Hollow heels can be replaced with solid ones on shoes where the heel covering can be re-used or the leather matched.
There is no formal height restriction on heels to take a calliper socket. However, the needs of the wearer may impose practical limitations.
The shoe must have a full back. Sling-back styles are unsuitable.
Change of fastening
- Fastenings can easily be changed from laces and buckles to Velcro and from lace holes to ski-boot hooks or D-rings.
- Elastic laces can be used to convert the shoe into a slip on, but one side of the tongue must be fixed to prevent it from slipping inside the shoe.
- 'No Bows', cinch fasteners and Velcro flaps can be purchased from shops and mail order catalogues supplying independence equipment.
- Instructions on a one-handed shoe lacing method are available from occupational therapy departments or clothing advice services.
Association of Occupational Therapists of Ireland (AOTI)
Ground Floor Office
Bow Bridge House
Tel: 01-633 7222
Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
380-384 Harrow Road
Tel: +(44) 0207 289 6111
Ricability(independent research body in UK which produces guides for older and disabled consumers based on professional research)
30 Angel Gate
326 City Road
Tel: +(44) 0207 427 2460
Fax: +(44) 207 427 2468
Children’s Foot Health Register(Produces a booklet which is updated annually containing names and addresses of centres of excellence for shoe fitting for children in the UK and Ireland.)
PO Box 123
Tel: +(44) 01295 738 726
Fax: +(44) 01295 738275
Diabetes Federation of Ireland(Provide information on foot care for people with diabetes)
76 Lower Gardiner Street
Tel: 01-836 3022
Fax: 01-836 5182
Helpline: 1850 909 909
Irish Association for Spina Bifida and Hydrocephalus (IASBH)(A fully trained Orthotist is always in attendance at all the clinics.)
Old Nangor Road
Tel: 01-457 2326
Fax: 01-457 2328
Solemates (Voluntary organisation in UK which offers a partnering service for people with different-sized feet or only one foot.)
46 Gordon Road
Tel: +(44) 020 8524 2423
Fax: +(44) 020 8524 2423
British Footwear Association(Produces a booklet entitled Footwear for special needs. Cost £3. Also has suppliers of specialist footwear listed under headings in the section consumer information eg allergies/vegan/vegetarian, bespoke/made-to-measure, outsize safety footwear etc)
3 Burystead Place
Tel: +(44) 01933 229 005
Fax: +(44) 01933 225 009
Society of Shoe Fitters(Trains people on how to fit shoes correctly, including shoe shop assistants and owners)
3 Burystead Place
Tel: +(44) 01933 229 005
Fax: +(44) 01933 225 009