Technical Note:

Shoeing the Deformed Foot:

A Method For Fabricating
Molded Sandals
Albert L. Howe, C.P.O.
C u s t o m - m o l d e d f o o t w e a r i s e s s e n t i a l for
the weight-bearing comfort of patients
w i t h s e v e r e , n o n - o p e r a b l e f o o t defor
mities. S u c h footwear, however, is expen
sive and time-consuming to make and
e q u i p m e n t for i t s c o n s t r u c t i o n i s n o t a v a i l
able in the standard orthotics laboratory.
T h e n e e d for d u r a b l e , e a s i l y f a b r i c a t e d
m o l d e d f o o t w e a r for t h e large n u m b e r o f
veterans with post-traumatic and de
g e n e r a t i v e foot d e f o r m i t i e s p r o m p t e d us at
t h e V e t e r a n s A d m i n i s t r a t i o n H o s p i t a l in
N a s h v i l l e , T e n n e s s e e , to d e v e l o p a m o l d e d
s a n d a l w h i c h c a n b e r e a d i l y f a b r i c a t e d in
any orthotics laboratory.
U s i n g c o m m e r c i a l l y a v a i l a b l e foam foot
impression blocks (Foam-art), a negative
m o l d o f t h e p l a n t a r s u r f a c e o f t h e foot is
m a d e . T h i s is d o n e w i t h t h e p a t i e n t partial
w e i g h t - b e a r i n g t o a l l o w n e a r l y full
s p r e a d i n g o f t h e forefoot a n d p a r t i a l flat
tening of the longitudinal arch. T h e toes
are m a n u a l l y p r e s s e d i n t o t h e f o a m t o a s
s u r e t h a t t h e full l e n g t h o f t h e foot h a s b e e n
i m p r e s s e d . A p o s i t i v e p l a s t e r m o l d is t h e n
cast. Modifications of the positive cast in
c l u d e (1) e x t e n d i n g t h e t o e - p l a t e a p p r o x i
m a t e l y o n e - h a l f i n c h to i n s u r e t h a t t h e t o e s
do not extend b e y o n d the anterior edge o f
t h e s a n d a l , (2) filling in t h e toe s u l c u s , ( 3 )
leveling the w e i g h t - b e a r i n g areas of the
h e e l a n d ball to t h e s a m e p l a n e a n d (4)
c o n s t r u c t i n g reliefs for a n y p l a n t a r p r o
tuberances.
A P e l i t e a n d t h e r m a l c o r k i n s o l e is t h e n
formed on the positive mold using a vac
u u m apparatus. T h e Pelite interfaces with

t h e f o o t . P e l i t e is u s e d r a t h e r t h a n l e a t h e r
for t h e foot c o n t a c t surface b e c a u s e it i s
more washable, more durable, adheres
b e t t e r t o t h e c o r k m i d - s o l e a n d i s e a s i e r to
form.
Successive thicknesses o f thermal cork
a d h e r e d w i t h M a s t e r C e m e n t are applied to
b u i l d u p t h e s o l e a n d fill i n t h e a r e a u n d e r
t h e l o n g i t u d i n a l a r c h . T h e p l a n t a r surface
a n d s i d e s o f t h e i n s o l e s are g r o u n d flat a n d
t h e e d g e s t r i m m e d a l m o s t flush w i t h t h e
P e l i t e i n s o l e . L a y e r e d s m o o t h c r e p e can b e
used to construct a rocker bottom. Crinkly
crepe provides a non-skid cushiony sole.
Heavy-weight elkhide makes strong but
f l e x i b l e s t r a p s . S t r a p d e s i g n is a c c o m m o
d a t e d to t h e f o o t d e f o r m i t y . D o u b l e t r a n s
verse straps over the metatarsals are com
f o r t a b l e a n d e a s y t o d o n (Fig. 1 ) . F a s t e n i n g s
o f o n e - i n c h V e l c r o , l a p p e d b a c k o n itself
through a keeper ring, allows easy strap
r e l e a s e for a r t h r i t i c p a t i e n t s w i t h little u s e

Fie. 1

metatarsal heads, degenerative arthritis,

p a i n f u l c a l l o s i t i e s a n d h a l l u x v a l g u s . All o f
t h e s e p a t i e n t s h a v e w o r n t h e i r s a n d a l s for
m o r e than two m o n t h s and report them to
b e c o m f o r t a b l e d u r i n g w e i g h t - b e a r i n g for
extended periods.
It i s h o p e d t h a t t h i s w o r k i n t h e d e
velopment of simple molded footwear will
g i v e i m p e t u s t o further effort i n t h i s a r e a .
ACKNOWLEDGMENTS

Fig. 2
o f t h e i r h a n d s a n d a l l o w s t h e f a s t e n i n g s to
b e fully o p e n e d t o a c c o m m o d a t e s e v e r e l y
d e f o r m e d feet ( F i g . 2 ) .
T h e c o m p l e t e d s a n d a l is c o m p a r a t i v e l y
l i g h t - w e i g h t . T h e total time r e q u i r e d for
fabrication is less than six hours. T h i s san
dal h a s b e e n u s e d s u c c e s s f u l l y d u r i n g t h e
past two years on patients with rheuma
toid arthritis, severe subluxation of the

Dr Harry J. Bugel, M . D . , Chief, Rehabilitative Medicine Service, Veter

ans Administration Medical C e n t e r , Nashville, Tennessee.
Dr. Cynthia A. Schneider, M . D . , Orthopedic Resident, Vanderbilt Uni
versity Hospital, Nashville, Tennessee.
David L . Norris, Orthotist, Orthotics a n d Posthetics Laboratory, Vete
rans Administration Medical Center Nashville, Tennessee

Mr. H o w e is with the Veterans Administration Medical Center in

Nashville, Tennessee

Address reprint requests to:

Albert L. H o w e , C.P.O.
1310 - 24th Avenue South
Orthotics a n d Prosthetics Laboratory
Veterans Administration Medical Center
Nashville, Tennessee 37203