A Mile in Their Shoes

ShoesMarilyn Monroe famously said, “Give a girl the right shoes, and she can conquer the world.” For wheelchair users, it’s certainly true that different pairs of shoes can significantly change their lowerextremity positioning.

Stephanie Tanguay, OTR, ATP, clinical education specialist for Motion Concepts, has seen first hand how differences in sole thicknesses and heel heights can impact a seating system’s effectiveness.

“Your sandals vs. your dress shoes vs. a pump: Every time you change your shoe and that thickness changes, it’s going to change the orientation of your foot platform or foot support,” she says. While the wheelchair’s seat-to-footplate length remains the same, shoes can alter the lengths of the client’s legs.

“With women, you can change 1.5" to 2" easily by changing your footwear,” Tanguay says. “So we can have more weight bearing on the thigh and less contact of the heel. If you go to [a shoe] that’s thicker or has a heel, now we’ve got that change in orientation: Your knee is up higher than your pelvis. You’ve offloaded a little bit underneath your thighs.”

ATPs and clinicians may notice that consumers position their feet differently depending on the shoes they’re wearing, Tanguay adds.

“If somebody wears heels, what happens? Is the heel on the foot platform or footplate? Do they tuck their feet back and drop their heel off the back side of it?”

While shoes might seem a minor point in the midst of other conversations on clinical efficacy and funding challenges, Tanguay points out that the problems caused by differing sole and heel thicknesses can be significant.

“A couple of years ago, we had a resurgence of platform [shoes],” she says. “Thankfully, it was rather short-lived. What happens to somebody who gets a thick shoe like that and goes into their kitchen or lunchroom or desk and pulls up to it, and doesn’t realize their knee is now 1.5" or 2" higher than it was? They ram their knee into the table or the desk. I don’t know a lot of people who are going to say, ‘Oh, I’ve got to lower my footplate a notch today.’ That doesn’t happen.”

Tanguay recalls working with a “fashionista” consumer who had a C4 spinal cord injury: “Sitting in her heels in her power chair all the time, she had a lot of contractures of her ankles because of the shoeware she loved and insisted on wearing. Because she lost a lot of stability, she got in the habit of riding in her power chair with one leg crossed over the other at the knee because this flexed her up a little more and helped to hold her back in the chair. But it caused her to sit with an obliquity, and scoliosis eventually developed.”

Because of potential side effects like these, Tanguay suggests it could be helpful to educate consumers about how footwear — or swapping out seat cushions, for that matter — can alter lower-extremity positioning. But she acknowledges there's no easy fix for the overall issue.

Part of it is human nature: When illness or injury has limited someone's personal mobility and drastically changed his or her life, “The last thing they want to hear is ‘And by the way, you can’t wear your favorite shoes,’” Tanguay admits.

And no: This isn’t just a female issue. Tanguay remembers working with male clients “who were in chairs [and] were still buying the brandnew Nikes, regardless of whether they were walking on the bottoms. It’s about showing the tops.

This article originally appeared in the August 2013 issue of Mobility Management.

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