HomeVA ProstheticsVA Handbook 1173.9 - Footwear and Foot OrthosesAppendix A - Footwear Prescription Guidelines

9.7. Appendix A - Footwear Prescription Guidelines

Pathology Shoe Type Insert Modification (as needed) Comments

1. Foot Deformities

Hallux abducto valgus,hallux varus, hallux rigidus

1. Standard Therapeutic Oxford: dress and/or casual shoe.*

2. Standard Therapeutic Oxford walking shoe.**

3. Oxford style boot.**

4. Depth shoe.

5. Custom molded.

1. Semi-rigid or rigid functional orthosis.

2. Additional accommodative padding as needed.

The type of shoe must be determined based on the severity of the pathology. ?áThe prescribing physician should work with the Prosthetics Service to ensure the most basic equipment to manage the condition is used.

2. Midfoot Deformities

Charcot Foot

1. Depth shoe.

2. Custom molded.

3. Oxford style boot.

1. Semi-rigid or rigid functional orthosis.

2. Additional accommodative padding as needed.

3. Ankle-foot orthosis or other stabilization and/or immobilization brace.

The type of shoe and orthotic must be determined based on the severity of the pathology. ?áThe prescribing physician should work with the Prosthetics Service to ensure the most basic equipment to manage the condition is used.

3. Rearfoot Deformities

a. Symptomatic pronation

b. Symptomatic supination

c. Symptomatic Pes Cavus

d. Symptomatic Pes Planus

e. Heel Pain

e1. Retrocalcaneal

e2. Inferior calcaneal

f. Symptomatic equines

g. Tarsel coalition

h. Ankle instability

i. Charcot foot

1. Standard Therapeutic Oxford: dress and/or casual shoe.*

2. Standard Therapeutic Oxford walking shoe.**

3. Oxford style boot.**

4. Depth shoe.

5. Custom molded.

1. Semi-rigid or rigid functional orthosis.

2. Additional accommodative padding as needed.

3. Ankle-foot orthosis or other stabilization and/or immobilization brace.

4. Heel cup.

The type of shoe and orthotic must be determined based on the severity of the pathology. ?áThe prescribing physician should work with the Prosthetics Service to ensure the most basic equipment to manage the condition is used.
4. Diabetic Neuropathology with no concominant deformities. Depth shoe.

1. Over-the-Counter (OTC).

2. OTC Accommodation Orthoses.

3. Semi-rigid or rigid functional orthosis.

4. Additional accommodative padding as needed.

As a preventative measure, this group of patients should be followed on a regular basis for the development of pathology to ensure quick intervention as needed.
5. Peripheral Vascular Disease with non concominant deformities (arterial or venous). Depth shoe.

1. Over-the-Counter (OTC).

2. OTC Accommodation Orthoses.

3. Semi-rigid or rigid functional orthosis.

4. Additional accommodative padding as needed.

As a preventative measure, this group of patients should be followed on a regular basis for the development of pathology to ensure quick intervention as needed.
6. Digital and Midtarsal amputations.

1. Depth shoe.

2. Custom molded.

1. Semi-rigid or rigid functional orthosis.

2. Appropriate filler.

3. Additional accommodative padding as needed.

As a preventative measure, this group of patients should be followed on a regular basis for the development of pathology to ensure quick intervention as needed.

* - In order to accommodate the need to address both dress and exercise requirements, two categories of oxford style shoes are listed.?á The exercise?áshoe must be accompanied by an indication that it is a requirement as part of a therapeutic plan listed in the progress note and consultation form.

** - Certain conditions and circumstances may require the use of boots that add ankle support.?á The boot must be accompanied by an indication that it?áis a requirement as part of a therapeutic plan listed in the progress note and consultation form.

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