Home → VA Prosthetics → VA Handbook 1173.9 - Footwear and Foot Orthoses → Appendix A - Footwear Prescription Guidelines

9.7. Appendix A - Footwear Prescription Guidelines


PATHOLOGY

SHOE TYPE

INSERT MODIFICATION (As Needed)

COMMENTS

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

*In order to accommodate the need to address both dress and exercise requirements, two categories of oxford style shoes are listed. The exercise shoe 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. The boot 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.

PATHOLOGY

SHOE TYPE

INSERT MODIFICATION (As Needed)

COMMENTS

3. Rearfoot Deformities

a. Symptomatic pronation

b. Symptomatic supination

c. Symptomatic Pes Cavus

d. Symptomatic Pes Planus

e. Heel Pain

(1) Retrocalcaneal

(2) Inferior calcaneal

f. Symptomatic equines

g. Tarsel coalition

h. Ankle instability

i. Charcot foot

 

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

2. Standard 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. The 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 concomitant 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 preventive measure, this group of patients should be followed on a regular basis for the development of pathology to ensure quick interventions as needed.

* In order to accommodate the need to address both dress and exercise requirements, two categories of oxford style shoes are listed. The exercise shoe 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. The boot 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.


PATHOLOGY

SHOE TYPE

INSERT MODIFICATION (As Needed)

COMMENTS

5. Peripheral Vascular Disease with non concomitant deformities (arterial or venous).

Depth shoe.

1. OTC.

2. OTC Accommodation Orthoses.

3. Semi-rigid or rigid functional orthosis.

4. Additional

accommodative padding as needed.

As a preventive measure, this group of patients should be followed on a regular basis for the development of pathology.

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 preventive measure, this group of patients should be followed on a regular basis for the development of pathology.


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