Orthoses and sneakers or sport shoes are the typical combination that seem to be easiest to fit. However not all shoe sales people have knowledge of what is desired or needed while parent and child may be willing to trade fashion rather than function.
Some basic knowledge of what components of a shoe can have variation and where the shoe, the foundation for the orthoses, must not deviate.
The upper segment of the shoe is not “supportive.” It may provide touch, sensory perception and clues regarding the spatial relationship or orientation of the foot to leg while the foot is moving forward in the air. However once the shoe contracts the supporting surface or ground don’t expect it to offer “support” for the ankle, lower ankle or joints of the feet; it will not.
Unfortunately for ease on fitting a shoe over a bulky SMO or AFO, the child is often fit with a shoe that is 2-3 times longer than their actual foot. The addition of length to a shoe adds functional length to the foot [extending its lever] so that unwanted proximal compensation results at the knee and hip joints or the child is limited to short, shuffling steps. The footwear must be as close in length to the child’s foot that we can offer while accommodating the orthosis.
The shoe must then be quite flexible [or made more flexible] at the “toe-break”; the point of the foot where the toes move or better yet, where the foot rotates over the toes during the last part of the stance cycle in gait.
To be continued….