Shoes and Foot

Management
Off-the-Shelf Shoes for
Management of Foot
Pathology

Orthotic Devices:
Post-Operative Shoe
Description and Features:
Rigid sole shoe that allows ambulation
while promoting foot healing
High degree of adjustability
May incorporate rocker bottom

Uses & Biomechanical Capabilities

Accommodates foot when sutures, wires,
and/or bandages are present
Rigid base of shoe allows for weightbearing with limited motion at foot
articulations

L3260 : Surgical boot/shoe, each

Post Op Shoe
Materials
Rubber or synthetic sole
Absorbs shock
May include rocker to limit foot motion and facilitate
gait

Canvas or synthetic fabric upper

Washable and breathable fabric
Usually lined and padded

Velcro adjustable straps

Typically across dorsum of foot
Heel counter may be adjustable

Orthotic Devices:
Unloader Shoe
Description and Features:
Rigid sole shoe allowing ambulation while
promoting region-specific unloading during healing
High degree of adjustability
Heel or forefoot unloading

Uses & Biomechanical Capabilities

Accommodates foot when sutures, wires, and/or
bandages are present
Rigid base of shoe allows for weight-bearing with
limited motion at foot articulations
L3260 : Surgical boot/shoe, each

Unloader Shoe
Materials
Rubber or synthetic sole
Absorbs shock
Transfers forces to weight-tolerant areas

Canvas or synthetic fabric upper

Washable and breathable fabric
Usually lined and padded

Velcro adjustable straps

Typically across dorsum of foot
Heel counter may be adjustable

Extra Depth Shoes

Purpose
Designed to relieve excessive foot pressure
Hammertoes
Bunions
Extreme foot shapes.

Construction Features
Seamless or limited seams at forefoot and
interior
Deeper toe box: 3/16 to
Accommodative materials

Extra Depth Shoes

Extra-depth shoe standards
Minimum of 3 widths
Minimum of 3/16 of extra-depth
Limited seams at the toe
Closed toe

Other factors for high quality

Genuine leather upper
Foam-padded collar
Long medial counter
High toe box
Steel shank
Adaptable sole for modifications, such as lifts, rocker
bottoms, etc.

Orthopedic Footwear
Definition
Shoes, shoe modifications or shoe additions which are used to:
Correct, accommodate or prevent a physical deformity or range of motion
malfunction in a diseased or injured part of the ankle or foot
Support a weak or deformed structure of the ankle or foot
Form an integral part of a brace.

Minimum orthopedic shoe specifications consist of:

Blucher or Bal construction
Leather construction or synthetic material of equal quality
Welt construction with a cement attached outsole or sewn on outsole
Upper portion properly fitted as to length and width
No unit sole
Bottom sized to the last
Closure appropriate to foot condition (Velcro strap or lace closure preferred)
Full range of widths, not just narrow, medium, wide
Extended medial counter and firm heel counter.

Sneakers and athletic shoes are not considered orthopedic shoes by the
Medicaid Program and therefore are not Medicaid reimbursable.

Orthopedic Footwear
Key Terms
Blucher Shoe
Lace-up shoe
One piece vamp

Balmoral (Bal/Oxford) Shoe

Lace-up shoe
Typically with side seam

Welt Construction
Strip of material sewn to upper
Sole is sewn or attached to welt
Allows for sole repair and modification

Counter

Counter
Reinforcement between lining and upper
Stabilizes heel in early stance
May also be external to shoe (heel cap)

Orthopedic Footwear
HCPCS CODE
L3215
L3216
2
L3217
45.00
L3219
L3221
2
L3222
52.50

FEE MAX

#Orthopedic footwear, ladies shoe oxford, each

#Orthopedic footwear, ladies shoe, depth inlay, each

$ 32.50
2
$ 45.00

#Orthopedic footwear, ladies shoe, hightop, depth inlay, each

$
2
#Orthopedic footwear, mens shoe, oxford, each
$ 40.00
2
#Orthopedic footwear, mens shoe, depth inlay, each
$ 52.50
#Orthopedic footwear, mens shoe, hightop, depth inlay, each
2

Shoe Coding: Modifications

Elevations
L3300 Lift, elevation, heel, tapered to metatarsals, per inch
L3310 Lift, elevation, heel and sole, neoprene, per inch
L3332 Lift, elevation, inside shoe, tapered, up to one-half
inch

Heel Modifications
L3350 Heel wedge
L3390 Outflare wedge

Other Modifications
L3580 Orthopedic shoe addition, convert instep to velcro
closure
L3649 Orthopedic shoe, modification, addition or transfer,
not otherwise specified

Foot and Shoe Measurement

Brannock Device
Available for age/gender
Mens
Sizes 4 to 16
Width sizes 3A to 3E

Womens
Sizes 3 to 13
Width sizes 4A to 2E

Junior
Infant 0 to childs size 5 (approximately age 10)

Key Measurements
Heel-to-toe length
Arch length (heel to 1st metatarsal head)
Width of foot

Shoe Sizing
Correct size is larger of two length measurements

Using the Brannock Device

Foot Length
Move all adjustments to their largest settings
With the patient standing, place the foot in the
correct side of the device with the heel firmly
against the heel cup
Press the longest toe lightly and read the foot
length

Using the Brannock Device

Arch Length
Slide the pointer until it is centered on the
first metatarsal head and record the arch
length

Foot Width

Slide the width bar until it firmly contacts

the lateral side of the foot
Locate the shoe size as determined by the
larger of the two measurements (foot
length vs. arch length)
Read the width that corresponds to the
appropriate shoe size

Foot and Shoe Measurement

Shoe Sizing Schemes
Shoe sizes are related to the length of the last, which is a
foot-shaped template used for shoe fabrication.
The American size of the shoe is three times the heel-to-toe
length of the foot (in inches) minus a constant
The subtractive constant is 22 for men, 21 for women, 9.75 for
children up to size 13
Example: a mans foot that is 10.5 long requires an American shoe
size 9.5
3 x 10.5 = 31.5 22 = 9.5

Each half size increment is 1/6 of an inch (4.23 mm).

Most countries in continental Europe and in Latin America
follow some version of the French rule
Shoe size is 1.5 times the length of the last measured in
centimeters, irrespective of gender or age

Mens Shoe Sizes

U.S. Men's Shoe
Size

Inches

C Narrow

6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
12.5
13
13.5
14
14.5
15

9.31
9.5
9.69
9.81
10
10.19
10.31
10.5
10.69
10.81
11
11.19
11.31
11.5
11.69
11.81
12
12.19
12.31

3.3"
3.3"
3.4"
3.4"
3.5"
3.6"
3.6"
3.7"
3.8"
3.8"
3.9"
3.9"
4.0"
4.1"
4.1"
4.2"
4.2
4.3
4.3

D
(Medium/Standard
)
3.5"
3.6"
3.6"
3.7"
3.8"
3.8"
3.9"
3.9"
4.0"
4.1"
4.1"
4.2"
4.3"
4.3"
4.4"
4.4"
4.5"
4.6"
4.6"

E Wide
3.7"
3.8"
3.8"
3.9"
3.9"
4.0"
4.1"
4.1"
4.2"
4.3"
4.3"
4.4"
4.4"
4.5"
4.6"
4.8"
4.9"
4.9"
5"

Womens Shoe Sizes

U.S. Women's
Shoe Size

Inches

Narrow

Average

Wide

X-Wide

11

16

2.81

3.19

3.56

3.94

5.5

13

16

2.88

3.25

3.63

2.94

3.31

3.69

4.06

6.5

9 316

3.38

3.75

4.13

9 516

3.06

3.44

3.81

4.19

7.5

9 12

3.13

3.5

3.88

4.25

11

16

3.19

3.56

3.94

4.31

8.5

13

16

3.25

3.63

4.38

10"

3.31

3.69

4.06

4.44

9.5

10 316

3.38

3.75

4.13

4.5

10

10 516

3.44

3.81

4.19

4.56

10.5

10 12

3.5

3.88

4.25

4.63

11

10

11

16

3.56

3.94

4.31

4.69

11.5

10

13

16

3.63

4.38

4.75

12

11

3.69

4.06

4.44

4.81

12.5

11 316

3.75

4.13

4.5

4.88

13

11 516

3.81

4.19

4.56

4.94

13.5

11 12

3.88

4.25

4.63

3.94

4.31

4.69

5.06

14

11

11

16

Shoe Donning
Loosen all laces and straps
Remove wrinkles from socks
Make certain any seams are appropriately
located to prevent abrasion

Assist patient with donning of shoe

Use a shoe horn as needed, particularly if
patient has limited torso flexibility/ROM

Tighten laces or straps as appropriate

Tight enough to prevent excessive motion
and maintain foot and ankle support
Loose enough to prevent skin and circulation
impairment

Shoe Fitting: Assessment of

Fit
Static Assessment (Standing)
Overall length
Should have thumb width between end of toes
and end of shoe leather

Heel fit
Counter contoured to match heel shape
Loose enough to allow appropriate heel slip without abrasion

Arch fit
Length supports entire arch
Height provides adequate support while allowing foot flexibility

Metatarsal heads
Adequate width to prevent impingement
Close enough fit to prevent excessive anterior foot translation

Toe fit
Toe box allows for spreading of toes during weight-bearing
Toes do not contact distal end of shoe

Shoe Fitting: Assessment of

Fit
While patient walking,
check:

Foot and shoe interaction

Anterior foot translation
Heel slip
M-L foot stability

Shoe and ground interaction

Heel and sole compression
Force path
Toe clearance

Patient balance