If you have hemiplegia, it is important to have footwear which is not only practical and comfortable but will help keep your affected foot in the best position when walking. And judging by the number of enquiries we get at HemiHelp, finding suitable footwear is one of the most common problems faced by both parents and carers of children with hemiplegia, and by adults with the condition.
Different sized shoes
The most common problem is that the child needs two differently sized shoes. Sometimes the affected foot is smaller, or the child may wear a splint, which requires a longer and wider shoe. Either way you need differently sized shoes, so you have either to find someone who will sell a pair of odd shoes or buy two pairs and hope for a discount. My good foot has always been considerably bigger than my affected foot, so with a splint, I could sometimes get away with one pair as the splint took up the extra space, but without a splint, I still need to get 2 pairs even now and I’m 35. I have just started wearing an insole to try and stop my foot from turning in and rolling out and hopefully that will help my trainers to last more than 2 months! They also put a toe block on the end of the insole, which has been a great success for me as I now only have to buy one pair of trainers In theory, children with hemiplegia should have orthopaedic shoes/boots e.g. Piedros, prescribed and fitted for free on the NHS, but often parents are refused this service, although it is worth persisting if you can get support from your physiotherapist. Once the child has stopped growing some parents have had an expensive cast (mould) made of his/her feet and then had shoes made to measure. These should be rather more comfortable and the cost can be little more than buying two ordinary pairs.
If one leg is shorter than the other, the shoe on that side can be given a raise. These can either be stuck on the sole/heel by the orthotist or fitted inside the shoe. These inner ones are removable and so can be put into different shoes, but the problem can arise that the shoe is then not deep enough and the heel comes out. You can often get around this by wearing boots, but this is not ideal in hot weather. My son has a 10mm raise on one shoe. It has all been arranged through his NHS physio. When he needs a larger pair of shoes, I buy them, and then drop one off at the health centre. It gets sent away, the sole is sliced off, the raise inserted, and the sole then glued back on to the bottom. It is returned to the health centre for me to collect a couple of weeks later.
Another problem is fastening shoes with one hand. Fortunately, many shoes for both children and adults now come with Velcro fastenings, and many orthotists will also replace existing fastenings with Velcro. If you would like to tackle the shoe lacing challenge you can look at our leaflet on the subject, but there are also easy lacing options such as coiled laces (see links below). If you want lighter shoes – slip-ons or sandals – members have found solutions to the problem of fastening them. A lot of the time I wear black school type plimsolls, which I sew elastic on so I don’t step out of them. I also found that I could buy Velcro fastening sandals etc and take them to the cobblers and he would put extra elastic and Velcro on to extend the strap so it actually fastens over the splint where it should do and so doesn’t look so odd. And talking about sandals and splints, one parent has also found a good solution for summer, when it is too hot for socks. She fixes a sock over the AFO, making holes in it to fit the straps through. So there is still a layer of sock between foot and splint. For some photos go to the HemiHelp message board at www.board.hemihelp.org.uk/index.php?showtopic=1622&hl=liner&st=15
Where to buy shoes
HemiHelp members have come up with various solutions to the problem of buying shoes without breaking the bank, so you may find you need to shop around and see what suits you. Some have found it best to go for good names for quality: brands mentioned include Clarks, Ecco, Geox, Hush Puppies and Startrite. These need not be expensive: members recommend companies such as Wynsors www.wynsors.com, Clifford James www.clifford-james.co.uk and Brantano www.brantano.co.uk, who have a good range of branded footwear at discount prices. Some firms (e.g. Clarks, Nike) have factory outlets with good discounts. Clarks also run an odd shoe scheme (see pg4). Others have found shoes, especially trainers, from cheaper shops or supermarket chains that have been just as good, especially if the foot is already being supported by an AFO. In fact trainers, whether brand name (Adidas is most often mentioned - also available from discount companies) or chain store, seem to be the easiest footwear for both children and adults with hemiplegia, since they are designed to support the foot and often have insoles that can be removed (if necessary by force) to accommodate an AFO. And of course many of them have Velcro fastenings. Parents should also ask their child’s school to allow them to wear trainers for PE rather than plimsolls, which allow the foot to roll over. Some black trainers you can pass off as shoes, no one would notice. If you buy two pairs of trainers of different sizes, make sure both trainers have the same height soles as the bigger the trainer the higher the sole height
The black trainer trick might go on working for young males, but for girls there is added pressure to look and feel fashionable, which makes finding shoes even more difficult. But as you can see from what some adult members have told us, having hemiplegia doesn’t mean staying in. One day soon she’ll be asking “which shoes should I wear to match my outfit tonight?” My hemi might mean I’m limited on styles, but not on colour, and I know the value of good quality footwear with support where it is needed. I’m rarely caught hobbling around after a night dancing in some silly ill-fitting shoes that cause blisters - like my girlfriends do! As a fashion conscious 70s teenager, I was determined to wear shoes of any style, and did, but yes it did require concentration and effort. Clogs, stilettos, 4’’ platform sole boots with 5’’ heels (ulp!) I wore the lot. I wish I still had those boots, just to prove I did wear them... sigh. Discovering that I could get a cobbler to add extra elastic to a strap so that it would fasten over my splint has transformed my footwear experience. For going out I have a pair of black pumps with elastic on the top so they stay on and I have a pair of 1 inch wedge leather black boots. One member wrote a whole story about the shoes in her life: This is the story of my shoes. I hated shoes when I was growing up - everyone around me could walk unaided and there I was with splints and piedros. All the parents out there will know it can be hard when your little one just doesn’t understand the need to wear these shoes... but you have to do what you have to do, and if you find a pair that work, stick with it! Anyway, I wore mine for a while but then I became dependent and my unaided gait deteriorated, so my parents agreed to dispense with them. By secondary school my gait improved and I could walk unaided but I still needed to wear big flat boots with lots of support. It didn’t seem very fair when other girls were wearing platforms like Ginger Spice. I owe a lot to her actually because she provided the incentive I needed to do my exercises, up my game and get walking: an unlikely source of inspiration you might think, but then I was 14! When I turned 16 I bought some black Mary Jane court shoes with a 1.5 inch heel. I felt a mixture of nerves and excitement as I held tight my latest purchase. I was determined to dance in them at my school leavers party six months later and so there was only one thing to do - practice! More blooming practice and exercise, it’s all I ever hear... but this time was different - see I’d set this goal myself and I wasn’t being coerced or pressured by any physios and the like. I danced the night away and you’d have no idea that my first steps in the shop were so tentative and weak. Those shoes saw me through sixth form, my first proper date and kiss. The first clubbing experience, first legal drink. They went with me to my first job interview and my interview to get to university. The danced with me at the freshers ball, and graduation. They were even there when I gave my first presentation and speech to a crowd of conference delegates in Manchester (scary stuff!). They went to the world trade center, a summer solstice celebration in Finland, they’ve climbed the Spanish Steps and the Palatine Hill in Italy, and wandered the markets in Africa. Then, two years ago they wore out, so I put them in the attic. I was very sad... and though they are neither use nor ornament I can’t bear to part with them! I’ve since graduated to 3 inch Mary Jane’s and even standard courts with heel inserts but no straps! I cried in the shop I was so happy I could finally walk away in them. Not bad, when you consider my humble beginnings. I still have to practice and make sure I don’t get lazy, but for anyone who hates physio like I did and can’t be bothered with the exercises (join the club) keep going because the rewards are so very worth it.
If you are concerned about shoes being properly fitted, the Children’s Foot Health Register www.shoe-shop.org.uk Tel: 0171 371 5185 have a list of Centres of Excellence for Children’s Shoe Fitting in the UK, which you can download from their site. Shops listed have trained staff and offer 4 width fittings and half sizes. The Disabled Living Foundation has a leaflet on Finding Suitable Footwear at www.dlf.org.uk/sites/default/files/Finding_Suitable_Footwear.pdf or phone their Helpline 0845 130 9177. Adaptawear www.adaptawear.co.uk is an adult clothing range including slippers with Velcro fastening. Chas A Blatchford and Sons Ltd www.blatchford.co.uk Tel: 0114 263 7900 Email: firstname.lastname@example.org stock a variety of orthopaedic footwear ranges including Mendivil, Bota Boots, Accommodative, AFC Boots, Podiabet Shoes, A-line, Camino and the Paediatric footwear range. Clarks Shoes Ltd, www.clarks.co.uk Tel: 01458 43131 run an odd shoe scheme on a limited number of styles. You pay the usual price plus 25% and postage and packing for children, 50% for adult sizes. Gilbert Mellish www.gilbert-mellish.co.uk Tel: 0121 475 1101 have a number of ranges of orthopaedic footwear including Piedro boots, but they are only available through medical professionals. Hush Puppies www.hushpuppies.co.uk Tel:020 7860 0100 have children’s shoes with features such as padded collars for extra support and range of width fittings. Some adult lines have removable insoles to adjust width. Inchworm www.inchwormshoes.com a children’s range that ‘grow’ up to one size. Not cheap but will last longer and might avoid buying two pairs Next http://www.next.co.uk/shopping/children/boysshoes/2 has boys’ suede Ugg-type boots with Velcro side fastening that are easy to use with a splint ( can be worn by girls as well). Padders www.padders.co.uk have an adult range called dual-fit which have removable insoles to accommodate an AFO. Remploy Healthcare http://healthcare.remploy.co.uk/products-and-services/orthoticfootwear.a... Tel: 08451460600 Email: email@example.com sell the Tivoli range to both prescribers and users and Made to Measure footwear for prescribers only Salts Techstep www.saltstechstep.co.uk Tel :0121 333 2099 Email: firstname.lastname@example.org have a wide range of Schein shoes and boots for children, available in three different widths and in split-sizes and a more limited adult range, as well as orthopaedic insoles. Solemates www.patient.co.uk/support/Solemates.htm 020 8524 2423 is a charity which aims to ease the problems with footwear experienced by people with different sized feet. They have information on manufacturers and suppliers of odd-sized footwear and run a partner service for both adults and children, to match people according to their needs. S tart-rite Shoes Ltd www.startriteshoes.com Tel: 0844 561 7263 Email: email@example.com sell a wide variety of shoes including those with wider fittings; there are usually special offers and discounts available. See also HemiHelp Information Sheets Shoe Lacing and Dressing