Footwear Modifications/Questionable Charges
Questionable footwear modifications refer to charges that may be excessive and/or inappropriate for various reasons outlined in this section.
Built-in Orthotic: Simply gluing orthoses into footwear does not qualify as a permanent modification of the footwear, nor does it make it an orthopaedic or custom-made shoe. Orthoses must be removable so they can be altered.
Elastic Laces: Not a permanent modification.
Firm Midsole: The midsole is the layer of material sandwiched between the sole and the upper of the shoe. It must provide a firm, stable base of support while offering optimal cushioning. It is an original manufacturer’s component of a shoe, not a modification.
Glued Insole Removal: Not a permanent modification. There should not be a fee for simply removing an insole from a shoe, whether fastened or not.
Heel Reshaping by Heat Forming to Cast: It is difficult and inappropriate to reshape a heel (counter) as it is made from rigid plastic or fibre built in with the purpose of preventing mis-shaping.
Increasing Vamp Depth/Vamp Raise: This would fall under stretching as a feasible modification, however the need to stretch this area of a new shoe would indicate that the shoe is inappropriate to begin with.
Lengthen Shoe: Often billed as a shoe modification, this implies the shoe is too short to begin with and therefore is inappropriate for the patient. This is an unnecessary modification if the patient was correctly fit for size.
Padding – Heel Cushioning/Heel Counter: Not a permanent modification. If footwear is also being claimed, a shoe should be chosen that: (a) already has padding; or (b) fits more appropriately so padding isn’t needed. [Note: A deformity to the rearfoot (e.g., Haglund’s deformity) would make this a reasonable modification, but the medical necessity must be made clear on a claim.]
Plastizote Insole: There are stock shoes that come with a plastizote insole/sockliner. If plastizote sheeting is directly moulded to the patient’s foot and has some modifications performed (e.g., posting, MT pads), it would not be considered a shoe modification, but a direct-moulded orthotic device and the medical need should be provided. If an orthotic device is also being claimed, this is a duplication.
Reinforced Heel Counter/Stiff Heel Counter/Extended Heel Counter: Some footwear – like canvas running shoes – has flexible heel counters. A reinforced heel counter is typically present in shoes designed for jogging or orthopaedic footwear. It is an original manufacturer’s component of a shoe, and not typically a modification. Any claim would have to include detailed information regarding the need.
Steel Shank/Shank Stiffener: The shank is a component part of all supportive footwear and is a rigid material placed into the midsole to stiffen the base of the shoe and provide torsional stability. While there might be the very rare occasion that this is warranted as a modification to a shoe, the necessity of this modification would deem the shoe inappropriate.
Stretch Toe Box: Billed as a shoe modification, this implies the toe box is too narrow, short, or shallow and therefore might be inappropriate for the patient. Occasionally, a specific stretch is needed to accommodate a specific toe or forefoot joint deformity to make room for that enlarged area with a specific spot stretch or ball-and-ring stretcher.
Toe Box Reshaping by Heat Stretching to Cast: 1. The need to stretch this area of a new shoe would deem the shoe inappropriate as it would mean it was too short or not deep enough to begin with. 2. It is difficult and inappropriate to stretch a toe box as it has a rigid plastic or fibre cap built in with the purpose of preventing mis-shaping.
Tongue Split and Material Added: Possible but highly unlikely. Any claim would have to include detailed information regarding swelling or foot deformity.
Velcro to Replace Laces: 1. This can be a feasible modification, but medical condition necessitating the fastener replacement should be satisfied – e.g., incapacity to tie due to age (child); upper extremity dysfunction (paralysis, arthritis, CMT); flexibility issue (back injury, hip replacement, obesity); or mental handicap. 2. Many orthopaedic shoes are readily available with Velcro closures; if a shoe is also being claimed, a shoe manufactured with Velcro could have been chosen in the first place.