You Say Orthopaedic, I Say Orthopedic, Let's Call The Whole Thing Therapeutic

Orthopedic or orthopaedic. Could the letter “a” resolve a dispute?

Diabetes and Shoes: What are the differences between Therapeutic Shoes, Orthopedic Shoes, Orthopaedic Shoes, Extra Depth Shoes, Custom Made Shoes and Pedorthic Footwear?

It was a shoe maker, originally from Hungary, but now working on the east coast of Canada, that called in to vent. It had been a relatively quiet Covid Tuesday morning up until to that point. There was not a lot going on.

He was adamant that the term “orthopedic footwear” should only be used to describe custom-made medical grade footwear and that as an “off-the-shelf” shoe company we were wrong to ascribe the term to describe our footwear. I tried, somewhat unsuccessfully, to rationalize with him.

My anxiety abated to a degree when I was able to point out that none other than the Pedorthic Association of Canada defines orthopedic shoes as “shoes that are specifically designed to support or accommodate the mechanics and structure of the foot, ankle and leg and they have a number of medically beneficial features and functions that separate them from everyday footwear.”Relief washed over me. As discerning as the contretemps might appear to be, I would not be rescinding my position. At the very least I knew I was anagramatically correct.

He wasn’t having it though and respectfully disagreed, the Pedorthic Association of Canada’s definition of orthopedic shoes notwithstanding. “In Europe the word orthopedic as it refers to shoes means custom made” he implored. Tempted as I was to remind him that Pedors is an American company and that he was in Canada, I managed to exert some degree of restraint of hubris.

As a manufacturer of “orthopedic shoes” his impassioned debate resonated with me as I’d been using the term to describe our products for over 20 years. What if I was wrong? My Hungarian interlocutor was causing me to pause for thought.

But something still poked away at my subconscious and I thought I’d better do some further research.

The Americanisation of the word orthopedic appears to have morphed to include how an extra depth shoe can accommodate a custom orthotic or be modified in some way to address a Pedorthic application. Here the term extra-depth footwear defines how a shoe is constructed with additional depth and volume in order to accommodate deformity such as claw/ hammer toes and/or to allow for space for a thick insole. Usually a minimum of 5 mm (~3/16″) depth is added compared to pre-fabricated footwear. Even greater depth is sometimes provided in footwear that is referred to as double depth or super extra-depth. And so by accommodating a custom insert or orthotic or some other device like a custom ankle foot orthotic (AFO) the shoe becomes an integral part of an orthopedic device.

In 1993 Congress enacted a bill known as the Therapeutic Shoes for Individuals with Diabetes. So now we’ve got another medical shoe term to come to grips with. Therapeutic footwear is regarded as a generic term for footwear that is designed to allow some form of treatment and may refer to both custom-made or pre-fabricated medical grade footwear. However, in order to be considered as appropriate footwear for diabetics certain design criteria needed to be met. The insole needed to be at least 3/16th’s of an inch thick and removable in order to accommodate a custom or prefabricated diabetic insert. The diabetic shoe needed to be available in full and half sizes and available in a minimum of three widths. Further the outsole needed to be graded to the upper, again in three distinct widths. Another key design feature was that internal seams would be best avoided as would anything else internal to the shoe that could cause rubbing, a blister or some other injury to the insensate diabetic foot. So the bar was set quite high for a shoe manufacturer trying to offer an off-the-shelf shoe that met the requirements for a therapeutic shoe to be fitted to diabetics in order for it to be reimbursed by Medicare. And so, for a therapeutic shoe manufacturer to enter the market they would be looking at a minimum of about 125 unique sizes and widths. Not strictly bespoke or custom but very close to it.

Which brings us to Pedorthic Footwear which is considered synonymous with medical grade footwear. Pedorthics is the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. Pedorthics uses footwear to help ease and treat these foot-related problems. A Pedorthist is someone who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. And it’s the Pedorthists around the world that are the closest relatives to the old school European bespoke orthopedic shoe makers.

And then there’s the discussion as to the missing “a”. In Europe the term is orthopaedic. In the US it’s orthopedic. And maybe that’s all I needed to argue in the first place. A different word for a different meaning.

Stephen O'Hare

President Pedors Shoes