Free Footwear Health Check


It could be that the person has spastic cerebral palsy.


The Cerebral Palsy Alliance website is bright, easy to navigate and extremely informative. The following excerpts have been taken from the site.


Spastic cerebral palsy is the most common type of cerebral palsy. The muscles of people with spastic cerebral palsy appear stiff and their movements may look stiff and jerky.


Spasticity is a form of hypertonia, or increased muscle tone. When people without cerebral palsy perform a movement, some groups of muscles turn on and some groups of muscles turn off. In people with spastic cerebral palsy, both groups of muscles may become turned on at the same time. In some instances the wrong muscle groups may turn on. This makes movement difficult or even impossible.


In cerebral palsy, spasticity is due to damage to the motor cortex of the brain before, during or after birth. This part of the brain is considered the supreme command centre for control of body movements.


Spasticity may affect any muscle group in the body however there are some common patterns that are seen in cerebral palsy.


Effect on the lower limbs (legs)
If spasticity affects one or both of the legs it can lead to:

  • Flexion at the hip (which causes the leg to lift upwards when lying or the body to lean forwards in standing)
  • Adduction or ‘scissoring’ of the thighs (which causes the legs to pull together)
  • Flexion at the knees (causing changes in a person’s standing posture)
  • Equinovarus foot posture (where the toes point downwards and inwards with the heel off the ground – this results from tightness in the calf muscles)
  • Hyperextension of the big toe (where the toe is pulled upwards and backwards towards the shin)


Spasticity in the muscles of one or both legs may affect a person’s ability to

  • Stand upright
  • Sit upright
  • Transfer from one position to another
  • Move and reposition in bed
  • Walk and run


So what can it mean for a person with cerebral palsy with regard to their footwear and / or other devices? We see a range of people at Happy Feet Pedorthics who have cerebral palsy. Footwear for this group of people can mean:

  • Prefabricated medical footwear, including the Piedro and Keeping Pace ranges of footwear
  • Fitting of devices
    • Ankle Foot Orthoses
    • subtalar control foot orthosis
  • Fitting of orthotics
    • Accommodative
    • sensomotoric
    • functional
  • Custom made shoes
  • Modifications to the footwear
    • Carbon fibre plates – to keep the shoe stiff to aid the gait
    • Internal or external wedges – to maximise alignment to the body from the feet up
    • Rocker soles – to support the person to roll through in their gait cycle
    • Hook and loop closures – easier than tying up laces especially when the hands have also been affected by the cerebral palsy
    • Sole and Heel flares – to improve balance in the footwear
  • Regular repairs to the footwear


Clare Nelson C Ped CM AU


When the client first came to Happy Feet Pedorthics she presented with very severe lymphoedema and was in the first stages of seeing allied health professionals to reduce the fluid. The client was receiving ongoing treatment from a physiotherapist/lymphoedema specialist and was maintaining the health of her feet with a podiatrist.


At the initial assessment the client walked in with the imitation crocs (which are softer and less supportive than the actual brand “crocs”) as she had not been able to wear any kind of shoe unless it was cut down at the dorsal surface to allow for the swelling in her feet. At Happy Feet Pedorthics we were able to fit her feet into some shoes. However the client was going through the Statewide Equipment Program (SWEP) for financial assistance and would have to wait a long time (currently up to 2 years) before supply if her application was successful. In that period the client managed to significantly reduce the severity of her lymphoedema.


Lymphoedema is the accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arms and/or legs. People with lymphoedema have full sensation of the limb, skin feeling tight, decreased flexibility and joints, and difficulty fitting clothes/shoes. Lymphoedema has a number of stages from mild to severe and can occur early or later in life.

Properly fitted depth shoes, or custom shoes dependent of severity, possibly with an accommodative orthoses to offload plantar pressure and compression therapy to help the movement of fluids were considered for this client by Happy Feet Pedorthics. Strap extensions and upper modifications to accommodate swelling in ankle and dorsal aspect of the foot were also a possibility. Additional inserts to add or remove as swelling changes over the day was also discussed as an easy way to have an adjustable fit.

Congratulations are in order for the client and the allied health team – with weight loss, podiatry care, and compression therapy there was a choice of prefabricated extra width and depth footwear with modifications, available to the client.


Being able to wear shoes again

“Being able to wear shoes again after not finding anything for approximately 3yrs was great. Finding shoes that fit properly and being comfortable and the proper size for my feet was heaven. Thanks to Clare and everyone at Happy Feet Pedorthics my feet were and continue to be very happy.” The Client

Clare Nelson

Virginia came looking at Happy Feet Pedorthics for shoes which would not hurt her feet. Following the assessment and fitting and trying the first pair in Happy Feet Pedorthics recommended list Virginia said “I don’t feel like an ugly duckling.” Her Mum said “she is walking more straight.”

Virginia has triple A syndrome . So what is triple A syndrome? Triple A syndrome is a rare disease but it’s prevalence is unknown. The link gives the reader some understanding of the condition.

Triple A syndrome is an inherited condition characterized by three specific features:

  • achalasia
  • Addison disease, and
  • alacrima

Achalasia is a disorder that affects the ability to move food through the esophagus, the tube that carries food from the throat to the stomach. It can lead to severe feeding difficulties and low blood sugar (hypoglycemia).

Addison disease, also known as primary adrenal insufficiency, is caused by abnormal function of the small hormone-producing glands on top of each kidney (adrenal glands). The main features of Addison disease include fatigue, loss of appetite, weight loss, low blood pressure, and darkening of the skin.

The third major feature of triple A syndrome is a reduced or absent ability to secrete tears (alacrima). Most people with triple A syndrome have all three of these features, although some have only two.

Many of the features of triple A syndrome are caused by dysfunction of the autonomic nervous system. This part of the nervous system controls involuntary body processes such as digestion, blood pressure, and body temperature. People with triple A syndrome often experience abnormal sweating, difficulty regulating blood pressure, unequal pupil size (anisocoria), and other signs and symptoms of autonomic nervous system dysfunction (dysautonomia).

People with this condition may have other neurological abnormalities, such as developmental delay, intellectual disability, speech problems (dysarthria), and a small head size (microcephaly). In addition, affected individuals commonly experience muscle weakness, movement problems, and nerve abnormalities in their extremities (peripheral neuropathy). Some develop optic atrophy, which is the degeneration (atrophy) of the nerves that carry information from the eyes to the brain. Many of the neurological symptoms of triple A syndrome worsen over time.

I don't feel like an ugly duckling

People with triple A syndrome frequently develop a thickening of the outer layer of skin (hyperkeratosis) on the palms of their hands and the soles of their feet. Other skin abnormalities may also be present in people with this condition.”

So for Virginia’s feet and the want for shoes which don’t hurt?

  • Callous under the great toes on the plantar surface of her feet
  • Her toes – red, rubbing, callous, sore
  • Ankle instability – Virginia wears has worn an ankle brace to give her more feeling of support. With her new shoes this may not be necessary

The recommended pedorthic footwear from Happy Feet Pedorthics will

  • have extra width and depth to accommodate
    • the 30 mm of height for her toes and orthotic at the toe box area
    • the ankle at the hindfoot to give more stability
    • custom made orthoses providing cushioning to the plantar surface of the feet
  • be modifiable to provide added comfort beyond the fit
    • release of leather sections to allow more give
    • extension and cushioning to straps to provide more comfort
  • provide an opportunity for a range of choices in the wardrobe

I don't feel like an ugly duckling

Happy feet at Happy Feet Pedorthics!