Footwear with a DBS Brace
The DBS brace system itself has three integral components: the brace, the shoe, and the SACH heel, all of which must work together. See The Dynamic Bracing Solutions (DBS) System, Chapter 1. The use of proper shoes, especially during the training phase, is very important! The shoe, brace and SACH heel need to function as one solid unit! The sole of the shoe needs to be as flat as possible to allow the “ground reaction” forces to maximally support the knee and allow the wearer to feel that, when standing and moving forward, he/she is totally supported and stable. When the wearer becomes proficient in the techniques of walking with the DBS brace, the toe of the shoe can have slightly more curve upward (called the toe spring). To keep the shoe tight on the foot and decrease any wobble in the shoe, the shoe generally should either be a tie shoe or have an adjustable strap across the instep. It would be helpful if the tongue is padded and the insole is removable.
A closed heel shoe allows the SACH heel (the foam pad that goes under the heel of the brace) to stay in place and be transferred from shoe to shoe. If a person wants to wear open back shoes/sandals then the SACH heel may need to be attached to the brace or shoe so it will stay in the correct position and not slip out. A shoe with laces that go well down toward the toe allows you to open the shoe wide when putting on the brace. This allows you the most ability to control looseness and tightness of the shoe and at various places across your foot.
As fashions change the amount of curve of the sole frequently changes. In the past, the shoes that had the flattest soles were “court shoes,” or tennis shoes as used for playing tennis, or “boat shoes”. In the early 21st century the flattest shoes tend to be the “skateboard” shoes. All of these shoes are designed to give the wearer the maximum surface in contact with the ground – the tennis court, the deck of the boat, or the surface of the skateboard– for the maximum stability of the person wearing this shoe. This design trend is also desired for DBS brace wearers. An “earth shoe”, rocker bottom shoe, or a shoe with a pronounced upward curve of the toe usually does not work well with a DBS orthosis.
One way to check to see if a shoe meets this requirement is to take a ruler or other straight edge and place it on the shoe across the ball of the foot to test if the shoe is flat side to side and then along the length of the shoe (from heel to toe) and check how much distance there is between the flat edge and the sole of the shoe – see photos below.
The life of the shoe may not be as long as you think (hope) it might be, so be aware that excessive wear can occur with the upper part of the shoe as well as the sole. In order to work optimally, the shoe and brace must function as one solid, stable unit! Shoes can change in the support they provide after cleaning, exposure to water, or with wear. Some signs that the shoe has lost some of its integrity and support are: new pains when wearing the shoe/brace combination; “turning over” of the shoe upper portion; excessive wear on one side of the sole; or new inability to correct one’s gait.
One way to prolong the life of the shoe, if the back of the brace wears down the heel cup is to have an orthotist or shoe repair person make a leather liner for the cup of the heel. Or line it with duct tape.
A Shoe Revue was held at the DBS Camp to help people make the best choices in footwear. Click here for the PowerPoint presentation (in PDF format).
Guidelines for choosing shoes for DBS braces
This information is available in the DBS Wearer’s Handbook (see Resources, HGI Links, DBS Wearer’s Handbook).