What Is The Role Of Extra-Depth Therapeutic Shoes After Flexor Tenotomy? Optimize Recovery & Prevent Ulcers

Extra-depth therapeutic shoes serve as a specialized protective interface essential for post-surgical recovery. Their primary role is to provide increased internal volume to accommodate custom pressure-relieving insoles while physically eliminating friction from the shoe upper against vulnerable toes.

The core function of this footwear is to manage altered foot biomechanics following a tenotomy. By combining extra vertical space with custom orthotics, these shoes prevent "transfer lesions"—new pressure sores that can develop as weight-bearing patterns shift after surgery.

The Biomechanics of Protection

Accommodating Specialized Insoles

The most immediate function of extra-depth shoes is to act as a housing vessel for fully customized pressure-relieving insoles.

Standard footwear lacks the internal volume required to fit these orthotics without cramping the foot.

The therapeutic shoe provides the necessary vertical space to insert these consumables without compromising the fit.

Eliminating Dorsal Friction

Following a flexor tenotomy, the position of the toes changes, making them susceptible to new sources of irritation.

The structural design of extra-depth shoes ensures the "upper" (the top part of the shoe) sits higher above the foot.

This clearance eliminates rubbing and pressure against the tops of the toes, preventing friction blisters that could evolve into complex wounds.

Preventing Secondary Complications

Mitigating Transfer Lesions

A prophylactic flexor tenotomy alters the biomechanics of the foot to relieve specific pressure points.

However, this mechanical shift can inadvertently move high-pressure zones to other areas of the foot, leading to "transfer lesions."

Extra-depth shoes stabilize the foot environment to mitigate this risk, protecting the foot from the consequences of its own altered mechanics.

Facilitating Pressure Redistribution

While the shoe provides the space, the insoles inside perform the active work of load management.

The shoe-insole system redistributes weight from the toe tips across the entire plantar surface.

By increasing the weight-bearing surface area, the system reduces local peak pressure and physically interrupts the mechanism that causes ulcer formation.

Critical Considerations and Trade-offs

The Necessity of the System

It is vital to understand that the shoe itself is only half of the solution.

An extra-depth shoe without the customized insole may offer comfort, but it will not provide the necessary pressure redistribution.

The effectiveness of the protection relies entirely on the pairing of the shoe's volume with the insole's contours.

Volume Management Risks

While extra depth is beneficial, excessive volume without a proper insole can be detrimental.

If the foot has too much room to move, the resulting instability can cause shear forces (sliding) inside the shoe.

This makes professional fitting essential to ensure the volume is filled correctly by the foot and the orthotic.

Making the Right Choice for Your Patient

If your primary focus is ulcer prevention:

Ensure the shoe is fitted specifically to accommodate a fully customized insole that redistributes plantar pressure away from toe tips.

If your primary focus is preventing dorsal lesions:

Verify that the shoe provides sufficient vertical clearance so that the upper material never makes contact with the post-surgical toes.

If your primary focus is long-term biomechanical stability:

Monitor the patient for transfer lesions, as the shoe must protect against new pressure points created by the change in foot mechanics.

The ultimate goal is to create a friction-free environment where the shoe accommodates the cure rather than contributing to the injury.

Summary Table:

Feature	Clinical Role Post-Tenotomy	Patient Benefit
Increased Vertical Depth	Accommodates thick, custom pressure-relieving orthotics	Maximum comfort without foot cramping
High-Volume Toe Box	Eliminates friction between shoe upper and dorsal toes	Prevents friction blisters and skin breakdown
Pressure Redistribution	Shifts load from toe tips across the entire plantar surface	Reduces risk of primary and transfer ulcers
Biomechanical Stability	Manages altered weight-bearing patterns after surgery	Minimizes development of new pressure points

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References

Mateo López‐Moral, José Luis Lázaro‐Martínez. Safety and Efficacy of Several Versus Isolated Prophylactic Flexor Tenotomies in Diabetes Patients: A 1-Year Prospective Study. DOI: 10.3390/jcm11144093

This article is also based on technical information from 3515 Knowledge Base .