Orthopedic shoe fastenings

The way in which an orthopedic, comfort, diabetic, therapeutic, or orthotic shoe tightens around the foot is very important to foot health.

The fastening mechanism that secures the shoe in a comfortable but secure way around the foot is a critical feature of any good orthopedic shoe. Shoes with poor fastenings can be uncomfortable, and even painful to wear, and they can restrict circulation and cause sores and blisters.

How the shoe fastens

There are two important parts of an orthopedic shoe's fastening system.

• The first is the collar. This is the open part of the shoe that is drawn together, by laces, buckles, or a “hook and loop” locking mechanism like Velcro. A good collar should be long and flexible and will allow the tightness of the collar to be adjusted along its length rather than just at the top.

• The second is the tongue. This is the floating and highly padded piece of material that sits under the collar and spreads the pressure of the tightened collar across the top surface of the shoe and down through the rest of the vamp.
• For the collar and tongue to work properly, the tongue must have sufficient length, strength and cushioning to prevent the strain of the collar from being applied only to the top of the foot. The shoe should also be constructed in such a way that the tongue maintains its position directly and centrally under the collar and does not slip or slide down to one side (as is often the case with poor quality shoes).

Orthopedic shoe fastening mechanisms

The three most popular ways to fasten a shoe are by using laces, buckles or a hook and loop system, the most popular being Velcro.

Each of these systems has different advantages and disadvantages along with different appearances.

Buckles are rarely found on orthopedic shoes. They have a limited degree of tension variation and are poor at spreading "tightening" pressure across the tongue.

Laces are the most conventional way of tightening a shoe, and adjusting the tightness of a shoe. The problem with laces though is that unless they are continually adjusted, they have a tendency to bite at the top of the collar and loosen at the base of the collar. If they are checked and corrected, then this need not be a problem and if the tongue works in unison with the collar the load should be spread evenly. Laces can also be adjusted quickly and they can be easily replaced.

Hook and loop fastenings like Velcro have become very popular in the manufacture of all forms of orthopedic, diabetic, therapeutic, comfort, and orthotic shoes over recent years. These "stretch and press" fasteners are easy to use, very secure and allow easy adjustment in seconds. By having two, three, or even four Velcro fasteners per shoe, this kind of system can offer maximum flexibility and an equivalent level of comfort. They also avoid any localised high pressure point by using large surface areas to spread the pressure and allow different levels of tightness along the length of the collar. They also have the added advantage of offering a modern and chunky shoe fashion look.