Shoes & shoe lacing
If your child has hemiplegia, it is important that they have footwear that is not only practical and comfortable but will help keep the affected foot in the best position when walking.
Unfortunately, finding suitable footwear is one of the most common problems faced by both parents and carers of children with hemiplegia, and by adults with the condition. You can talk to your child's physio about any issues they're having finding appropriate footwear.
Different sized shoes
The most common problem is that the child needs two differently sized shoes. Sometimes the affected foot is smaller, or the child may wear a splint, which requires a longer and wider shoe. Either way you need differently sized shoes, so you have either to find someone who will sell a pair of odd shoes or buy two pairs and hope for a discount. Insoles are another option.
Children with hemiplegia should have orthopaedic shoes/boots, for example Piedros. Piedros are prescribed and fitted for free on the NHS. Often parents are refused this service, but it is worth persisting if you can get support from your physio. Once their child has stopped growing, some parents have had an expensive cast (mould) made of their feet and then had shoes made to measure. These should be rather more comfortable and the cost can be little more than buying two ordinary pairs.
If one leg is shorter than the other, the shoe on that side can be given a raise. These can either be stuck on the sole/heel by the orthotist or fitted inside the shoe. These inner ones are removable and so can be put into different shoes, but they can mean the shoe is not deep enough for the foot and the heel comes out. You can often get around this by dressing your child in boots, but this is not ideal in hot weather, so it's often a case of finding the right shoe.
Another problem is fastening shoes with one hand. Fortunately, many shoes for both children and adults now come with Velcro fastenings, and many orthotists will also replace existing fastenings with Velcro. A few parents, however, have mentioned that this can look rather strange unless it is well done.
Piedro boots and other special shoes, which many children obtain through their physiotherapists, can be ordered with Velcro fastenings, and straps on shoes, slip-ons and sandals can be extended with elastic and Velcro to fit over splints.
Bear in mind, however, that as your child grows they might want to choose from a wider range of footwear. Sooner or later you need to tackle the shoelace problem head-on!
These stretchy, 'curly' laces, which come in a range of colours, are the best solution for many children. You put on the shoe, pull them tight and they stay tight without actually being tied. The shoelaces have no pressure points and allow natural movement.
Greepers (www.greeper.com) are another clever kind of shoelace that doesn't need tying and untying, but is tightened/loosened by pulling on tabs. If you go to the website you will be directed to a video on YouTube showing how they work.
Nottingham Rehab www.nrs-uk.co.uk sell elastic shoe laces, in brown or black, that convert lace-up shoes to slip-ons.
If your child finds it difficult to learn to tie laces, it is worth experimenting with different types. Some children find flat laces easier than round ones, some find round ones easier. In general, the thicker the lace, the easier it is to tie.
Four methods for tying laces with one hand
If your child can only use one hand or finds it difficult to reach their feet, there are several ways of tying laces single-handed. We list four such methods below, with diagrams.
You may find your child needs a longer lace than the type supplied. But it is not necessary to use a conventional lace: strong string or stool cord is just as efficient if a lace of the right length is not available.
The numbers indicate the direction in which the lace should be threaded. For all these methods, only one end of the lace is threaded down or up the shoe and then tied. The other end is secured in position with a knot.
Secure the knotted end at 1. Thread the other end down 2, up 3 and so on to 8. Thread 8 up through 2 to tighten lace. Work up from the toe and pull at 2. Make a loop in the end, pass under 1, 2 and pull tight. NB: Run lace underneath and come up to 2.
This is A in reverse. You lace from the top towards the toe. Pull the lace back up through 2 and secure as shown in diagram.
This is the simplest method. Lace up from the toe and secure as shown in diagram.
Hook method. Start by attaching a ring to the unknotted end of the lace. Lace in the direction of the numbers and fix by hooking the ring attached to the end of the lace on to one of the ski-boot hooks. To loosen, unhook the lace. If the boot has an ordinary eyelet at the bottom the fixing knot can be threaded through this.
Some open-to-toe boots have holes in the base of the tongue and the lace can be fastened through these. This holds up the tongue and keeps the knot on the surface where it cannot rub the toes.
Where to buy shoes
In general, you'll usually find the bigger brands (Clarks, Ecco, Geox, Hush Puppies and Startrite) cater well enough. Wynsors, Clifford James and Brantano are other options. Some firms have factory outlets with good discounts. Clarks runs an odd shoe scheme for children with different sized feet.
People with hemiplegia often cite trainers as the easiest footwear for both children and adults, since they are designed to support the foot and often have insoles that can be removed (if necessary by force) to accommodate an AFO. Many of them have Velcro fastenings.
You can ask your child's school to allow them to wear trainers for PE rather than plimsolls, which allow the foot to roll over. Some black trainers you can pass off as shoes if your child needs to look more formal.
And if you do buy two pairs of trainers of different sizes, make sure both trainers have the same height soles, as the bigger the trainer the higher the sole height.
If you are concerned about shoes being properly fitted, the Children's Foot Health Register http://www.fitkidsshoes.org/ is a list of Centres of Excellence for Children's Shoe Fitting in the UK, which you can download from their site.
The Disabled Living Foundation has information on finding suitable footwear at https://www.dlf.org.uk/factsheets/footwear