Ortopedia Elegante, S.A. de C.V.

Our custom-made fashionable lightweight orthopedic footwear by Old World Dutch craftsman fits and supports your feet perfectly: tradition, elegance and advanced technology

Ortopedia Elegante is located in Mexico's center of shoemaking León in the state of Guanajuato. We offer our services to the consumers who are looking for a solution for their foot problems, the physicians who are looking for a medical sound but elegant solution to solve their patient's foot problem, and to the orthopedic workshops who want to offer their clients their services within reasonable time.

In part I of this document we address to the consumer, in part II to the physician, and in part III you can meet our orthopedic shoemaker.

PART-I: Do your feet cause you more pain than pleasure and/or are your visits to regular shoe shops disappointing?

We offer the following products

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Custom-made and orthopedic shoes are individually made shoes on individual lasts.

There are many reasons why quite a number of people are not able to find shoes in the regular shoe shop that fit well. Diseases, accidents, congenital defects, but also a special foot size might create a reason to wear custom-made or orthopedic shoes.

Like all shoes, custom-made and orthopedic shoes are made on a last (a mould) too. Before the shoes can be made individual lasts are required. The dimensions of the lasts match exactly with the measurements of the feet. In addition to this it is important that the last has a character too, for example typically classic or casual.

Custom-made shoes are made for people with healthy feet of special size, like extra large, very narrow, small, or wide: a type of shoe that cannot be supplied by the regular shoe shop.

Orthopedic shoes however, are made if there is a foot problem caused by pain, important difference in size between left and right foot, congenital defects in proportion or stand of the foot, defects after accidents or operations, deformations caused by diseases etc.

If there is such a reason then it is our utmost concern, in addition to producing a pair of shoes for a comfortable and natural walk, that we deliver a pair of shoes that look normal .

Our goal is to camouflage the imperfections of your feet, for example if you have a small foot and a larger foot we will make the shoes of equal size without loosing the perfect fit. After all, you don't want your shoes to show that your feet are different. Therefore, when we are making your shoes, we take into account today's fashion and your preferences.

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Our footwear

Further more

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To give the right support and to avoid future complaints shoes should fit well

Shoes that fit perfectly offer the feet sufficient wiggle room and don't pinch, because pinching shoes cause different types of physical complaints. Think of hammer toes, corns, hallux valgus etc. Further more tight footwear behaves as a corselet. The consequence will be that the functionality of the foot muscles will be reduced, because step by step the muscles will be weakened. Spacious shoes cause less harm then tight fitting shoes. However, spacious shoes are not experienced as being comfortable, and their support to your feet is not sufficient.

If there is a physical disorder that effects the feet and the walking pattern negatively orthopedic shoes become a necessity.

Two examples: For people with rheuma walking is painful and difficult. The disease rheuma will deform the foot more and more, and the pain will increase. Especially with rheuma it is highly important that the person in question keeps on walking. Obviously all measures must be taken to create the right conditions.

A different example is diabetes. Because diabetes is a metabolic disease it takes more time for small wounds to heel. An other consequence is that the ability to detect external stimuli is being reduced considerably. A diabetic doesn't feel whether the shoe is pinching or slipping. Often the diabetic is not aware of a little stone in the shoe. In other words: the diabetic easily catches wounds without noticing a thing.

An awful consequence might be that the toes are to be amputated.

These are only two of the many examples for the necessity of perfectly fitting shoes and why in some cases these shoes have to be orthopedic.

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For every inconvenience with your shoes we will at your service.

Obviously not every symptom requires orthopedic shoes to make you walk comfortably, and for particular cases we will advise you to consult your podiatrist.

A much quicker and cheaper solution to many foot problems is individual inlays. You should think of: heel spurs, pain caused by overpressure of the feet, slight symptoms of hammertoes, differences in length of legs, flat feet that can be corrected, feet with too high arches, hallux rigidus and slight symptoms of hallux valgus.

Generally we can state that, by using our individual inlays, during walking the strong parts of the foot are used and the vulnerable, painful parts are spared. Because they have to fit in regular shoes we make them as thin as possible.

Solutions for other types of symptoms, like exostosis (increase of bone tissue) on instep or heel, are modifications to the shoe itself.

For some cases the symptoms are much more serious. These symptoms can be the result of a strong anomaly of the foot, a fixed position of the foot, loss of functionality of certain muscles, or partial amputation of the foot. In these cases orthopedic shoes can bring about the solution.

Individual inlays and artificial rolls underneath the shoe can solve certain knee problems too. Think for example of knock-knees, bow-legs or instability of the knees.

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You can choose from a variety of orthopedic footwear solutions.

We bear in mind all your wishes with regard to a beautiful and comfortable pair of shoes. Obviously the foot problems will impose particular limitations. Your individual inlays are produced in such a manner that they can be put in your readymade shoe.

To disguise difference in length of legs adaptations of less than 1 cm (less than half an inch) are made within the shoe itself. If the difference is larger then the adaptation is made both within and underneath the shoe. Obviously we will use lightweight materials.

There is a variety of options for shoes made individually. Provided that they are in accordance with the given symptom any model in any type of leather and color can be chosen. A further clarification about why an amputation that took away the larger part of the forefoot cannot be shoed by pumps won't be required. Neither why we cannot use rigid leather to shoe a foot with hammertoes.

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To obtain a product that matches the individual customer's feet and taste completely we take the following steps. For the first pair of shoes:

We must emphasize that the prototype is simply a testing shoe to check and correct the last. Afterwards it won't be needed anymore.

And for the next pair of shoes:

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To comply with the guidelines of your physician the following steps can be taken:

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For most cases we are sufficiently equipped to find an adequate solution to foot problems.

If you are coming from far away it's advisable to combine business with pleasure. Therefore, to know how much time is required to make your first pair of shoes, is very important to you. In case you don't know yet, the city León, shoe center of Mexico, is located in the state of Guanajuato, central Mexico, with its beautiful historical cities Guanajuato and San Miguel de Allende. Also should be mentioned a comfortable hacienda in the high mountains nearby León where golfing, fishing and horseback riding are a few of the many options for a pleasant pas-time.

To come to the point now we will explain the procedure to let you know how much time is required.

To be clear about the timing, the amount of time for your first pair of shoes is one week. Of course we are flexible to match your time schedule. Sundays are an option too to record all data.

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PART-II: Are you looking for the best solution for your patient's foot problems?

We offer the following products

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Custom-made and orthopedic shoes are individually made shoes on an individual lasts.

Custom-made footwear is for people with feet without defects but who find it extremely difficult to buy regular shoes because these shoes do not match the proportions of their feet. Their feet might be very narrow, very wide, very large or very small or there is a big difference in size between left and right foot. On the other hand, orthopedic footwear is used if there are serious foot problems that are a result of diseases, accidents deformations etc. This type of footwear corrects the walking pattern, compensates disorders, and disguises imperfections and differences between left and right.

Many times optical illusion is used in our designs, for example if the feet are extremely wide or small. By using optical tricks the shoe looks more like a regular one.

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Our footwear

Furthermore

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In this section a list is given of the most frequent symptoms and Ortopedia Elegante's solutions.

Patients who need adaptations for their shoes, who for particular reasons are not able to wear regular shoes, or who need that many adaptations to their shoes that orthopedic shoes are the only solution.

Often, for cosmetic reasons, a patient doesn't want to wear the right shoes. For these patients Ortopedia Elegante will find an esthetically and medically sound solution.

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Hammertoes: To avoid too much painful pressure against the upper part of the shoe sufficient space for the toes is required. If there is a possibility to stretch the hammertoes by a supporting adaptation of the metatarsal area, we will add it. However, cases where this option is not a possibility space has to be created. For the serious cases orthopedic shoes are the only correct solution. Obviously in all cases an inlay to support the foot must be made to avoid more sagging of the forefoot: often the cause of hammertoes.

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Pes planotransversus: we examine the anterior flatfoot on its possibilities for an appropriate correction, and we apply them and as much as can be tolerated by the foot. Bearing in mind "the larger the surface the lesser the pressure per square cm" we add an arch support to the inlay. Extra attention is given to painful extremities of the metatarsal bones by extra support and cushioning material.

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Heel spurs: Common practice is to add a soft inlay to cushion the heel. Our solution however is different. We support the medial arch to avoid sagging of the arch and prevent traction on the aponeurosis plantaris. In addition to this we determine the exact spot of the heel spur and we release the pressure by simply making a hole and fill it with cushion material. The heel is carrying weight in a normal way except its painful spot, which is floating.

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Pes valgus: As much as can be tolerated by the foot we correct the valgus-position by a proper arch support. For a child under the age of 6 the valgus-position will be corrected only if the impact on the knees is too much. If this is not the case we prefer to wait until the correction comes spontaneously around the age of 6 years, as it often does.

If valgus-correction is needed for a child we correct the position of the foot by stimulating right under its sustentaculum tali, in most cases in this way the foot reaches a permanent correction. This kind of correction is an active correction, passive correction gives support to prevent further sagging.

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Pes varus: If possible we realize an optimal correction of the varus position of the rear foot by giving pressure right behind and before the basis of the fifth metatarsal bone. It is very important that there is not too much arch support in order to allow the arch to come down, caused by the lateral correction. If necessary we make adjustments to prevent adduction of the forefoot together with pronation of the forefoot. With this three-point set-up we obtain an optimal correction for this type of foot.

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Pes equino varus: This kind of foot needs more measures and in most cases to obtain the best results orthopedic shoes are required. A perfect bedding of especially the lateral side of the foot, a strong stabilization of the calcaneus together with lateral shore, are the main characteristics of the shoe. Lateral shore should prevent further increase of the varisation and it should give stability while standing still.

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Amputations: You could say that partial amputations of the foot, depending of their size, demand orthopedic shoes.

If one or two toes had to be amputated an artificial roll together with a rigid sole might be sufficient. If the amputated area is larger one needs to wear orthopedic shoes to protect the remainder of the foot, to achieve a normal walking pattern, and to support the healthy foot.

If we have major amputations like Lisfranc of Chopart, there are two distinct options: a) flexible supplement and b) a rigid supplement with an artificial roll of the shoe.

Age, physical condition, and cosmetic aspects determine the choice. There will be special attention for the scar tissue and for the healthy foot. After all this foot will do the main part of the job, and we don't want it to get worse. For all cases the missing part of the foot is substituted by means of lightweight materials.

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Difference in length of legs: There are several options to compensate differences in length of legs. Smaller differences up to 1 cm usually are made within the shoe itself. If the difference is larger then the adaptation is made both within and underneath the shoe. To spare weight of the adaptations we reduce the height of the heel of the shoe for the longer leg. For the same reason we use lightweight materials. When the mutual length between the legs differs a lot, 10 cm and more, it becomes unavoidable to resolve it with orthopedic shoes. For these special cases carefully is investigated what should be the right position: a) the shorter leg can either be set in equinus position or b) both ankles are set in the same position. Both options have their own advantages and disadvantages. At this point careful consultation with the customer is prerequisite.

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Difference in size of feet: As a consequence of for instance poliomyelitis, feet can differ so much in size that custom-made shoes are required. In such cases we aim at making the shoes equal in length without loosing the fit in the heel and middle part of the foot. Because a last is a model of a foot we will have a short and a longer last. The missing length will be adjusted by adding lightweight material on the inlay or the lining.

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Spasticity: If spasticity is the question then our main concern is to position the feet in such a way that the spasm will be restrained, and that the functionality of the foot is optimal. By means of footwear we try to prevent that, as a consequence of the spasm, a pes equino is developed. Therefore it is important that the ankle is kept in a position as close as possible to 90 degrees, the ideal position to restrain the spasm. This can be achieved by fitting the ankle. Because there is a wide variety of materials the exact choice can be made to match the required rigidity.

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Instability of knee(s): If the instability of the knee in forward direction is the only symptom then a two-phase artificial roll is sufficient. However, often there is a complex of factors and orthopedic shoes have to made. For these cases the two-phase artificial rolls, together with the other adaptations, are made inside the shoe.

If there is a sideward instability we have to fit the ankles until halfway the calf in order to stabilize the knees.

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Rheumatoid arthritis: Contrary to the complexity of the rheuma syndrome and its defects, to give a summary of the characteristics of footwear to ease the pain is simple: a) a perfect fitting, b) a reduction of the pressure of the forefoot and hammertoes, and c) an artificial roll to prevent painful flexion of the ankle and to reduce pain on the overpressured extremities of the metatarsal bones.

For the very serious cases the patients might need two different pairs of shoes. One that provides optimal inactivity to ease the pain when rheuma is in a very active phase, and one that supports the functionality of the foot to the fullest when the activity of rheuma is low.

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Diabetes mellitus: The low ability of the body to heal wounds and the diminished sensibility are of a daily concern to the patient with diabetes. Therefore it is of the utmost importance that their shoes fit perfectly: pinching or slipping have dear consequences. Many times diabetes is the cause for unnoticed fractures that deform the foot seriously, and in some case the os naviculaire will puncture the medial arch. These wounds have a bad prognosis. It is our greatest concern that the pressure on this wound is removed. The wound floats in the shoe, as it were, so as to stimulate its healing. The typical Charcot-foot can be made completely inactive by means of a stiffened sole combined with an artificial roll. Obviously, good wound care is vital.

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Hallux valgus: Patients with the symptoms hallux valgus should not wear pointed footwear. By means of an orthesis, to be used during the night, in slight cases gradually the hallux can be brought back to its original position, by which further development of the hallux valgus can be slowed down. Patients with serious halluces valgi, that is inoperable, are able to walk without pain by wearing orthopedic shoes. Because in these cases the model of the last is very important special attention is given to this aspect.

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Hallux rigidus: Slight cases of hallux rigidus have sufficient relief by an artificial roll underneath the shoe, to "help" the foot over its rigid big toe, as it were. In serious cases, when there is increase of bone tissue at the dorsal side of the foot too, the solution is to wear orthopedic shoes. Main characteristics are sufficient space right above the hallux joint and underneath the tip of the big toe, together with an artificial roll.

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Pes calcaneus: Somebody with pes calcaneus tends to fall backwards, so this is the first aspect to be taken care of. Extending the heel of the shoe in its rear part can easily prevent this. When there is also active dorsoflexion, which cannot be controlled by the customer, a stiffened tongue is required.

To create a more attractive shoe we lower the heel of the foot into the heel of the shoe. In this manner at forefoot height the shoe can be kept more flat.

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Pes equinus: are shod in the most neutral position that can be tolerated by the foot. Because the forefoot carries all the weight it is crucial that we create a proper support for the forefoot. To make both shoes look equal the front part of the shoe for the pes equinus is lengthened, in order to have virtual equal lengths of the front part of the shoes.

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Metatarsalgia of Morton: The main complaint of this symptom is the pain in the forefoot one feels when the foot is pinched by the shoe. This pain originates in a sensory nerve that gets wedged between second and third or third and fourth metatarsal bone.

To relief the pain, we make an inlay. On this inlay we add a teardrop form heightening right between the two metatarsal bones. This heightening will spread them in order to prevent the nerve from being wedged in the shoe. Obviously it is important that the shoes have sufficient width, because without it the adaptation is useless.

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To obtain a product that complies with the medical and the esthetical demands we work according the following procedure.

In order to produce perfect fitting shoe we need a variety of data that is obtained by an examination of the feet and walking pattern, measurements taken from both feet, imprints in two dimensions and, if more data is required, in three dimensions too. Based on this data the lasts are made. Because every pair of feet is unique, the pair of lasts that is made for a customer is unique too.

Two important aspects can be found in the lasts a) the measurements and specifications taken from the foot, and b) the character of the last that is chosen by the customer (for example classical or casual).

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If you send your patients to us we follow the procedure as described in previous section.

If you prefer to act as the middleman we suggest the following procedure. For the first pair of shoes:

According to common guidelines, to be elaborated between you and us, all data required to make a custom-made product is collected by you: detailed description of the symptoms and walking pattern, measurements taken from both feet, imprints in two dimensions and, if more data is required, in three dimensions too. All written and two-dimensional data can be sent by fax or email. Obviously, sending a cast should be done by courier. Once we have received all data the following steps are taken:

And for the next pair of shoes:

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PART III: Do you want to meet our orthopedic shoemaker?

Toos Rook, the shoe-technician of Ortopedia Elegante SA de CV got her education and training in the Netherlands and is fully certified. The Dutch education for orthopedic shoe-technicians takes a minimum of 8 years and includes all the technical aspects of the profession, as well as an extended medical training.

She has more than 20 years of experience and during this time she worked in small and large sized Dutch companies. Her last position was as a trainer in a daughtercompany of the Otto Bock Group.

She masters all the skills of the profession and speaks next to Dutch (her mother tongue) English, Spanish and French.

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