Shoes After a Stroke and for an AFO Brace: Volume, One-Handed Fastening, Two Different Feet

After a stroke, a shoe has several jobs at once: support a weak foot, take an ankle-foot orthosis, go on and fasten with one hand and stay out of the way of each step. A ready-made pair usually manages one of these. The two feet also tend to differ in volume after a stroke, so shoes made identical for both fit only one of them. The brace, exercises and activity level are prescribed by the doctor and rehabilitation specialist; the shoes are made to follow their recommendations.

This article is for general information. The workshop does not diagnose or replace a doctor: diagnosis, treatment and any correction are decided by a medical specialist. Bespoke shoes are made to follow a doctor’s recommendations.

How the foot changes after a stroke

A stroke often weakens one side of the body, and on the foot this shows in different ways. The muscles that lift the toes may weaken, so the foot drops during the step. Raised muscle tone can curl the toes and turn the foot inwards. Sensation may drop, and the affected side often swells.

A British observational study from 2023 examined 30 people living at home after a stroke. Every participant had foot problems: 93% could not do a single-leg heel raise, 77% had reduced range of motion and 47% had reduced sensation. Half had foot pain and hallux valgus, and 40% had swelling.

All of this feeds directly into the choice of shoes. A swollen foot no longer fits the old pair. A dropped foot catches the floor with the toe, and a foot with reduced sensation does not feel that a shoe is rubbing.

Why footwear after a stroke is a safety question

In the same 2023 study most participants wore slippers at home. More than half of the indoor shoes gave no support and fitted poorly, and 47% of the outdoor shoes fitted poorly too.

The authors linked foot problems with lower balance confidence, activity and participation. Among people who had fallen, 13 of 16 reported foot problems; among those who had not fallen, 4 of 14.

A 2016 survey of 145 people after a stroke and 218 people with Parkinson’s disease showed a similar picture: most wore slippers indoors, 43% of the stroke group reported foot problems, and half of all respondents reported falls.

Studies like these do not prove cause and effect. They do show that footwear deserves to be discussed with the doctor and rehabilitation specialist alongside the exercises.

What people after a stroke say themselves

A 2020 study interviewed 15 people after a stroke. Their main priorities in choosing shoes were comfort, a secure fit on the foot and ease of putting the shoes on.

Participants said these needs clash with appearance: a comfortable pair often looks like hospital footwear, and nobody wants to wear it. Finding shoes that take a brace or a swollen foot was named as a separate difficulty.

Many said they had received almost no footwear advice from professionals, and their experience in shops varied widely. The authors suggest including a footwear assessment in rehabilitation and referring people to a podiatrist.

Foot drop: what a pair has to do

With foot drop, the toe does not lift while the leg swings forward, and it catches the floor, a rug or a threshold. To avoid that, many people lift the leg higher or swing it out to the side, and walking becomes tiring.

Shoes do not replace a brace if one has been prescribed, but they can help. A raised toe spring on the sole makes catching less likely. A sole with moderate grip at the toe glides over carpet, while a patterned heel holds on tiles.

A light pair pulls the leg down less. For a weak foot every hundred grams in the air is noticeable, so the sole and upper are chosen as light as possible without losing support.

An ankle-foot orthosis: how much room it takes

An ankle-foot orthosis, or AFO, is a plastic or carbon splint that wraps the heel, runs under the foot and rises up the back of the calf. It is prescribed by a doctor and made by an orthotist.

The brace takes up room at the heel, under the arch, along the sides of the foot and sometimes under the toes. With the brace the foot becomes longer, wider and higher, especially at the back, and it does not go into an ordinary pair of the usual size.

Buyers respond by taking shoes one or two sizes larger. For the braced foot that sometimes works on volume, but the other, healthy foot ends up in a pair that is too big and slides around inside it.

Two feet of different sizes

After a stroke the feet often drift apart in size even without a brace: the affected foot swells, or over time becomes thinner as the muscles weaken. With a brace the difference grows further.

Ready-made shoes are sold as a pair of one size. You have to choose which foot will be uncomfortable, or buy two pairs in different sizes.

For a bespoke pair a separate last is made for each foot. One is built around the foot in its brace, the other around the healthy foot, and from outside the pair looks matched: the difference is hidden inside, in the volume of the heel, instep and toe.

Fastening with one hand

If the hand on the affected side is weak, tying laces is impossible and pulling on a narrow boot is hard. The fastening is chosen around how the person actually puts shoes on.

Hook-and-loop straps with a wide loop close with one hand. A side zip with a large puller and a ring opens the boot wide, and a braced foot goes in without effort.

Elastic laces turn a lace-up boot into a pair that never needs tying. An upper that opens almost to the toe makes it easier to put on when the foot does not straighten fully.

At the measuring appointment you will be asked how you put your shoes on: sitting or standing, with help or without, with which hand. This decides which side the zip goes on and where the strap runs.

Heel counter, sole and heel

A firm heel counter holds the heel with or without the brace. When the foot tends to roll, it keeps it from tipping over. It does not collapse as you put the shoe on, so the boot goes on easily with a shoehorn.

The sole is wide, with a stable heel and a slip-resistant pattern. The heel is low, around two centimetres, and bevelled at the back so the heel meets the floor gently at each step.

The insole is removable. If the brace is sometimes taken off, a thicker insole goes in instead, and the pair still fits.

Swelling and reduced sensation

On the affected side the foot often swells towards evening. The last is built with extra volume at the instep, and an adjustable fastening can be loosened without taking the shoe off.

If sensation is reduced, a person does not notice that a shoe is rubbing. Inside the pair rough seams are removed, the lining is soft leather, and the edges of the pattern pieces stay clear of prominent bones.

Check the foot every evening. Redness that stays after the shoe is off is a reason to show the pair to the shoemaker and the foot to a doctor.

Outdoor and indoor shoes

Both studies, from 2016 and 2023, found that most people wear slippers at home after a stroke. The 2023 authors write that people after a stroke need support in choosing comfortable, well-fitting footwear both outdoors and indoors. At home people also get up at night, walk on tiles and climb stairs.

The workshop makes outdoor footwear: boots, low shoes and dress shoes. The lasts stay in the workshop, so all of one person’s pairs fit the same way.

If the brace is worn only outdoors, that is planned from the start: the outdoor pair is built for the brace, and the volume is reduced for a second pair.

What a pair for a brace can look like

The most common complaint about orthopaedic shoes is how they look. People after a stroke often refuse to wear the prescribed pair because it looks clinical.

On your own last it is possible to make boots or shoes that look like ordinary men’s or women’s footwear: smooth leather, a neat toe, a familiar colour. The room for the brace is hidden in the height of the heel counter and the instep, while the toe stays neat.

If you have a favourite pair that stopped fitting after the stroke, you can bring it as a model.

Walking with a cane or walker

Many people walk with a cane or a walker after a stroke. Support in the hand changes the gait: weight moves unevenly, the healthy leg works harder, and that foot tires too.

That is why the healthy foot needs a pair just as stable as the affected one. A wide heel, a firm counter and a slip-resistant sole matter on both sides.

If you walk with a cane, bring it to the fitting. The shoemaker will see how you place the foot with support and take it into account in the sole and heel.

Raised tone and curled toes

With spasticity the toes curl and the foot turns inwards and down. Curled toes press up into the toe box, and the joints get rubbed.

For such a foot the toe of the last is made higher, so the toes have room even when curled. The upper over the toes is soft leather without a stiff toe puff, or with a raised one.

Muscle tone is treated by a neurologist. If they have prescribed a brace that straightens the toes, the pair is built around it.

How the work is done

Sergey Grechushkin makes the lasts himself. Both feet are measured: the healthy one separately, the affected one in the brace and without it if the brace comes off. Bring the brace to the measuring appointment.

The lasts take about six weeks. The fit is checked on a demo pair, a trial shoe: how the brace goes in, how the pair fastens with one hand and whether the toe catches the floor.

The first pair takes about ten weeks. A pair starts from 100,000 ₽. Further pairs on the existing lasts take from four weeks.

The workshop is on Shelaputinsky Lane 6/3 near Taganskaya metro in Moscow and works 10:00–20:00 by appointment only. If getting to the appointment is hard, say so in advance and we will set a time with no waiting. Family members are welcome at the measuring and the fitting.

When the pair needs changing

Rehabilitation changes the foot. Swelling goes down, tone falls or rises, the brace is replaced or removed altogether. A pair made six months ago may become too big or too tight.

If the rehabilitation specialist changes the brace, show the new one to the shoemaker. Sometimes a new insole is enough; sometimes the last is corrected to new measurements.

Check sole wear regularly. A dropped foot wears the toe, rolling wears the outer edge, and heavy wear changes the fit. The sole and heel tip can be replaced in the workshop.

When to see a doctor

Prescribing a brace, exercises and the level of activity is the job of the neurologist, rehabilitation specialist and orthopaedist. Shoes are made to their recommendations and with the prescribed brace.

A sudden increase in weakness, new pain, fast-growing swelling in one leg, darkening skin or a wound on the foot are reasons to see a doctor urgently.

If you are not sure whether you need a brace, ask your rehabilitation specialist before ordering shoes: the volume of the pair depends on that decision.