Introduction
There are multiple types of special footwear, depended on the potential to get injured, the injury or the deformity. People who have lost feeling in their feet as a result of nerve damage from leprosy or diabetes, are more prone to develop cuts or ulcers, as they are often unaware of objects inside the footwear or new foot injuries. Besides protective footwear with a thick outer sole, they need training in self-foot care. This training should focus on checking the feet and the inside of the footwear on a daily basis, and the practice of good skin and nail care. The people who already have injuries, ulcers or deformities, need custom-made and fit footwear or accommodative insoles that relief the pain, ease the pressure and improve walking.
For health workers it is important to recognize and select the appropriate footwear for an affected person. In some cases local, commercial footwear can be selected, whereas in the more difficult cases with unusually shaped toes/feet, custom-made insoles or footwear is required.
In remote areas, mobility is necessary to work in fields, walk to school/job or to collect water from the pump. NTDs can damage the feet, making walking painful and impossible. For the people in remote areas with a high prevalence of these NTDs, protective footwear is essential to reduce infections and injuries, and prevent deformity. Besides that, protective footwear means the difference between someone becoming self-sufficient or dropping further into poverty.
For which NTDs is this relevant?
Footwear is relevant to leprosy, Buruli ulcer, Guinea worm, soil-transmitted helminths, podoconiosis and lymphatic filariasis.
In May 2014, NLR and the Liliane Foundation started the project ‘These shoes are made for walking’ to address footwear problems. The aim of the project is to make orthopaedic means accessible for people who need these for proper walking. Within the next two years, young people from various Southeast Asian countries will join a new – internationally recognized – training program in Hanoi, Vietnam. They will be trained to become orthopaedic shoemakers. After their graduation, the students will be stimulated to work in their own countries. NLR and the Liliane Foundation will use their existing network to get them started. By working together with existing orthopaedic and rehabilitation centers in Vietnam, Indonesia, Myanmar, Laos and Cambodia, they will make a start with building a network of workplaces throughout Southeast Asia.
In December 2015, the first class of students has graduated successfully. The 13 students went through a rigorous study and training program for 18 months. In their final week they impressed the examination board and exam jury with their newly acquired knowledge and skills, their final presentations and their products: Shoes made for Walking for patients with a variety of foot deformities and walking problems.