Healthy shoes – a long way to go

In 1900, there were around 10,000 cobblers in Vienna

The history of the shoe is as old as the history of mankind. We have always tried to protect our feet from the harshness of the environment. In ancient times, however, only sandals were known. Closed shoes and boots were only invented much later. Still, this is the cradle of the orthopaedic shoe. There is evidence that even the Romans inserted cork structures into their sandals to make up for various deficiencies.

The birth of the modern orthopaedic shoemaker's trade wasn't until much later, however.

As all too often, it was a war that lead to the development of new techniques. During World War I, an orthopaedic ward was installed in the Hofburg. Here, doctors were able to take care of the wounded together with orthopaedics and shoemakers. It was from this "national protheses-factory" that numerous specialist shops emerged later, since all of its master craftsmen set up their own shop after the war.

In the beginning, it was mostly war victims that had to be taken care of-- because those who need a prothesis also need a shoe to fit. But soon other fields of application were found for this special knowledge. In the case of foreshortened legs or polio, for example, the oprthopaedic shoemakers were able to make life easier for the affected persons.

During and just after World War I, most protheses were made from wood, and the fitting shoe crafted later.

In the case of a foreshortened leg or deformations of the foot, special shoes were made. The remedy for foreshortened legs was predominantly a heightening of the heel and soles. Since surgery was not an option in either case, the soles often got up to 20 cm thick (interesting examples of this can be found in the shoe museum in Vienna). The necessary height of the soles was determined either by a regular measuring tape or simply by trial and error. The only materials available for the soles at that time were cork and rubber cork. The leather shoes were then crafted around this core. If there was a deformation of the foot in addition to the foreshortening, or if there was only a deformation, a cast mould would be taken first. Based on this mould, either the lasts or a sample shoe could be made. After several fittings, the shoe itself would be manufactured.

In World War II, around 400,000 people were injured. It's impossible to say today how many of them needed orthopaedic shoes. However, since land mines were used quite frequently even back then, it was probably a fairly high percentage.

The trade adjusted to the new requirements. If until the 1950s any cobbler who felt like it could manufacture orthopaedic shoes, the professional training was standarised after that. In the beginning, a cobbler had to take an additional examination. Later on, orthopaedic shoemaking became its own skilled profession with its own master diplomas. Not only was it reassuring for customers to be in well-qualified hands, but it was also financially easier that way. After the professional diplomas were introduced, orthopaedic shoes were covered by the health insurance (before, it was not so simple: individual applications had to be filed, which were sometimes granted, sometimes not).

It is also interesting how the shoemaker's trade in general developed: Around 1900, there were approximately 10,000 shoemakers in Vienna, 1945 there were 5,000 and today there are only 230. Only 20 of these are orthopaedic shoemakers. All over Austria, there are only 199 expert orthopaedic businesses.

Naturally, the problems that our profession are confronted with have changed over time. In our peaceful times there aren't as many war victims to take care of anymore, but accidents and an unhealthy lifestyle contribute to the orthopaedic shoemakers' massive workload. Foreshortened legs are extremely rare today, since they can often be surgically corrected. Polio has been almost eradicated thanks to the vaccination. These days, the specialists are occupied with the consequences of accidents, diabetes, or strokes. Because of the good cooperation between orthopaedics, health insurances, and shoemakers, many people get the shoes that are necessary and right for them.

There are also many people that are constantly "up and about". Many of them recognise that taking good care of their feet today will can be important for them in the future. Waiters, police officers, nurses, or postal workers are only a few of the affected professional groups. If small problems are corrected early, it can save a lot of hassle and pain later on.

Much has changed during the last hundred years also in terms of the materials used. If in the old times only leather and cork were available, today's specialists have a whole range of synthetic materials to choose from. Of course, leather and cork were rather hard and brittle. The types of leather available today are much softer and synthetic materials have additional qualities (e.g., resilience) to better solve present-day problems. Which is not to say that leather is outdated. It's the specialist's task to find the best material for each patient-- which is not always easy considering the wide variety of materials.

As we have seen, the profession of the orthopaedic shoemaker demands not only good craftsmanship but also a lot of medical knowledge and intuitive feeling. Only an established qualification can guarantee an individual solution for each patient-- insoles from the supermarket are certainly not the answer.