Early loss of the second primary molar prior to the eruption of the first permanent molar can lead to space loss in the pediatric patient. Patients who don't utilize space maintenance can have an average of "2.12 mm of space lost at six months, and 4.02 mm at 12 months" (Alnahwi, 2015). The Distal Shoe Space Maintainer is indicated to avoid space loss. The Distal Shoe if improperly placed, or without routine follow-up, can lead to problems with the eruption of the permanent second premolars. Such was the issue with the following case. A nine-year-ten-month-old male presented to the UNLV dental clinic with the chief concern of "We haven't seen our dentist since before Covid - Guardian ". This case is a good example of the disadvantages of using a distal shoe in the primary dentition as seen where the appliances were impeding the eruption of 29, and 20. Practitioners can use this information to make better decisions when they encounter early loss of primary second molars. Specifically, improper placement or design can lead to more patient issues.