Need help with Footwear for Narrow Heel, Wide Fore Foot & Orthoses

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Hi Everyone

I need some advice for a couple of patients of mine.
I'm a rural podiatrist & while I keep up with new footwear it is sometimes hard to actually physically see & hold new footwear.

I have been making my own orthotics and fitting them for quite a number of years and have learnt to adjust things for different types of shoes.

Recently I have had 2 patients come to the clinic with existing orthotics from other podiatrists. The cases are very similar so I will discuss this as a single case.

The orthotics have been comfortable and fit in their footwear. However the patient felt the orthotic was worn out (had them for 10 years) and that they needed new devices with more control. They also complained that when they'd been trying to replace their work shoes (slip on court/dress shoe) they couldn't find a single pair across 8 shops that didn't slip up and down at the heel and cause them to slip out of the shoe. They could find one or two pairs of shoes if they didn't put their orthotic in but were still having quite a problem.

I've come across this problem quite a bit so wasn't concerned. Their orthotics did need replacing as they were experiencing a lot of midfoot pronation and 1st MPJ pain resulting in increased HAV. The existing footwear was quite stretched and sloppy across the midfoot area.

Examination revealed mild calcaneal eversion (about 4 deg) and significant midfoot pronation/collapse. The foot shape when corrected has a narrow heel and midfoot with a wider forefoot. The arch is quite high when in its corrected position (about 3cm under the navicular to ground). The patient needs to wear dress shoes (low heel) and often skirts for work so lace ups are not really a realistic option.

I have tried narrow devices and fashion devices and even temporary additions to in shoe arch supports and off the shelf devices - every time I correct these feet to their best functional position (or obtain a partial correction) the patient slips out of every pair of shoes. Even those shoes that have a strap around the ankle still slip up and down at the heel and gape through the midfoot. I have checked and changed the width of the orthotic at heel and midfoot, I have changed the depth of the heel cup and slimmed everything as much as possible but most of the problem "appears to me" to be the height of the arch and narrowness of the foot across the midfoot.

I have discussed this with some of the specialist footwear stores and all they've told me is that they are having a big problem with narrow heel, wide fore foot feet and footwear - some of them said they're actually adjusting the shoe by filling in the heel space with EVA after the patient has bought the shoes.

I have a good relationship with the local stores who supply Kumfs, Naot, Rockport etc and who are quite happy to get shoes in but I need to give them something to order. I thought that maybe a "Munro" shoe may be a better fit for such a narrow foot but I can only get them in Brisbane and the patient won't be going to Brisbane for another 3 months.

Does anyone have any other ideas re footwear (other than laceups ) - please keep in mind this is Queensland and patients need to wear these shoes all year round - even when hot.

Please let me know if I overlooked anything basic too

Cheers
RStone

 

l would love to see a picture of the Orthosis as most of the Brands are 75mm deep at the heel and should accommodate your needs.

2 ideas for you.
Go to the Kumfs website and select another style that your store may not stock? the same can be said for most of the brands that you have listed.

OR

Talk to Ernie, he should be able to help you, tell him l said he would he has a couple of location that he works from

Ernest Tye
Brisbane Footwear Services
128 Logan Road
Woolloongabba QLD 4102
Telephone (07) 3391 2066
Email ernie@tyes.com.au

 

Thanks David

It's not the depth of the heel - but the width of the heel. The pt's heel when WB is only 4.8cm wide and she's got about 3-5mm room medially and laterally at the heel when in any of the Kumfs style (definitely not a snug fit).

The problem with the other shoes is the depth (or lack of) through the midfoot as well as the width across the midfoot. The patient's foot has a 3cm gap under the navicular when in a corrected position and her foot is only 5.7cm across the midfoot area so she ends up with 3-6mm gap in the shoe in this area when in a correct position. The problem isn't so bad without orthotics simply because her foot pronates through the midfoot so much that it is about 1-1.5cm wider and 2.5 cm closer to the ground so it takes up more room and sits lower in a shoe in the midfoot region.

The patient isn't keen but I may have to get some new shoes adjusted - ie length of straps, some filler around heel - or at least get Ernie to have a look at options for mem. I was just trying to avoid having the patient spend $200 on a pair of shoes only to have them spend more on getting them adjusted just to be about to wear them :wacko:

By the way - in absence of photo - the orthotics are 2mm thick at heel, 4.5cm across heel cup (virtually no heel cup - almost a fashion/hook slim device but not quite - I haven't actually cut out the hook), wtih a 1/4 heel post for stabilty, 27 mm arch - 4 mm polyprop 3/4 shell with Vita Topcover, no forefoot extensions.

Cheers
RStone

 

Have you tried doing the same using some felt??
This would be similar to heel grips, but extend them further around the heel so that the inside of the shoe is effectively narrower. If this works you could do the same with EVA or poron then cover with leather or similar- this is not a difficult modification- you should not need to use a specialist shoemaker to do it. At the very least this would show you whether the modification would work before a more permanent mod.