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Foot Orthoses and Dress Shoes

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Nov 30, 2005.

  1. Craig Payne

    Craig Payne Moderator


    Members do not see these Ads. Sign Up.
    ProLab Orthotics have an article on this in latest newsletter:
    How do you manage the orthotic patient with less than "optimal" footwear? Any tips?
  2. Felicity Prentice

    Felicity Prentice Active Member

    Having worked in a CBD practice where the patients worked in the type of jobs where high heeled court shoes were mandatory dress requirements, I have battled this phenomenon (along with, doubtless, legions of my colleagues). I find the court-style orthotic of some value, but I suspect there is a huge element of placebo involved, as I cannot really rationalise how a foot cramped in the high heeled and laterally squishedposition can really function at all!

    I have tended towards encouraging plenty of stretches of the posterior muscle groups, and the use of well constructed runners (preferably with orthoses) whenever the court shoes are not required (at home, weekends etc).

    It is interesting how many patients will opt to continue with killer footwear and then add surgery to reduce deformity. It's the whole body image thing, kind of bullemia of the feet really. Vanity and peer pressure is a powerful force indeed - about as strong as any aberrant biomechanical force that passes through the foot.


  3. PF 3

    PF 3 Active Member

    It's certainly easier than it was with the current trend of fashion trainers. I have found alot of my clients are happy to where these shoes to or from work. Most fashion trainers fit an orthoitc that would normally go in a runner quite nicely.

    Newalk have a new thong that I have been getting quite a few pt's to try instead of Havaiana's for those living in warmer climates. (Quite common in Sydney to see people wearing their thongs to and from work at the moment)
  4. I totally agree with you both. I think fashion will always dominate and we have to try and work within those limitations to get the best functional result, but also so the patient will be compliant. Always a challenge but I find most women are well aware that the shoes are the problem so happy to have the discussion.
  5. Now, after 28 years of beating my head against the wall, trying to get my female patients to wear shoes that actually don't deform their feet, I just now say, "I think you should keep wearing those shoes as much as possible....I still have a few more years of mortgage payments to make.";)
  6. I tend to the view that they are free to wear whatever they like! Its my job to tell them what will happen IF they keep wearing them, NOT to tell them not to wear them.

    In a similar style, I get annoyed with my dentist when he tells me off for sugar. Honestly the last time I needed a filling you'd have thought I'd poisoned his dog or slept with his wife at the very least! He was far more upset than I was and they're MY TEETH!! Thats creepy. Thats like tooth stalking. He has no right to become emotionally invested in my teeth just because he's fixed them a few times. My paying him gives him no propriatorial rights to whats inside my mouth. Its an absurd situation when I feel I have to lie to him about how often I floss to avoid being told off for not looking after myself better. THEY'RE MY TEETH!!!! If I want to roll into bed from time to time without doing the full 2 minutes brushing regime, thats my business!

    I mean when you take your car to the garage, you don't get the same thing there! They don't tell you that you should not use your brakes so heavily or to avoid wearing out your windscreen wipers. You don't get the heavily ironic, over the imaginary spectacles look and the "we've not been looking after ourselves have we sir" (why do dentists do the "we" thing, is he admitting to a similar laxity?!). No, they accept whatever abuse you've decided the vehicle deserves, patch it up, bill you, and send you on your way with a smile, a wave, and a secret hope that you'll keep taking speed bumps too fast so they can sting you for another set of suspension bushes in 12 months time. Good for them. My car, I shall clip the kirb if I like.

    If the patient is not too fussed then the clinician certainly shouldnt be. Same applies to food. We'd probably all live longer if we gave up bacon, but I for one have no intention of doing that. Without bacon (and whisky and pie and biltong and strawberry laces and candy floss and beer) it wouldn't be living longer, just dying slower.

    If I have a patient who does not want to quit wearing impractical shoes, provided they are aware of the risks, It worries me not an atom. Its their feet. They have a perfect right to shove them into whatever shape they like, and good luck to them. Why should I try to get them to do anything if they don't want too? That way lies madness. And concussion, and unsightly blood stains on the wall at head level.
  7. Long day. ;) Sorry, that rant got away from me a bit.
  8. alextsang

    alextsang Member

    Hi guys,

    Just wondering what orthosis modifications you guys make for people who wear dress shoes. Not necessarily woman's shoes but men's shoes like e.g. oxford shoes. Many of my patients wear dress shoes to work and as a result need a pair of orthosis that can fit into dress shoes but at the same time function as optimally as possible to correct their condition.

    Since many of these dress shoes are quite narrow at the midfoot. I find that particularly inverted orthoses (3-5 degrees) with deep heel cups have a very difficult time fitting into dress shoes. The width of the orthosis at the midfoot is usually wider than the width of the shoe and as a result the orthosis cannot fit entirely into the shoe. The heel cup however, normally fits fine.
    In all these cases the orthosis fits the shape of the foot perfectly.
    I'm wondering if there are any modifications I can make to the orthotic shell without compromising function too much (e.g. decreasing width of orthotic shell at midfoot).

    Or is it a case of recommending shoes with greater width?

  9. Phil Wells

    Phil Wells Active Member


    I would like to offer the following advice regarding orthoses and dress shoes.
    Simplify things by identifying the predominant plane of motion that is causing the tissues stress/pathomechanics.
    If this is in the frontal plane and you 'know' that large degrees of frontal plane posting are required then modify the footwear as well as providing the insole. For example a Brogue is usually very easy to have modified with a rearfoot wedge.
    The same goes for the sagittal plane with heel raises and rocker soles etc.
    The insole can then be used for fine tuning rather than being asked to do too much and compliance issues occurring.
    Regarding the insole design try mods such as making the heel cup flat and relying on the shoe heel counter to help with holding the foot onto the orthotic, making the heel an oval shape rather than round, get the heel pitch correct and making the final third of the shell more flexible to help with the pitch. Also 'scooping' in the arch at the midfoot works well but leave the top cover full width to stop sliding.
    There are a few others that can be done with CAD software as well but I won't bore you with the details.

  10. RobinP

    RobinP Well-Known Member

    Sound advice from Phil

    Not all orthoses need to be total contact and structurally rigid. It is the footwear/orthoses combination that is important. Does the shell need to come the full width of the foot the whole way down or can you apply force to reduce tissue stress to the important bit and leave the shoe to do the rest? With a solid brogue shoe or in a trainer with a nice stiff heel counter, I will often use a flat heel seat and allow the heel counter of the shoe to do the work.

    Also think about things like MOSI style adaptations to apply external supination moments across the sub talar joint to reduce the inverting post required. If nothing else, I always think it is important to bear in mind that walking around the office in your smart shoes is probably not going to create the same pathomechanics as running 5 miles, therefore the required tissue stress reduction is probably less and hence a lower profile, less "controlling" device may be sufficient
  11. Boots n all

    Boots n all Well-Known Member

    Two very sound bits of advise from Robin and Phil.

    There is also the other option, that is to have the shoe relasted at the mid foot, making it as wide as an extra 10mm in need be. Very difficult in womens fashion shoe but very do able for mens
  12. alextsang

    alextsang Member

    Thanks guys for the help, just to clarify Phil, what do you mean by scooping in the arch?


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