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One lady aged 55 years, non diabetic had bilateral pronated feet with chronic foot pain. She had overstrained tibialis posterior. She was advised moulded sole to accommdate the deformity in neutral. Symptomatically she had good relief. Yesterday she had a long walk and developed ulcers over the dorsum of toes. I found she also has mild clawing of toes. No sensory deficit.
How to relive this?

 

Reduce the thickness of insole; deeper toe box; met dome on insole

 

Yep, agree, deeper toe box, thinner insole, met dome to help intrinsic muscle function more appropriate footwear.

 

If she is not diabetic,why is she getting ulcers?What is her medical history?

 

she is a diabetic

 

Silly As It May Sound Lower The Bottom Or Raise The Top . You Could Consider An Stj Implant Or Surgery. But Why If The Shoes Are Working .

 

make silicone props UNDER the toes. Mould them in the available space while the s/t is in neutral. Tuck it between 1/2 and 4/5. do not make them too big. They are also called 'silica orthodigita' in some literature.
I know this sounds crazy but it lets the overridden short plantar muscles that act on the mpj's to plantar flex the proximal phalanges on the metatarsals again and bring the toes down a touch.
Also check the tightness of the gastrocnemius and soleus muscles as this can lead to reverse origin to insertion extensor substitution in swing phase making the toes rub on the shoes.