Hi Everyone
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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 :D
Cheers
RStone
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