As podiatrists, one of our biggest challenges is how we often have to compromise with our patients on which shoes we want them to wear and the shoes that they’re willing to wear. Our jobs would be so much easier if everyone wore joggers but no everyone wants to go for the Jerry Seinfeld look. Thankfully, some of our wonderful colleagues like Bared and Frankie 4 are making it easier to get our patients into supportive shoes whilst still allow us to get an orthotic in the shoe. But what are the orthotic prescription parameters we can modify to help get a better fit, particularly in ‘dress’ shoes (i.e. anything other than a jogger!).
Firstly we can consider the plasterwork, specifically the lateral plaster expansion. With a non-weight bearing cast/scan we’ll typically add a 5mm lateral plaster expansion which allows for the difference in fat pad expansion in weight bearing. In some ‘dress’ shoes, this may mean the heel cup of the orthotic pushes out the heel cup of the shoe, and the patient’s heel will slip straight out of the shoe when they start walking. By reducing this down to 3mm, you’d be surprised at what a difference this can make to the shoe fit. This request is one that is often overlooked but can make your life so much easier when it comes to the fitting appointment.
Secondly consider rearfoot posting. Will a full extrinsic rearfoot post fit in the shoe? Would a quarter post be an appropriate compromise? Asking for a quarter post as opposed to a full post can be another way to reduce the bulk of the orthotic in the shoe. Or could you do away with the rearfoot post completely? Asking for no post will mean we’ll put a flat grind on the bottom of the shell so stop it from rocking in the shoe.
The shell material should be the next consideration. We often make carbon fibre devices for ‘dress’ shoes. The thin and light nature of carbon fibre lends itself beautifully for this application. Few labs use real carbon fibre these days, instead favouring carbon composite materials which are not the same as carbon fibre. Carbon fibre can be really time consuming to work with and difficult to mould around heel cups, but with skilled technical staff, a beautiful orthotic can be delivered; and one which fits nicely across a range of dress shoes.
Going hand in hand with shell material is the shell shape. A narrow shell shape request will often be utilised for ‘dress’ shoes. Where space is at a real premium, the coathanger (otherwise known as the cobra) shell shape can be a life saver. Going hand in hand with the shell shape is the heel cup depth. For orthotics going into joggers, we typically see heel cup depths of 14-20mm. For dress shoes, we’ll typically see requests of 6-10mm.
The final consideration is the top cover. We usually advise against really cushioned top covers (including a poron cushion layer) and favour thin covers like leather (which is genuine calf leather), vita (a synthetic leather) or vinyl.
All of these orthotic prescription variables can make your life easier when it comes to fitting orthotics to ‘dress’ shoes. In some patients you may not be able to make these compromises and you may have to stick to a more supportive orthotic. However, where it’s clinically indicated, some of these variables will mean your patient has more options when it comes to footwear choices to get your orthotic in.