A Closer Look At Orthotic Solutions For Women’s Dress Shoes

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Author(s): 
Alona Kashanian, DPM

Given the challenges of prescribing orthoses in women’s dress shoes, this author addresses biomechanical considerations, device modifications and the five most common mistakes in writing orthotic prescriptions for this growing patient population.

   Terror strikes the hearts of many practitioners when a woman walks into their office with a bag full of dress flats, wedges and pumps. Regardless of gender, the podiatric physician cringes at the thought of dealing with a “shoe” issue rather than a pathological or symptomatic foot.

   The practitioner should not shy away from the professional and educated woman with expensive taste in shoes. The podiatric physician can follow some important yet practical suggestions about fabricating and dispensing custom functional foot orthotics. The patient can use a fashionable woman’s shoe and still receive treatment for her foot and ankle pathology.

   There are a few guidelines to ensure effective outcomes with orthotic therapy as well as adherence in daily wear by the female patient. When treating the female pathologic foot with custom orthotic therapy, one must take into account the variety of functional and fashionable shoes, the biomechanical evaluation, the specific orthotic materials and the unique orthotic modifications.

   The female patient looks to her practitioner for guidance and education about both athletic and dress shoes. The patient needs to understand that the orthotic/ shoe interface plays a significant role in her clinical outcome. It is the podiatric physician’s duty to help these patients make appropriate footwear choices as well as educate them about functional yet fashionable dress shoes.

   The dress shoe can be categorized from the most functional and stable to the least stable. The criteria for categorizing a dress shoe are very similar to the athletic shoe. A stiff heel counter holds the heel in a stable position and allows a functional foot orthosis to increase the stability of the rearfoot. A good test is to squeeze the heel counter of the shoe and make sure it is firm.

   Midshoe stability allows for the midfoot to be held in a rigid position and prevents excessive side-to-side torque at the midtarsal joint. A good test is when a shoe does not bend like a pretzel side to side. Employing a removable insole in a dress shoe allows flexibility with orthotic fit and prevents the patient from having to increase her shoe size.

   The loafer or flat dress shoe represents the most stable shoe with a stiff heel counter and stiff upper. The functional loafer or flat dress shoe comes with a removable insole to allow the custom functional foot orthotic to fit properly without changing the shoe size.

   The ½-inch to 1-inch heeled shoe represents the lesser of the functional shoe yet still incorporates a stable heel counter and a less rigid shoe upper.

   The 1½-inch pump and wedge shoe represents the least stable and functional shoe. The pump-heeled shoe does not have a stable heel counter or a removable insole.

   The female patient needs to understand that the outcome of orthotic therapy will depend on both the orthotic device as well as the proper dress shoe.

Essential Insights On Biomechanical Considerations

   Whether the physician is educating female patients about the necessity and effectiveness of a custom functional foot orthosis for the first time or the 10th time, he or she must review the biomechanical exam for the specific pathology. For the practical purpose of this article, the biomechanics of the foot will be significantly simplified.

   The pes rectus foot type presents a perpendicular heel bisection in stance, which is considered the stable foot. When it comes to the unstable pathological foot type, we can categorize these into four foot types.

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