Key Insights On Prescribing Orthoses For Dress Shoes And Sandals

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Dr. White says sandals offer greater width for increased support and more depth for increased cushioning.
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Author(s): 
Guest Clinical Editor: Lawrence Huppin, DPM

For Dr. Huppin, orthotic sandals are an option when patients wear regular orthotics less frequently in warmer weather. He uses Bite® sandals, noting the orthoses are made to fit perfectly. The orthoses can be removed for adjustment and patients can move the orthotics into other sandals, according to Dr. Huppin.
“In our practice, we find that patients love the sandals,” notes Dr. Huppin. “They help provide better clinical outcomes and offer a boost to the bottom line of the practice as well.”
Dr. Williams is a strong proponent of using newer orthotic sandals, which allow patients to fit their own custom devices into the sandals as opposed to using devices that are built into the sandal’s shoe last. He says both he and his patients find the freedom of such sandals “refreshing” and the more choices in sandals that women have, the more likely they are to wear the orthotics. Patients who cannot afford another pair of orthotics can buy sandals from Dr. Williams or another shoe store.

Q: How do you change your orthotic prescription for sandals relative to shoes?
A:
Dr. Huppin says orthotics in sandals usually provide less control than in shoes due to the lack of a heel counter in sandals and some limitations in the size of the orthoses in the sandals. The size of sandal insoles likewise limits the depth of the heel cup and he notes deep heel cups or orthoses with a medial flange will not fit into most sandals.
“This should not limit your use of orthotic sandals, but both the physician and patient should be aware that there will usually be less control so patients will need to adjust their activity accordingly,”explains Dr. Huppin.
However, as Dr. White argues, sandals offer greater width for increased support and more depth for increased cushioning. For sandals to be compatible with orthotics, he says sandals must have a removable footbed that one can replace with the custom orthotic. Dr. White says this will permit the use of full-length devices as opposed to using devices that typically end proximal to the metatarsal heads in a dress shoe.
Dr. Huppin also notes that sandals lack heel counters, which may cause eversion of the calcaneus. In turn, this may result in increased force under the medial arch, leading to an increased probability of arch irritation in a sandal orthosis compared to an orthosis in a shoe. When prescribing sandal orthoses, Dr. Huppin says one can prevent arch irritation by using a standard rather than minimum cast fill and avoiding an inversion technique.
If you use a medial heel skive in sandal orthoses, Dr. Huppin suggests limiting it to a maximum of 4 mm. As he explains, with a larger skive, there is more potential for the foot to slide off the orthosis, causing the lateral edge of the heel cup to irritate the foot.
If it was a shoe, one could use a deeper heel cup to compensate for this, according to Dr. Huppin. However, since heel cups in sandals are limited to about 14 mm, Dr. Huppin says one should avoid using medial heel skives larger than 4 mm.
On a rare occasion, Dr. Williams will decrease a heel lift in a sandal but as long as the sandal will accommodate the custom orthotic, he says he would not alter his prescription.

Dr. White is a Diplomate of the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.
Dr. Williams is in private practice in Indiana. He is also a Fellow of the American Academy of Podiatric Sports Medicine and a Fellow of the American College of Foot and Ankle Surgeons. He is a consultant to Tekscan.
Dr. Huppin is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is also the Medical Director for ProLab Orthotics. Dr. Huppin can be reached at lhuppin@prolab-usa.com.

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