Inside Insights On Orthotic Modifications For Sports

Clinical Editor: Timothy Dutra, DPM

When prescribing orthotics for athletes in widely varying types of sports, one must take into consideration both the needs of the athletes and the advantages and disadvantages different types of shoes may offer. With that said, these panelists offer their expertise on orthotic modifications they use to keep their patients on the athletic field. Q: What influence does athletic shoegear have on sport specific orthotics and orthotic modifications? A: For Stephen M. Pribut, DPM, the patient’s specific shoe category and sport have a “major impact” on the orthotics he prescribes. He also emphasizes that one should be aware of differences between different models of shoes for a specific sport. When the contours of the shoe arches vary, it can have a significant impact on how the orthotic functions, according to Dr. Pribut. He is often surprised to find an orthotic placed on top of the shoe’s sock liner or insole. Dr. Pribut says this can tilt the orthotic into an improper position, pushing the orthotic too far forward or tilting it too far into varus. To remedy this, he advises removing the liner from certain shoes. In his experience, Dr. Pribut has found that if you remove the liner from many Asics shoes, the footbed becomes flat and orthotics will generally fit well inside the shoe. However, if one places the liner below the orthotic, then Dr. Pribut recommends cutting the arch, heel and any “rim” around the posterior aspect of the liner in order to facilitate a flat fit into the shoe. Since the arch is prominent in many Adidas shoes, Dr. Pribut will sometimes trim the insole and place it below the orthotic so the orthotic will be in a more functional position in the shoe. Timothy Dutra, DPM, says it is best to try to fit shoes to the orthotic in order to maximize control for that particular sport. For example, when treating a sprinter, one may need a special pair of orthotics specifically for use in shoes with spikes. Dr. Dutra says he often sends the athlete’s shoes with the negative casts to the orthotic lab to ensure the best fit, especially when cleats or spikes are involved. He says a graphite orthotic commonly works well as it is thinner and may fit with more narrow spikes or cleats. Since cleats for field sports may or may not have a removable insole, that will help determine the type of cover and accommodation one can use, according to David Levine, DPM, CPed. If the insole that comes with the shoe is thin and tightly adhered, Dr. Levine says one needs to address this with the thickness of the orthotic, the cover and the forefoot extension. While the forefoot extension should be “fairly thin,” Dr. Dutra says it should have enough cushioning for a heavy athlete and durability to facilitate changing between shoes. However, he warns of a loss of some control when employing a thinner, narrower orthotic with a shallow heel cup. Dr. Dutra adds that for most sports, adding a rearfoot post to the shoe is “essential to get the rigidity needed to adequately control shoe function for the sport.” Q: What is the importance of various modifications in your orthotic prescription for athletes? A: Modifying the thickness of orthotics is important for Dr. Dutra, who notes that thicker orthotics are more rigid. Although one can add an arch fill to help facilitate better control for a heavier athlete, Dr. Dutra says the arch fill can make for a bulkier orthotic. He likes to use a wide orthotic plate and as deep a heel cup as possible to maximize motion control for the athlete. In order to maximize control of the foot, Dr. Dutra says rearfoot posting is essential for most athletic shoes. He notes there are some sports exceptions, such as sprinting and volleyball, sports that don’t require athletes to be on their heels that much. Adding a medial skive or inverted technique can be helpful when it comes to increasing control of pronation. Dr. Dutra frequently uses a medial skive of 2 to 4 mm to facilitate maximum control of pronation without adding bulk to the orthotic. Dr. Dutra says employing forefoot extensions can help in offloading metatarsal heads and cushioning the transverse metatarsal arch area. They are especially helpful when athletes are participating in sport activities in which they are mainly using their forefoot and midfoot, according to Dr. Dutra. However, he says one should exercise caution when adding bulk in the toebox of the shoe, especially in shoes with cleats. Dr.

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