Inside Insights On Orthotic Modifications For Sports

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Many runners who are smaller and lighter prefer a graphite orthotic for fit and control of pronation, according to Timothy Dutra, DPM. He says it is important for the running shoe to be stable in order to get maximum control from the orthotic.
The reverse Morton’s extension (as shown above) is a forefoot modification that can alleviate pressure under the first metatarsal head.
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Author(s): 
Clinical Editor: Timothy Dutra, DPM

Q: What specific modifications should be considered when treating runners?
A:
Clinicians should initially ensure that their patients are wearing an appropriate running shoe. When treating patients who present with a difficult case of plantar fasciitis, Dr. Pribut says one should check their running shoes to see if they exhibit flexion stability and torsional stability. Drs. Dutra and Pribut recommend checking out the list of running shoes at www.aapsm.org, the Web site of the American Academy of Podiatric Sports Medicine, in order to determine which is appropriate for patients.
Once the runner is wearing the right type of shoe, Dr. Levine says one can then design an orthotic that fits properly.
Dr. Pribut uses a deep heel cup for most long-distance runners. He uses a full-length orthotic that is as thin as possible for sprinters. Dr. Pribut tailors his modifications to the basic devices he employs for the particular injury he is treating.
Dr. Dutra likewise tailors his orthotic modifications based on the type of shoe or spike the athlete uses. Normally, he prefers to use a topcover to the toes that is made of a high-density material. He adds that it should be as thin as possible so it does not take up too much room in the toebox. Runners normally prefer a lightweight and flexible orthotic, according to Dr. Dutra. He adds that one may need to adjust the heel width of the orthotic in order to ensure a secure fit in the back of the shoe.
In Dr. Dutra’s experience, many runners who are smaller and lighter prefer a graphite orthotic for fit and control of pronation. He says it is important for the running shoe to be stable in order to get the maximum control from the orthotic. Often, he waits to make additions or modifications to the orthotic after finding out the desired fit and control.

Q: Do you use prefabricated or pre-custom orthotics?
A:
Although Dr. Dutra prefers custom functional orthotics in the majority of cases, if issues with cost arise, the pre-fab and pre-custom inserts can help determine if a functional device will help. Dr. Levine concurs, noting that “using prefabricated devices is often a good test to see if mechanical control will be helpful.” Dr. Dutra cautions that most of the prefabricated inserts are more accommodative than functional, mostly because they will not be a custom fit.
Dr. Pribut does not dispense prefabricated orthotics. He does recommend over-the-counter devices when he feels they are appropriate or he may temporarily modify the insole of the shoe to limit pronation and unload segments of the forefoot.

Dr. Dutra is a Vice President and Fellow of the American Academy of Podiatric Sports Medicine. He is a Fellow of the American College of Foot and Ankle Orthopedics and Medicine. He is a team podiatrist for the University of California at Berkeley and California State University, Hayward. He is also an Assistant Clinical Professor at the California School of Podiatric Medicine at Samuel Merritt College.
Dr. Pribut is a Fellow of the American College of Foot and Ankle Surgeons and President-Elect of the American Academy of Podiatric Sports Medicine. He is a Clinical Assistant Professor of Surgery at George Washington University Medical Center and is a Consultant with the Georgetown University Athletic Department. He has a private practice in Washington, D.C.
Dr. Levine is a Fellow of the American Academy of Podiatric Sports Medicine. He is in private practice and is also the director and owner of the Frederick, Md.-based Physician’s Footwear, a fully-accredited pedorthic facility.

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