Orthotic Modifications And Shoewear For Specific Jobs

Clinical Editor: Nicholas Sol, DPM, CPed

Addressing Specific Complaints
For complaints (leg pain, knee symptoms related to pronation) associated with the hindfoot and superior to the ankle, Dr. Weil prefers the semi-rigid devices such as the Benefoot Gait Flex-SR. A cashier may have to wear a nicer flat-type shoe and he thinks a dress orthotic such as the PAL System 3.0 could provide value. He says modifications of the orthotic would be specific to the patient’s structural malalignment or complaint.
When patients have specific forefoot complaints, Dr. Weil uses softer and cushioned devices, such as the Langer Blue Line series, whenever possible. However, he cautions that these devices require adequate room within the shoe and this is not always possible.
If there is increased plantar pressure in the forefoot, Drs. Stern and Mathur will try to accommodate the area by adding a small metatarsal pad or extra padding in an extension to the sulcus or end of the toes. They may add a Shafer plate to control the pronatory forces and give the devices more stability. For more enhanced control of the pronatory forces, they may add a deep heel cup. Drs. Stern and Mathur note they’ll also add normal rearfoot posting or a small varus increase to the orthotic.

Q: What about patients who have prolonged forefoot pressure from kneeling, stooping or squatting in their jobs?
For these patients, Dr. Weil favors the Sears and Red Wing work boots, citing their “excellent protection,” durability and room to add an OTC cusion or custom orthoses. He says you should add insoles in order to provide more specific accommodation. He adds that electricians may also need a special “grounding sole” for that occasional “lightning bolt.”
Forefoot pressures are increased during kneeling, stooping and squatting, and there is excessive pronatory pressure in the midfoot (even with the windlass mechanism), according to Drs. Stern and Mathur.
They suggest using a deep heel cup to try to stabilize rearfoot eversion, which sometimes can decrease medial midfoot pressure. You may need to modify the midfoot and forefoot because of increased pressure in those areas. They suggest adding some padding to the top of the orthotic and adding a Shafer plate to help with the midfoot. When it comes to accommodating forefoot pressures at the metatarsal heads, they recommend using a small metatarsal pad or cutouts of symptomatic metatarsal heads.

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