How To Prevent Heel Slippage From An Orthotic

Jenny L Sanders DPM

Heel slippage arising from a dispensed orthotic is not an uncommon problem. Ways to address this problem include modified shoe lacing (lock-lacing) and tongue pads. For a how-to on lock-lacing, see my prior post at http://tinyurl.com/cu3r4ml .

To make a tongue pad, cut 1/8-inch adhesive felt in an oval shape and apply it to the underside of the vamp of the shoe, just distal to the throatline (see photo at left). Apply this to one shoe first and have the patient compare it to the shoe without a tongue pad while walking down the hall.

This method works for both slip-on and lace shoe styles. Your patients will be delighted by the effectiveness of a tongue pad and appreciate your ingenuity in solving an otherwise annoying orthotic problem.

Comments

There are two other things that have also worked for me.

Once in a rare while, the outsole of the shoe is can be too stiff. Just flex it beyond its elastic limit. This will be seen in children's shoes more commonly than adult shoes.

The most common reason is that the orthosis is not letting the calcaneus sit posteriorly enough. If you look at a shoe, you will notice that the posterior part of the heel cup starts off at a right angle to the shoe and then angles anteriorly at a 10 degree angle (to go along with a normal calcaneus). If the heel is not all the way back, then it isn't held in place by the superior part of the heel cup. First check the orthosis in the shoe to see that it is flush with the back of the heel cup. If not, find where the restriction is. Most commonly this occurs where the shoe narrows just posterior to the 1st or 5th metatarsal head, and thin out the width of the orthosis here to fit the shoe better.

Next, look at the posterior thickness of the heel cup. Excessive posterior thickness will push the foot anteriorly. Remove the excess material and see if this helps.

If not, look at the depth of the heel cup of the orthosis. The deeper heel cups are wider and protrude more posteriorly. Make the heel cup more shallow and then remove the excess material that is left posteriorly. Recheck to make sure that nothing is restricting the orthosis from sitting back flush against the shoe.

Another less common reason is that the shank of the shoe is not the same shape as the orthosis. If you look at the shank of a higher heeled shoe, you will notice the curved shape is more extreme. This will cause a rocking of the orthosis casted in the normal manner. For higher heeled shoes, you may want to try a dangle cast, which replicates a higher heel.

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