Key Insights On In-Office Shoe Modifications For Athletes

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Jenny L. Sanders, DPM

   Typically, the inside counter of the heel of the shoe will have a wear pattern. After identifying this pattern, apply a ½-inch wide strip of adhesive felt to either side of the pattern. This modification is initially temporary but once you are sure of correct placement, make the accommodation permanent by gluing on 1/8-inch covered Poron®.

   Metatarsocuneiform exostosis. When a patient has a dorsal metatarsocuneiform exostosis, shoe irritation over the prominence is common. Lace shoes are preferred in this case as patients can skip the corresponding laces and reduce pressure across the site.

   In some sports (skiing, hockey and skating), modified lacing is not possible or is insufficient to eliminate pressure. In these cases, one can use a doughnut pad to surround the prominence and offload the area. Doughnut pads can be adhesive or non-adhesive, and one can use them in conjunction with lacing modifications if desired.

How To Prevent Heel Slippage And Squeaky Orthotics

Patients frequently complain of having narrow heels when they actually have a low volume forefoot. Instead of using heel grips, which push the foot forward, a tongue pad can take up the excess volume in the forefoot, resulting in a more secure fit. One can use commercially available pre-cut tongue pads or trim 1/8-inch adhesive felt and size it to fit.

   When heel slippage happens, most people intuitively tighten the shoelaces closest to the ankle, which will not help with slippage. The laces that need to be laced tightest are those farthest away from the ankle. It takes more time but each and every time patients lace their shoes, they should tighten the laces closest to toes first and progressively cinch up until they reach the ankle.

   If heel slippage still occurs, especially when patients are using an orthotic, then patients can tighten the laces utilizing the lock lace method. This creates a more secure fit by preventing slipping of the shoelaces at the level of the ankle.

   Orthotic squeaking is usually caused by friction of the orthotic plate against the insole of the shoe. In most cases, sprinkling powder or cornstarch into the shoe prior to placing the orthotic will eliminate the squeak. In those instances in which this does not work, covering the distal half of the orthotic with athletic tape or moleskin, or gluing vinyl to the underside of the orthotic will solve this problem.

Final Thoughts

I am constantly surprised when patients come into my office after seeing another podiatrist who made no mention of shoes. A well fitting, structured shoe is important to the success of many podiatric treatments. Most of the in-office modifications I have discovered arise from utilizing a common sense approach of matching shoes to pathology in an effort to optimize outcomes.

   The aforementioned examples are simple and effective ways to improve patient adherence as well as stimulate thinking on ways to incorporate everyday shoe modifications into our overall podiatric treatment plans.

   Dr. Sanders is in private practice in San Francisco. She writes a monthly blog for Podiatry Today. For more information, please visit Dr. Sanders also blogs at

   Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine.

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