Keys To Prescribing Orthotics For Sports, Neuromas And High Heels

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Author(s): 
Guest Clinical Editor: Joseph D’Amico, DPM

These experienced panelists discuss the unique challenges of fabricating orthotics and creating modifications for various types of sports, high heels and Morton’s neuroma.

Q:

What are some key orthotic considerations for a sport or sports that you are particularly familiar with in treating athletic patients?

A:

In regard to sports activities, Ronald Valmassy, DPM, finds that the standard three-quarter length orthotic device, whether it is polypropylene or graphite, typically works quite well with a sports shoe. Dr. Valmassy says the patient also has the flexibility to utilize that same orthotic device in a variety of other shoes.

   However, if he chooses to prescribe an orthotic device that patients would utilize only in a specific pair of shoes, such as running shoes, basketball or tennis shoes, Dr. Valmassy typically will ask for a full-length device. He notes the full-length device will still incorporate the same inherent and intrinsic varus or valgus correction with the medial or lateral calcaneal skive. Dr. Valmassy will also ask the lab to add a soft, shock absorbing material to the arch area and throughout the topcover material.

   “Clearly, having a full-length orthotic device for sports-related activities allows the device to stay better seated in the shoe without having the patient experience the common complaints of the orthotic device slipping excessively. Additionally, a flat rearfoot post will assist in decreasing lateral instability,” says Dr. Valmassy.

   Joseph D’Amico, DPM, prescribes unique sport devices for water sports such as paddleboarding, windsurfing and aqua aerobics. As he notes, the module he uses for all water sport orthoses is ethyl vinyl acetate (EVA) to the sulcus with an AliPlast topcover (AliMed) to the toes with rearfoot posting and forefoot posts extended to the sulcus. When he receives the orthotics, Dr. D’Amico makes a series of 1/8-inch drill holes through the entire shell to allow for water drainage.

   “These lightweight, floatable devices not only fit into most aqua footwear but work exceptionally well at improving alignment, function and performance,” notes Dr. D’Amico.

   Bicycling is one sport that requires special orthotic consideration, according to Stanley Beekman, DPM. He will make full-length rigid orthoses and add a metatarsal pad and toe crests. Dr. Beekman says the full-length rigid orthosis aids the propulsive phase of the pedal stroke whereas the metatarsal pad and toe crest aid the bottom half of the cycle when the foot is pulling back. As he notes, this allows the foot to pull against the orthosis more effectively. The force then transfers to the plantar portion of the counter, which is more rigid than the superior portion. From the counter, the force transmits to the sole and then the pedal, according to Dr. Beekman.

Q:

The prescription of foot orthoses for use in women’s high heel fashion footwear can be challenging. What orthotic prescription adjustments and modifications do you find most effective?

A:

When fitting orthoses to women’s pumps, Dr. Beekman cites several important keys. First, he says one must make as much room as possible by removing the sock liner and making the orthoses as thin as possible in the areas that contact the shoe. Second, get the orthoses to fit the shape of the shank by casting with the feet in a dangling position and using a flexible material. Third, keep the heel in the shoe by keeping the calcaneus as posterior in the shoe as possible, which one can do by lowering the height of the heel cup. When grinding a heel cup to a lower height, Dr. Beekman says podiatrists will see thickness around the heel cup. Reduce this thickness and the foot will be able to move posteriorly, according to Dr. Beekman.

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