Keys To Prescribing Orthotics For Sports, Neuromas And High Heels

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

   As Dr. Wernick notes, the object in orthotic design is to control motion in the subtalar joint while stabilizing the lateral column with an arch both under the calcaneocuboid joint as well as the medial side. One can achieve this by modifying the positive impression with the removal of plaster under the calcaneocuboid joint area. Dr. Wernick cites the importance of resisting flattening of the lateral arch. He also notes that since most shoes, particularly women’s shoes, have a last that has the longest part of the shoe at the third toe, there is a lateral compression force.

   In regard to orthotic modifications for a neuroma, Dr. Valmassy says in some cases the use of a forefoot extension that leads to the sulcus is helpful in providing some additional shock absorption and cushioning in the forefoot. He also notes that utilizing a pad in the interspace to separate the metatarsals in a gentle fashion will sometimes reduce the compression on the neuroma or the neuritis. Dr. Wernick usually asks patients to be quite cautious in regard to the shoes they utilize as a more flexible forefoot will tend to increase pressure to the neuroma site whereas a stiffer soled shoe will clearly increase the overall correction of the orthotic device.

   The crest pad improves performance of the digits, thereby lessening the retrograde irritation that occurs with pathomechanically induced over activity, according to Dr. D’Amico. He notes that the orthotic device itself must realign the osseous and soft tissue structures, and promote normal function in order for any modification to achieve its full potential.

   Dr. Beekman is a Diplomate of the American Board of Podiatric Surgery and the American Board of Podiatric Medicine. He is also a Fellow of the American Academy of Podiatric Sports Medicine.

   Dr. Valmassy is a Past Professor and Past Chairman of the Department of Podiatric Biomechanics at the California College of Podiatric Medicine. He is a staff podiatrist at the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco.

   Dr. Wernick is a Professor in the Department of Orthopedic Sciences at the New York College Of Podiatric Medicine. He is also a Diplomate of the American Board of Podiatric Orthopedics and the Medical Director of Eneslow Comfort Shoes and Langer, Inc.

   Dr. D’Amico is a Professor and Past Chairman in the Division of Orthopedics at the New York College of Podiatric Medicine. He is a Diplomate of the American Board of Podiatric Medicine, and a Fellow of the American Academy of Foot and Ankle Pediatrics. Dr. D’Amico is in private practice in New York City.

   For further reading, see “A Closer Look At Orthotic Solutions For Women’s Dress Shoes” in the December 2009 issue of Podiatry Today, “Inside Insights On Orthotic Modifications For Sports” in the October 2004 issue or “A Guide To Orthotic Treatment For Metatarsalgia” in the April 2012 issue.

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