When you have a patient who is not going to wear a running shoe and you need an orthosis with maximum support and minimal bulk, what do you do? A lower profile orthoses incorporating the following key features works every time (see the photo at left).
Shallow heel cup depth. A 10-mm or even 8-mm heel cup depth will allow a custom orthosis to fit easily into most Oxford, slip-on or loafer style dress shoes. This design also works with lower-profile sport shoes such as cleats (soccer, football, baseball and golf), skates (hockey and figure) and cycling shoes.
Strip-type rearfoot post. This reduces the bulk of custom orthoses while retaining rearfoot control. You can request a 0/0 or 4/4 grind, just as you would with a standard rearfoot post.
Medial flange. This works especially well with a medial deviated subtalar joint axis. Most orthotic labs default to a wide width when one orders a medial flange. However, if you specifically request a normal width device, you get the desired midfoot support while still being able to fit the device into a narrower shoe.
Additional control measures. One can also incorporate minimal arch fill, a medial heel skive, inversion and a plantar fascial groove into a lower profile device as needed.
I order the above device in 3/16-inch polypropylene without a top cover. This allows for in-office narrowing if required. ProLab Orthotics/USA is the orthotic lab I use for manufacturing of this extremely versatile, well-controlling device.