A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of.
Jenny Sanders, DPM, recently wrote an excellent DPM Blog (http://www.podiatrytoday.com/blogged/how-prevent-heel-slippage-orthotic  ) on how to use lacing techniques and tongue pads to decrease heel slippage.
One important technique I would add to Dr. Sanders’ list is to use a grinder to thin the heel of the orthoses. If you have a polypropylene orthoses, you can simply take it to a grinder and grind the bottom of the heel post or, if there is no heel post, the heel contact point of the orthoses. Grind it so it is almost paper thin.
One of the nice attributes of polypropylene is that it will not crack after grinding. I will usually grind the device to a point where the polypropylene is very slightly pliable and will move slightly with finger pressure. At that point, I know it is as thin as I can make it without grinding all the way through the orthosis.
Even decreasing the heel contact thickness by a millimeter or so can make a tremendous difference in eliminating heel slippage.
Editor’s note: This blog was originally published at
http://www.prolaborthotics.com/Blog/tabid/90/EntryID/450/Default.aspx  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .