Demands of work and home life often require patients to wear dress shoes, at least on occasion. Here the panelists share their experiences and advice on successful implementation of dress orthotics into a biomechanical treatment plan for both men and women.
What do you feel are important features in a dress orthotic for women? Are there any specific modifications or materials that you find especially successful?
Primarily, the orthosis needs to be low-profile to fit into the shoe, says Jenny Sanders, DPM, FACPM. Her preferred materials include a thin shell of carbon graphite or polypropylene. She also shares that most labs can fabricate a custom Cobra-type design for high heels. In this case, Dr. Sanders adds that submitting a sample of the heeled shoe to the lab, along with the prescription, will ensure proper fit.
Jennifer Sartori, DPM, FACFAS agrees that a Cobra modification works well as it fits in a variety of shoes from flats to heels.
“It needs to sit in the shoe properly,” states Dr. Sartori. “I don’t advise orthotics for any heels over two inches. Once you get above that, it is hard to make the orthotic functional and patients adhere less to their prescribed regimen.”
Dr. Sartori adds that a thin but supportive, semi-flexible shell with an intrinsic post and minimal rearfoot post are important features for women’s dress orthotics.
Natasha Baczewski, DPM, FACFAS focuses on educating patients on realistic dress shoes and proper fit of the orthotic. She relates she tries to keep the orthotic as thin as possible with a simple leather topcover and a ¾ or sulcus length to avoid crowding of the toe box. She concurs that an intrinsic post is best and prefers minimal modifications.
What do you feel are important features in a dress orthotic for men? Are there any specific modifications or materials that you find especially successful?
Dr. Sartori feels ¾ length devices are best unless the shoe liner is removable. She opts for an intrinsic forefoot post with a deeper heel cup and a slightly thicker semi-flexible shell than what she chooses for women, usually polypropylene.
Conversely, Dr. Baczewski stays close to the type of device she chooses for women but may extend it to full-length with a thin midlayer cushion if the shoe gear will allow.
“Men have more options than women as they typically wear low-heeled oxfords or loafer-style dress shoes,” says Dr. Sanders. “In the case of men’s custom orthoses, a narrow device with a shallow heel cup (eight to 10 mm) will work.”
What features of dress shoes for any gender do you recommend in order for that shoe to accommodate an orthotic?
Drs. Baczewski and Sartori agree that a removable liner and adequate depth are key. Dr. Sartori specifically shares examples of Aetrex® and Samuel Hubbard® shoes.
Oxford styles for men and t-strap, Mary Jane, bootie or boot styles for women have proven successful for Dr. Sanders. She shares that ideal high heels for women secure the foot and keep it from sliding forward with height less than three inches, even for special occasions.
“We have done F-Scan studies with four-inch high heels and no matter what the style, this heel height does not support the foot properly for extended walking or standing,” explains Dr. Sanders.
What expectations do you have for a dress orthotic in an overall treatment plan and how might this differ from the patient’s expectations? What tips can you share for best integrating a dress orthotic into an overall treatment plan?
Dr. Baczewski states she incorporates a dress orthotic when the patient indicates that there is a desire or requirement for this type of shoe.
“Many patients want the option to use one device for both exercise and dress shoes,” she says. “In these cases, I show patients samples of both and discuss why each serves its own purpose.”
Setting clear expectations is imperative, agrees Dr. Sanders. The most functional high heel device will never be as supportive as one for a sneaker, she explains. If a patient had success with an athletic device but still has pain in dress shoes, she then adds a custom device for the dress shoes as well. Alternatively, she has found that consistent use of an athletic device for those that only wear dress shoes is not likely.
If a patient only wants orthoses for dress shoes, then Dr. Sanders recommends a prefabricated device first, which can be just as supportive as a custom device. Her favorite for women is Superfeet® Everyday High Heel Insoles and Superfeet Everyday Slim Fit for men. These both work well in a variety of shoes and heel heights in an affordable fashion, she shares. An exception to this would be dress dance shoes (tango, salsa), for which she opts for custom low-profile orthoses due to shoe constraints and the demands of the sport.
Dr. Sartori finds most patients do not realize orthotics are best worn at all times, instead thinking they are only for exercising. She informs patients that in order to prevent injuries and stabilize the feet, they may need more than one style depending on their shoe habits. Dr. Sartori obtains a complete work and hobby history in order to determine this.
“I will work with patients though to at least get an orthotic into their most worn shoe styles even if it is a high heel,” says Dr. Sartori “The orthotic has to be practical in order for the patients to wear them.”
Dr. Sanders is an Adjunct Professor with the California School of Podiatric Medicine at Samuel Merritt University. She is a Diplomate of the American Board of Podiatric Medicine and is in private practice in San Francisco.
Dr. Baczewski is a Diplomate of the American Board of Foot and Ankle Surgery. She is in private practice in Portsmouth, NH.
Dr. Sartori is a Diplomate of the American Board of Foot and Ankle Surgery. She is in private practice in Portsmouth and Nashua, NH.