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Sunday, April 10, 2011

"25 Common Shoe/Insert Modifications in a Podiatry Practice"

Left Outersole Lift for short leg tapered to the toes and cuts for flexibility.
Flexibility cuts demonstrated in outersole lift to avoid Sagittal Plane Blockade

Sole or Your Sole inserts are much better than Superfeet for adjustments. This is the soft athletic red version. Blue version is much thicker, and grey version for dress shoes too wimpy. For simple mechanical changes, or for biomechanical experimentation, these work great.
Pure plastic orthotics for water aerobics---nothing that can dissintegrate
Here are some wedges used for midsole wedging for pronation or supination (when the shoe and/or orthotic still do not do the whole hot tamale)
After the midsole is cut with a 10 blade about 1/3 way in, Barge cement is used to glue.
1/8 to 1/4 inch grinding rubber is skived and then glued on both sides. After 5 minutes, the glue is dry enough to place into the shoe.


Superglue is used to seal any looseness. Here a 1/4 valgus wedge for supinators is being demonstrated in the lateral heel and midsole area of a left shoe.









Custom Inserts can now be made for alot of sandals with the explosion of ones with removable inserts.
Sole insert with added medial arch with Hapad and additional 1/4 inch varus wedge with grinding runner. If you are unsure if the pronation you see in gait is causing the symptoms in the patient's knee, hip, shin, or back, experiment with Sole and get their response before designed an appropriate custom orthotic device.
Bottom view of the Hapad arch and 1/4 inch varus wedge.
The famous Blue Dot of 1/8th inch Poron or spenco (less easy to skive the edges) to give added cushion to any sore spot that bears weight.
I love Hapads. Began using them in Ballet slippers and Pointe Shoes and the rest is history. Get a supply of small and extra-small Longitudinal Metatarsal Arch Pads. Easy to thin out when too thick.
When I use these Hapads in shoes directly, always use the right in the left shoe and vice versa. Tends to work better with the shape of the curve in the arch area of the shoe.
Also love Hapad Metatarsal pads. Never put under a sore spot, always behind. See the diagram shows it one way and I demonstrate another. Experiment and think outside the box always. Patients should feel whether the pad is in the right spot or not, and should feel free to move around and thin. Get a box of small Metatarsal Pads to start.

Lace Skipping is a simple experiment to discern if bunion or pain at the top of the foot may be coming from tight laces. Here bunion pain with this hiking boot is greatly reduced with simple lace modification. See how you normally do not have to skip the entire front area, so there is less loss of stability.


When using lifts for short legs, I prefer the added stability of full length (or sulcus length) lifts.


This photo just put on emphasis on the flexibility cuts in full length lifts.
Dancer's Pads are made to help protect and off weight the big toe joint (including the sesamoids). It can be multi-layers, but care should be taken to discuss with the patient if they feel the pads off weight the sore area or toss them into the hole.

When you are experimenting with patients and making changes in their biomechanics, it is a good idea too remember to have some humor, and remember if you make any mistakes, I have made them 100 fold before you.

Remember spenco as topcovers and forefoot extensions ---very durable and the best cushion out there. Even with rearfoot posts, consider a softer product if you use plastic. This is birkocork which holds its shape well and much kinder on knees and hips than plastic posts.

Here is an example of a heel lift applied directly to an orthotic for a short leg. I would recommend keeping them separate and going full length with the lifts.



 Here is a combination of Budin Splint for Hammertoe and metatarsal pad. Remember that you can combine anything.
 Severe heel pain, think 1/8 tto 1/4 inch adhesive backed gel padding before you put on the topcover. In these cases, if the orthotic device is plastic, ask the lab to thin the plastic as thin as possible before the rearfoot post is applied.
Here a patient with chronic pain under the big toe joint is having the shoe modified. 1/4 inch hard shoe material will be replaced with 1/4 to 3/8 inch soft material.
See the hole created.
Very soft material, like memory foam, is used to fill in the hole. Normally, you have to use more thickness of soft material since it will compress more than the original material.
Frontal plane instability (excessive pronation and/or supination) can be addressed with medial and lateral buttressing with 1/8 to 1/4 inch grinding rubber. Greatly improves overall feelings of stability on any insole. It can be appropriately skived to minimize the heel lift effect.
1/8 to 1/4 inch plastazote actng as memory foam ia a great material for padding when you want the foam to mold to the foot. Here it is used as forefoot padding.

Here a scalpel is used to create a loop on the tongue of the shoe to help keep the tongue from sliding.
The famous Blue Dot used for extra heel cushioning in plantar fasciitis.

Here a scalpel surgically increases the flexibility of the metatarsals. It is importantt not to cut all the way through to the bottom of the shoe or to the sides of the shoe. Normally, 4 or 5 cuts are made 1/8 inch apart.
Varus or valgus outersole wedges to control pronation or supination forces are commonly used in harder to control shoes like dress shoes or sandals. Shoe Repair Stores are experts in making it cosmetically pleasing.
Vertical Cuts can be made in the heel or forefoot area of a shoe

Skip Laces to avoid pressure in sore areas. This is normally alright in a walker, but too unstable for running or hiking on uneven ground.

Here a cut is made 1 to 1and 1/2 inch deep to place a 1/16 th inch of plastic for Hallux Rigidus.
Tongue Pads can add stability to a shoe and can also accommodate a sore area on the top of the foot. This function of accommodation made be combined with appropriate lace skipping.

Don't forget shoe stretching techniques (shoe repair stores mnormally need to keep the shoe overnight)
Surgery to add more padding can be done in the heel or tongue areas

Insoles can be used for accommodations

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.