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Sunday, April 3, 2011
Custom Orthotic Devices and Shoe Inserts: They Do Not Coexist
When using a custom orthotic device, it is generally very important to remove the insert that comes with the shoe. Not only are there crowding issues, but the form of the shoe insert can effect the position of the orthotic device within the shoe. Thus, it can either help or hinder the orthotic device from doing it's job. The photo above illustrates this principle. My patient was complaining of 4th toe pain. When I looked at his shoe inserts you could see the 4th toe was overhanging the front edge, thus getting irritated. Had he bought the shoe too short? The solution was found at looking at how the orthotic devices were sitting in the shoe. The photo above shows the orthotic is being pushed forward by the heel cup of the shoe insert. If you push the orthotic forward, the whole foot will go forward, and the length of the toe will not be exact.
Here again you get a full view of the orthotic device sitting forward in the heel cup which would push the whole foot forward. To hedge my bet, I also taught the patient power lacing and gave some tongue pads to hold him back into the shoe heel counter better. I had him replace the shoe insert with a flat spenco insole.