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About Me

San Francisco, CA, United States
I have been a podiatrist for 34 years now and I am excited about sharing what I have learned on this blog. I love to exercise, especially basketball and hiking. I love to travel. I am very happily married to Patty, and have 2 wonderful sons Steve and Chris, a great daughter in law Clare, my new grandson Henry, and a grand dog Felix.

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Friday, October 19, 2012

Shoe Wedging to Stop Supination

Supination following heel strike is one of the most deadly biomechanical problems. The shoe industry is starting to pay attention with a range of mor stable neutral shoes which will work with orthotic devices to stabilize that problem. However, almost weekly I need to do in-office shoe wedging to eliminate this problem even in the face of good orthotics and shoes. When we strike the ground walking or running, our legs must internally rotate from the feet, ankles, knees, hips and pelvis to absorb the shock. This internal rotation of the entire lower extremity allows the foot to pronate, and the foot to adapt to the ground. If our foot supinates at this time, forcing external rotation of the foot and ankle, problems arise in many ways. The foot can no longer adapt to the ground well and sprains can occur. The shock wave of heel strike will intensify potentially causing bone and joint problems. The peroneals and iliotibial band must work overtime at stabilizing the lateral/outside of the foot/ankle/knee/hip and strains occur. 

So, when I watch someone walk and run, I look for over-supination at heel strike. I see if simply the shoe needs changing from stability to neutral. I teach the patient how to perform lateral power lacing. I evaluate any shoe inserts/orthotics to see if I can adjust for anti-supination. And, I may also wedge their midsole as shown in the photos below to see if this helps eliminate supination at heel strike, and ease their symptoms. 

Lateral (baby toe side) of the midsole is opened with a scalpel. This process can be easily done by some shoe repair stores.

In this case, a 1/4 inch wedge of grinding rubber from JMS Plastics is placed into the opening. Both sides of the midsole and both sides of the wedge are initially glued with Barge Cement and let to dry for 10 minutes.

All excess wedge material is cut and ground off and SuperGlue is used to seal any gaps that did not seal completely.

The final product is shown. This patient Vince has chronic medial knee joint compartment disease, and this wedging has allowed him to avoid knee replacement successfully for the last 15 years by eliminating the excessive supination which was causing the medial knee compartment to compress abnormally with every step.


So, when evaluating individuals with various injuries, watching them walk and/or run, can give you great clues to treatment. Gait evaluation should be done in most non-acute injuries to see if gait changes may help. This is one example of this process in action. 

2 comments:

  1. Hi richard...Can this help my ITBS? I have tried everything but not this...I did notice that trying to run on the inside of my foot relieved the pain a little whilst running but I think the band is too infalmmed that even if my biomechanics are now ok..it won't settle down...I can't afford to go to a podiatrist...nor do i trust that they know what they are doing. All progress on my IT Band has been acheived online...NOT...with the various practitioners I have seen. Cheers. Greg

    ReplyDelete
    Replies
    1. Definitely ITBS can be caused by rolling out too much (AKA over supination or underpronation). If you have a tendency to supinate, you can try various pads only under the outside of your foot (from heel to toe) to see if it helps. Many shoe repair stores may be able to help design a insole, outersole, or midsole support to the outside arch. Rich

      Delete

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.