Saturday, January 10, 2015
Pes Cavus (High Arch) Orthotic Devices: General Thoughts
Dear Dr Blake.
Thank you for checking this message.
What are the characteristics of a custom-made foot orthotics for a professional volleyball player with pes cavus foot type (high arch)?
He has metatasalgia, hammer toes and very big callus under the first Met heads.
Dr Blake's response:
Thank you so very much for your questions. Pes Cavus feet have more pressure on the metatarsal heads since the metatarsals are more downward angled.
You need to get as much arch into the orthotic as possible to even the pressure out from heel to ball of the foot. As long as the heel and metatarsals take too much pressure, the athlete will have problems. The arch created in the orthotic device should not be painful, but borderline obnoxious. I will use a flexible 5/32 inch polypropylene to design the device to give flexibility. I do not want any arch filler under the orthotic to rob the inherent flexibility of the plastic. I want the orthotic device to go as far out onto the metatarsals as possible, without feeling that they are cutting into you as you go up onto the ball of your foot. The heel cup needs to be high (25 mm medial and lateral), with the plastic under the heel thinned out maximally without breaking through the plastic. This keeps the orthotic as low in the shoe as possible, but very stable. I probably would start without a rear foot post, which can lift you out of the shoe and tilt you forward, and add a Denton Modification (see mentioned in this blog). I would definitely make the orthotic device as wide as the shoe, so it does not move around. I would add a full length 1/8th inch spenco top cover, and play with even more forefoot padding, and even more metatarsal arch/pads. I hope this helps you. Rich