In this article in the Les Bailey orthotics series, I am looking at the differing types of shoes that patients present with, and how we can best offer them the correct orthotics for those shoe types.
If we look at the vast array of shoes people wear; trainers, casual shoes, smart shoes, court shoes, wellington boots, lace up boots, walking boots, specific sports shoes and work safety boots, to name but a few, we see how patients shoes differ.
In the past, practitioners would prescribe orthotics on a "one fits all" basis.
The problem with this was that the orthotic would work in one type of shoe, but not the others, or it wouldnt fit properly, either too wide or too narrow.
Some patients require top covers that take cut-outs or accomodations, and these may only fit in their everyday shoes or trainers. Therefore we may need to make other orthotics to go into other less roomy shoes, that correct the foot posture, but do not allow us room to add the top covers. ( it gets confusing !! )
We may need to instruct our patient that these shoes without the top covers and accomodations should only be for occasional use for nights out etc.
I have an arrangement with the orthotic lab I use that I have a set of templates for both width and length, so I can assess the individuals average shoe width and length, then the patient gets the correct length and width first time.
I will give you my personal way I tackle the differing shoes / orthotics conundrum. Other practitioners may vary.
1/ Casual shoe. I generally prescribe a three quarter length top cover, as most casual shoes are generous in the toe box, allowing me to request accomodations and / or accomodations for the metatarsals.
2/Smart mens shoe. I prescribe a half length ( shell only ) orthotic as fit would be a perennial problem if we were to add padded top covers.
3/Court shoe. I prescribe a half length orthotic, from a specially shaped template .
The lab then take heel height into consideration and shape the orthotic accordingly.
4/ Trainers. These are usually a prescribers dream, as we can fit any accomodations we choose without alot of restrictions.
5/Tennis or squash shoes. One thing that should be of concern to the prescriber is that in either of these sports, there is an awful lot of foot stomping, and therefore shock going through the foot.
As we have room in these shoes, it gives me freedom to use a thinner shell, accompanied by what we term " arch infill " so we get the support and accuracy, but lots of lovely shock absorption for all that foot stomping !
We also get room for paddings aplenty to reinforce our padding effect.
This list is by no means exhaustive, but I hope it goes a way to explaining why your practitioner may wish to use multiple orthotic types.
By Dr Les Bailey phd, DO, acopm, apta (int part ). Les Bailey orthotics articles. Dr Les Bailey.
About Dr Les Bailey phd,DO, acopm.apta(int part)
Author of the laymans guide to foot and heel pain.
Direct line 07801418080
Les Bailey orthotics articles
Dr Les Bailey started in the physical therapies in 1981,qualifying in remedial massage, going on to qualify as an osteopath.
He gained his phd from OIUCM for a thesis on the treatment of plantar fasciitis.
He was awarded a teaching/lecturing diploma from the northern school of osteopaths in 1993.
He also holds a diploma in foot biomechanics .
Dr Les Bailey works from his clinic near Banstead in surrey.