The Shoe Goes On Before the Orthosis Goes In

Individuals who use custom foot orthoses tend to bring their everyday shoes to their orthotic appointment. However, before the appointment, it is important to purchase a new and appropriate shoe so the right orthotic material can be chosen and fit comfortably into the shoe.

“It’s a chicken and egg story. You can’t have the orthosis without the shoe. It’s like trying to have prescription lenses without the frames,” Bruce Williams DPM, of Breakthrough Podiatry, told O&P Business News. “When it comes to a custom foot orthosis, the shoe itself does come to play an important role in how that orthosis will end up affecting the patient’s foot.”

Why the shoe is important

When purchasing a new orthosis, it is important that patients first do research on the type of shoe that will work best with the type of orthosis they are purchasing. According to Williams, a flexible shoe and a rigid orthosis can work most of the time for a given individual. However, it can be problematic if both shoe and orthotic material are flexible.

“You want to use an orthotic device that is going to provide biomechanical control into a piece of footwear that it will work well with,” Jeff Jacobs CPed, owner of Foot Dynamics and Advanced Casting Technology, told O&P Business News. “That generally does not mean something that is old and beat up that’s already been compensated.”

Jacobs noted that he has achieved improved results fitting orthoses by lowering the patient’s heel height, so it is virtually level with the forefoot height.

The type of shoes and orthosis that a patient buys also depends on their foot ailment. In fact, sometimes the type of shoe a patient already wears can perpetuate the reason why they are having problems. An evaluation of the shoe and an understanding of what symptoms a patient is feeling will help the practitioner decide which orthosis is best and how long the patient will have to wear it.

“It is a difficult situation depending if the patient has different sized feet, different functioning feet or one foot that is collapsed severely and another foot that looks more normal,” Williams said. “There are a lot of different issues that can lend to why the patient needs to get different shoes.”

Recommend the proper shoe

To ensure patients will be using the correct shoe gear, pedorthists can recommend different shoe brands they find most reliable so both know that the patient is buying the right shoe the first time.

“I usually recommend several brands for patients to try before getting the orthosis because the sizing of the orthosis can depend greatly on what types of shoes are chosen. Adequate toe spacing, stability of the shoe and sizing varies from one manufacturer to another,” Charles A. Mutschler DPM, medical director of Footcare Express, said.

Take time to talk to patients about how to evaluate a shoe and what they should be looking for, to ensure patients are buying the right shoe before they receive their orthosis.

“I have handouts in my office to show patients specifically how to evaluate shoes the way we want them to,” Williams said.

Sometimes it is best when patients buy their shoes from the source. Jacobs recommends that the best way to guarantee patients receive the correct pair of shoes is for practitioners to provide the shoes themselves.

“My suggestion to practitioners who don’t have a large shoe inventory is that they ought to get to know someone locally who does and work with them closely,” he said. “If you dispense a device and it doesn’t work in shoes it’s not going to be of any value to the patient.”

Disclosure: Jacobs, Mutschler and Williams have no relevant financial disclosures.

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