Back in the Game

St. Louis pedorthist Chad Brown, CPed, knows that shoes and custom orthotics can help athletes recover more quickly from foot injuries. Brown’s family shoe business includes five New Balance concept stores in Missouri, Kansas and Illinois.

But Brown told O&P News athletes who visit him often doubt the importance of footwear in their rehabilitation regimen.

“Most athletes [who] have been prescribed custom orthotics and/or shoes to help them recover from an injury or surgery are fairly skeptical at first,” Brown said.

Three-stop shop

Brown said he leads each patient through three “stations” to help them better understand why shoes and orthotics can hasten their return to the game.

Chad Brown, CPed
Chad Brown

“First, we will visit the foot scanning station where we can scan the patient’s feet. Then, while viewing the color-coded topographical display, we can discuss the patient’s foot shape, arch height and unique pressure distribution,” he said.

Next, he ushers the patient to a display of custom orthotics and over-the-counter (OTC) insoles, explaining how they help feet that hurt.

“It is my opinion that there are two main benefits with OTC insoles and custom orthotics,” he said. “The first benefit is pressure distribution. We want to distribute an even amount of pressure throughout the entire plantar surface of the foot. This will reduce the pressure on the overexerted areas we noticed on the foot scanner.

“The second big potential benefit is ankle control,” he continued. “We have the ability to take strain off the feet, ankles and knees by using deep heel cups and or medial or lateral posting.”

Step three is a short stroll to the shoe wall.

“I introduce the patient to the different external components available with the footwear. Neutral cushioning, stability and optimal control shoes are all available.” If a patient needs OTC orthotics, Brown fits his patients’ feet to footwear on the spot. If custom orthotics are required, shoe fitting comes after the devices are fabricated.

Changes in footwear design

Foot injuries can be difficult to diagnose accurately because a foot is complex; its 26 bones, in addition to ligaments, joints, tendons and muscles all can be injured, according to the Pedorthic Footcare Association (PFA). As stated on the PFA website, “A credentialed pedorthist, working with a medical practitioner, can be of unique assistance by focusing on the foot, orthosis and shoe as a unit.”

Brown said athletic footwear has come a long way from old-time leather cleats and canvas gym shoes, neither of which provided much foot support. He thinks athletic shoe design peaked shortly after the turn of the 21st century.

“Now shoes are devolving. Most shoe categories and brands keep getting lighter in weight, with thinner midsoles and more midfoot flexibility. Materials keep getting thinner, softer and so on,” Brown said. “All these changes in footwear are occurring while the athletes wearing the shoes keep getting taller, bigger, faster and stronger.”

Brown said mass producers of athletic footwear have put planned obsolescence into their strategy for designing and making shoes. Athletic shoes break down faster while “increasing sales and boosting company growth,” he said.

According to Brown, the decreasing quality of athletic footwear has increased the importance of ready-made insoles, custom orthotics and shoe modifications including “heel spur cutouts, excavations/off-loads, medial or lateral posting, [metatarsal] pads or [metatarsal] bars and Morton’s extensions.”

Brown said he is partial to certain materials for crafting custom orthotics.

“DBX6 [a material made of fiberglass, graphite and resin] is my overall favorite to use as the shell. It is the thinnest and lightest weight material that I know of that can be pressed with deep heel cups.”

He added, “You can use a full-length top cover and bottom cover to provide great cushioning or you can keep it half-length and use it in a soccer cleat or even a dress flat. Athletes love it because it is so lightweight and so easy to fit into their current footwear.”


He said if room inside the footwear is not a potential problem, he likes polypropylene as the shell. Brown uses 1/8th–inch shells for smaller, thinner athletes and sturdier 3/16th–inch shells for taller and heavier athletes.

“It is my preference to top cover and bottom cover these devices with full length [ethylene-vinyl acetate] EVA cushioning,” he said.

He added that all orthotics used in athletic shoes are subject to considerable wear and tear in a short period of time.

“It is so nice to be able to just refurbish the device by removing the abused cover and adhere a new top cover and bottom cover. The device ends up looking and feeling brand new,” Brown said.

Special care for athletes

Brown said Trilam cork and foam orthotics are suitable for most of his everyday patients.

“They are not as maintenance friendly as I need them to be for today’s athletes. They break down and then need to be completely replaced.”

While custom orthotics are designed to ward off or help ease many different foot problems, Brown said “the number-one foot ailment in the galaxy is plantar fasciitis.”

He said most athletes come to him because they have been hurt or they have undergone a surgical procedure to help straighten ankles misaligned by flat feet or high arches. Shoe-related problems bring in others.

Still, his patients also experience other issues, ranging from post-tibial and peroneal tendonitis to sesamoiditis.

“We keep it simple and we do the same thing for everyone,” he said. “Again, we go through the foot scanning process, migrate to the custom orthotic display and talk about whether their unique case would be benefited by having a more even distribution of pressure on the plantar surface of the feet or by getting better ankle control or both. Patient education is our number-one priority, and then we decide how we can best serve the patient.” – by Berry Craig

Disclosure: Brown reports no relevant financial disclosures.

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