Some Thought on Orthotics for Your Consideration

Most PCF is characterized by some residual adduction of the forefoot on the rear foot - the forefoot curves inward toward the centerline of the body. There is also some residual equinus, or at least, tight achilles tendon. This is often made more complex by an increase in pronation of the midfoot, especially as we age. This combination can make the proper design for orthotics a real puzzle, even for the best orthotist. Because we have this tendency toward greater pronation, coupled with a greatly reduced range of motion (especially at the subtalar joint,) we can find ourselves sliding off the orthotic laterally. This can have several effects - an increased potential for riding on the lateral edge of the device, which can lead to some rather substantial callous build-up; and due to this lateral slippage at the rear foot, can force the forefoot medial, leading to shoe distortion, and the high likelihood for callosities along the medial great toe, or hallux.

One solution that I had great success with was to make the device with a deeper heel cup, and an especially deep lateral heel flange. This served to hold the foot more effectively on the center of the orthosis, and thus increase its effectiveness. In some instances, it could take a number of adjustments to get the right combination for success. This might be due to a more substantial lateral fat pad along the border of the heel, or sometimes from a tight achilles and/or a small leg length discrepancy that can cause the heel to rise off the ground earlier in the gate cycle, and thereby permit more torquing of the rearfoot laterally, making the heel rub against the heel cup.

Some orthotist use a technique called drape-molding, a vacuum forming technique that allows a deeper cup, rather than using computer-aided manufacturing, which cannot achieve as deep a cup, so ask your orthotist about their molding technique.

Another issue re: orthotics and shoe choice: because orthotics take up some amount of space inside your shoes, you need to find shoes that can accommodate this added bulk. Extra-depth shoes do exist, though most are not all that attractive. New Balance is one of the few athletic footwear companies that offer both good extra depth, and offer a very good array of widths - most of us clubbies tend to have short, wide feet, so being able to find shoes with the proper width can make a big difference. Always try shoes on with the orthotics - don't rely on guess-work to get the right size. I usually recommend looking for at least one size larger, but when you have a bulky orthotic, you may need to go to two sizes larger (unless, by some big miracle, you can find a brand of shoes that still makes 1/2 sizes!)

Some of the shoe brands that do make extra-depth footwear include Alden (men's only), PW Minor (men and women), Shaw (not easy to find, women only.) As I have not been in the business for a while now, there may be more such brands out there, so if you are aware of them, please share them with everyone right here in good old Talipes Town!

And, though harder to find and far more expensive, it is worthwhile considering custom footwear. This would allow greater shoe design choices, significantly better fit, and function designed for YOUR feet, not just for the feet of the general public. Yes, they can cost a lot, these days (it takes more than seventy and as much as one hundred separate steps to custom-make footwear, not to mention the time involved - as much as thirty hours in some instances, so the cost is in fact realistic. If those shoemakers who make therapeutic shoes wanted to get rich had a choice, they'd probably go back and learn to make women's high fashion shoes, or cowboy boots - people pay even more for shoes like those.) The decision can be difficult if price is the first consideration. For me, the only consideration has always been the reduction of pain, and the increased likelihood I will still be able to walk years from now.

But that's just me.