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Just a little confused about high arches...

Posted by D.Thomas on 8/13/01 at 16:49 (056614)

Ok. I admit that I am a little confused about what are the best types of shoes and orthotics for high arches.

SHOES

Runnersworld states, 'Generally, A curved, high-arched foot is generally termed a supinated or underpronated foot. This type of foot doesn't pronate enough, so it's not an effective shock absorber. Best last: Curved. Best shoes: Cushioned shoes with plenty of flexibility to encourage foot motion. Stay away from motion-control or stability shoes that reduce foot mobility.'

Arthur Manoli II, MD, and Brian Graham, CPed state, 'Selecting the proper footwear is an important and often overlooked aspect of treating the cavus foot. Uppers should be made of a soft, flexible material with long, wide lace openings to accommodate the prominent instep and forefoot. The heel should be flared and a little higher than the forefoot. This supports the hindfoot equinus and inversion instability often found in the cavus foot. The forefoot should have extra depth and an oblique toebox to reduce contact with contracted toes. Outsoles should be more cushioned than rigid, avoiding a medial post that is flared or of a higher durometer. It is also advisable to avoid an extended steel shank when dealing with the cavus foot. Athletic shoes provide the best combination of support and cushion. If social or business constraints dictate that the patient wear a dress shoe, lace-ups are preferred over loafers and a crepe sole over leather.'

Donna SL posted earlier about, 'The important thing to remember is high arched feet tend to have most of the weight of your body concentrated on the balls of the foot, and heel. They are usually unstable laterally also. The shoe has to have decent midfoot support to balance out the weight, and have a good lift in the heel, and have good lateral stability. If the heel, or midfoot is too soft you will sink into the softer bits more, put more strain on the fascia, plus lose more stability through out the entire foot.'

At this time I have the NIKE Pegasus which are very cushioned running shoes. But I am starting to think that they are not giving me the support I need and may be causing more problems. All the foot doctors that I have seen, I asked about what shoes would be best for me and was told by all of them that its not the shoes that are important, it's the orthotics. I don't believe that at all. I believe the shoes are just as important as the orthotics. Any thoughts on which shoes tend to be better for high arches (cushioned, etc.)?

ORTHOTICS

I found this part of an article written by Arthur Manoli II, MD, and Brian Graham, CPed very interesting, 'In our experience it is a far too common occurrence to see a cavus foot patient who already has one or more pairs of orthoses. Many of these devices are fabricated with materials that are too rigid and have an excessively high medial arch support, based on the theory that a high-arched foot needs extra medial arch support, when in fact it needs less. Almost all custom or prefabricated orthoses that we have seen are made either to correct the pronated flat foot or to support the cavus foot arch. Even in the rare instances where the forefoot has been correctly fashioned with the lateral forefoot post described below, the insert is still made to fit snugly against the under-surface of the medial foot, negating any possible hindfoot pronation the posting might allow. We question how the cavus foot can be treated with short, 3/4-length orthoses without any forefoot extension.'

This is exactly what I have been prescribed. They are 3/4 rigid made with some hard plastic that pushes way up on my arches. According to this article, that is not the way to go with high arches. Is this correct for high arches in general?

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/13/01 at hrmin (056635)

There is a major misconception that just keeps getting repeated by certain magazines and it is really confusing people.....high arches equated with supinators or underpronators and low arches equated with overpronators.

The height of the arch is an architectural feature of the foot associated with STRUCTURE-- usually a high upward pitch of the heel bone (calcaneus) and/or a high downward pitch of the metatarsals (bones that make up the ball of the foot).

Pronation and supination, on the other hand, refer to motion, that is FUNCTION, not structure. To simplify things somewhat, pronation is the inward roll of the foot and supination is the outward roll of the foot.

It is thus possible to have a high arch yet pronate too much. It is possible to have a low arch and supinate too much.

Since the action or motion of pronation carries the arch inward and downward, it has often been associated with low arches and supination with higher arches.

A person with a high arch who is an overpronator will need a different orthotic prescription than an over-supinator.
Ed

Re: Just a little confused about high arches...

BG CPed on 8/13/01 at 22:22 (056671)

Well said Dr Davis. Yes it can get confusing. And I would respectfully say any Dr that claims the shoe doesnt matter, its the orthotics need to go back and get some C E points and take some orthotic theory and fabrication courses. If you build a 3 million dollar mansion on beach sand does it matter what the foundation is cause the house is so expensive?

It is best to get shoes at a place that has salespeople that know shoes. Dr Davis is correct that you can have a higher arch but still pronate too much, these usually have tight gastroc which will cause the foot to collapse too much due to lack of range in ankle. The real test is the peek-a-boo heel and the coleman block test. This should be as common as taking blood pressure when evaluating a possible cavus foot, but unfortunatly it is not.

An easy thing to do is set your shoe on a table, look at it from behind if it tilts to the outside or the material on the inside of the heel is thicker or harder that is not good for a supinator.

Many supinators have a plantarflexed 1st ray and a heel that tilts outward some. That is why a hard orthotic with a high arch is not good because it just holds the foot in a rigid and unyielding position. A simple analogy is if you were near sighted and they made you glasses that didnt correct but made your vision the same as without them that would not achieve anything. So if you have a true cavus foot and you have a high hard orthotic than what are you doing but holding the foot in a rigid poor functioning position

Unfortunatly I see way too many of these to be an accident or coincidence. Also the shoes that have air in the heel while soft are BAD for supinators, in fact bad for everybody. Not all but most like reebok DMX are too unstable. It may look like a nifty idea but imagine if you jumped on a tennis ball, it would be VERY unstable, it may be soft but too soft is bad. This all may sound confusing, and believe me it takes a while to get a grip on this, I am still learning.

The only thing you can do is seek out knowledge on your own and ask for recomendations. In my opinion there are way too many people out there making orthotics that have no business doing it.

Re: Just a little confused about high arches...

D.Thomas on 8/14/01 at 09:44 (056689)

Out of the 8 doctors I have seen only two of them asked me to walk in front of them. None of them have said anything to me about if I have supination or pronation. And as I stated above, none of them have talked about my shoes at all. From reading certain publications, I just assumed I had supination because of my high arches.

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/14/01 at hrmin (056704)

How many of the doctors were podiatrists?
Ed

Re: Just a little confused about high arches...

D.Thomas on 8/14/01 at 11:20 (056709)

3 of them were podiatrists.

3 of them were orthos.

2 of them were PTs.

1 ortho and 1 PT were the only ones who asked me to walk for them. 1 pod checked (not measured) my FootFlexibility. Everyone else just looked at them elevated and wanted to give me orthotics (Period).

The PT who had me walk was the only one who checked and measured my FootFlexibility. He probably gave me the best exam I have had to date, but I wasn't smart enough back then to know.

I told one Pod that the PT I was seeing was giving me deep soft tissue massage to break up the scar tissue in the fascia. The pod told me, 'You don't have scar tissue, the only way you can have scar tissue is if you have had surgrey.' Is this true? I thought you could have scar issue on the fascia from the injury?

Re: Just a little confused about high arches...

Helene M on 8/14/01 at 13:34 (056725)

Hi D.Thomas. Your pod is incorrect. I've never had surgery and I have LOTS of scar tissue on the fascia. My chiropractor refers to it as adhesions. I am currently having much success with Active Release Technique in breaking up the adhesions. Your PT is on the right track but you might want to look into ART. I had an advanced case of PF/TTS, was barely able to walk, yet I am walking a bit now. 10 years and about 25 doctors later, though not out of the woods yet, I finally have hope of recovering from this awful condition.

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/20/01 at hrmin (057294)

Scar tissue can be caused by surgery or any form of chronic inflammation.
Ed

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/13/01 at hrmin (056635)

There is a major misconception that just keeps getting repeated by certain magazines and it is really confusing people.....high arches equated with supinators or underpronators and low arches equated with overpronators.

The height of the arch is an architectural feature of the foot associated with STRUCTURE-- usually a high upward pitch of the heel bone (calcaneus) and/or a high downward pitch of the metatarsals (bones that make up the ball of the foot).

Pronation and supination, on the other hand, refer to motion, that is FUNCTION, not structure. To simplify things somewhat, pronation is the inward roll of the foot and supination is the outward roll of the foot.

It is thus possible to have a high arch yet pronate too much. It is possible to have a low arch and supinate too much.

Since the action or motion of pronation carries the arch inward and downward, it has often been associated with low arches and supination with higher arches.

A person with a high arch who is an overpronator will need a different orthotic prescription than an over-supinator.
Ed

Re: Just a little confused about high arches...

BG CPed on 8/13/01 at 22:22 (056671)

Well said Dr Davis. Yes it can get confusing. And I would respectfully say any Dr that claims the shoe doesnt matter, its the orthotics need to go back and get some C E points and take some orthotic theory and fabrication courses. If you build a 3 million dollar mansion on beach sand does it matter what the foundation is cause the house is so expensive?

It is best to get shoes at a place that has salespeople that know shoes. Dr Davis is correct that you can have a higher arch but still pronate too much, these usually have tight gastroc which will cause the foot to collapse too much due to lack of range in ankle. The real test is the peek-a-boo heel and the coleman block test. This should be as common as taking blood pressure when evaluating a possible cavus foot, but unfortunatly it is not.

An easy thing to do is set your shoe on a table, look at it from behind if it tilts to the outside or the material on the inside of the heel is thicker or harder that is not good for a supinator.

Many supinators have a plantarflexed 1st ray and a heel that tilts outward some. That is why a hard orthotic with a high arch is not good because it just holds the foot in a rigid and unyielding position. A simple analogy is if you were near sighted and they made you glasses that didnt correct but made your vision the same as without them that would not achieve anything. So if you have a true cavus foot and you have a high hard orthotic than what are you doing but holding the foot in a rigid poor functioning position

Unfortunatly I see way too many of these to be an accident or coincidence. Also the shoes that have air in the heel while soft are BAD for supinators, in fact bad for everybody. Not all but most like reebok DMX are too unstable. It may look like a nifty idea but imagine if you jumped on a tennis ball, it would be VERY unstable, it may be soft but too soft is bad. This all may sound confusing, and believe me it takes a while to get a grip on this, I am still learning.

The only thing you can do is seek out knowledge on your own and ask for recomendations. In my opinion there are way too many people out there making orthotics that have no business doing it.

Re: Just a little confused about high arches...

D.Thomas on 8/14/01 at 09:44 (056689)

Out of the 8 doctors I have seen only two of them asked me to walk in front of them. None of them have said anything to me about if I have supination or pronation. And as I stated above, none of them have talked about my shoes at all. From reading certain publications, I just assumed I had supination because of my high arches.

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/14/01 at hrmin (056704)

How many of the doctors were podiatrists?
Ed

Re: Just a little confused about high arches...

D.Thomas on 8/14/01 at 11:20 (056709)

3 of them were podiatrists.

3 of them were orthos.

2 of them were PTs.

1 ortho and 1 PT were the only ones who asked me to walk for them. 1 pod checked (not measured) my FootFlexibility. Everyone else just looked at them elevated and wanted to give me orthotics (Period).

The PT who had me walk was the only one who checked and measured my FootFlexibility. He probably gave me the best exam I have had to date, but I wasn't smart enough back then to know.

I told one Pod that the PT I was seeing was giving me deep soft tissue massage to break up the scar tissue in the fascia. The pod told me, 'You don't have scar tissue, the only way you can have scar tissue is if you have had surgrey.' Is this true? I thought you could have scar issue on the fascia from the injury?

Re: Just a little confused about high arches...

Helene M on 8/14/01 at 13:34 (056725)

Hi D.Thomas. Your pod is incorrect. I've never had surgery and I have LOTS of scar tissue on the fascia. My chiropractor refers to it as adhesions. I am currently having much success with Active Release Technique in breaking up the adhesions. Your PT is on the right track but you might want to look into ART. I had an advanced case of PF/TTS, was barely able to walk, yet I am walking a bit now. 10 years and about 25 doctors later, though not out of the woods yet, I finally have hope of recovering from this awful condition.

Re: Just a little confused about high arches...

Ed Davis, DPM on 8/20/01 at hrmin (057294)

Scar tissue can be caused by surgery or any form of chronic inflammation.
Ed