Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

question for richard.......

Posted by JudyS on 3/25/04 at 21:39 (147798)

Richard, I'm puzzled about how exactly to use orthotics. First, if I have orthotics to accomodate my pronating,high-arched feet, then wouldn't I buy neutral, stabilizing athletic shoes - which would allow the orthotics to do their work- as opposed to buying athletic shoes that are designed for my kind of feet? It seems like using that second kind of shoe plus the orthotics would be overkill and create more problems.
Also, does the orthotic go over or under the insole? One thing
I heard was to not use the shoe's insole at all with orthotics but rather buy a flat, OTC insert to go over (or under?) the orthotic.

Re: question for richard.......

Richard, C.Ped on 3/26/04 at 07:52 (147805)

Ok...now I'm puzzled. haha
You said you have pronating high arched feet. Its early here and I have not had my coffee, but wouldn't that be supinating high arched feet?

When I have people with mega flat feet who need orthotics, I will sometimes put them in a motion control shoe such as the Beast. Why? Well, the inside of the shoe is still flat. When they take a step, their arch still collapses and has excessive pronation. All the shoe is doing is giving extra support on the medial side of the shoe, not your foot.
The shoe does not 'push' you out of pronation. The orthosis in the shoe allows proper arch support so you do not have the excessive pronation.

Now, high arched feet can be difficult. In fact, they are. You do not want any extra support pushing you into a more supinated position. The high arched foot mostly is rigid. You pretty much want support, but good cushion as well.

I do not suggest any type of insole while using an orthosis. Reason being, if the orthosis sits on top of the insole, the weight of the person along with the cushion of the insole will allow the orthotic to 'sink' and not be properly supported. This could throw everything off. The orthosis should sit flat in the shoe. The 'sinking' could cause the heel to be unsteady.

I would not put anything on top of the orthosis unless it will properly sit on it. That sentence sounded weird, but I can't think of another way to say it...haha. I have added material to customers orthotics, but i heat them and properly glue the cushion to the orthosis.

I hope this helps in some way.

I need CCCOOOFFFFFFFFEEEEEEE

Re: question for richard.......

elliott on 3/26/04 at 08:27 (147813)

Richard, good comments as always. The shoe guru at Runner's World has always said the same as you about sticking with a flatfooted overpronator sticking with a motion control shoe when getting orthotics. Yet a sizeable number of runners who get orthotics complain that the combo of orthotics and MC monster shoe seem to overcontrol their problem. They often end up going down to a stability shoe.

Re: question for richard.......

JudyS on 3/26/04 at 10:24 (147820)

OK - now I need coffee!
Yes, believe it or not, I have high arches but also overpronate a bit - a lethal combo if you ask me - and my Pod.
Also, I was thinking about the construction of most insoles of athletic shoes - don't the insoles themselves have a fairly well-defined arch cushion? It seems to not be a good idea to combine that arch-cushion and an orthotic........but then, I'm no expert and that's why I'm asking!

If you do not recommend an insole at all when using an orthotic - how would you accomodate the forefoot if the orthotic is 2/3 or 3/4 length?

Thanks for your comments :)

Re: question for richard.......

Richard, C.Ped on 3/26/04 at 11:47 (147830)

I did some reading and I came across your foot type. I might have seen that before, but I can not remember.

Most, if not all, athletic shoes I have seen, only have a small lumpy, bumpy thingy (are you amazed at my technical terminology???) is on the insole. That really does nothing. It does have a little cushion, so I agree with you that it is not a good idea to combine the two.

For this very reason is why I do not usually make 3/4 length orthotics. I have worn them myself and know how uncomfortable it is to your toes. Also, to accomodate the forefoot, you do not need the toe area on the orthosis. If any part of the forefoot needs accommodation, the posting will be added to certain areas of the ball of the foot. Example, if there is forefoot varus that needs attention, the posting will go underneath the first met head.

Hope that helps.
BTW: the coffee was good. I need more because I just at a turkey sandwich from Arbys. Man those things are good.

Re: question for richard.......

JudyS on 3/26/04 at 12:52 (147842)

It's late in the morning.........think I'll switch to Diet Coke! Thank you so much, Richard, for your patience with me! May I presume upon it to ask just one more question? My question about the forefoot and 3/4 length orthotics wasn't about support or control for the forefoot....rather, if one removes the shoe's insole altogether in order to have only the orthotic in the shoe, then the forefoot is forced to rest on just the bed of the shoe with no cushion, per say. That tends to leave it exposed to the shoe's stitching, rough edges and maybe too much room in the toebox. That's why I was wondering about it. Do I make any sense? If not, well, what's new!

Re: question for richard.......

Richard, C.Ped on 3/26/04 at 13:52 (147862)

Yes, that is what I put about be not liking the 3/4 length. It is uncomfortable to the toes. I like to make full length for that purpose.
:)

Re: question for richard.......

JudyS on 3/26/04 at 15:01 (147870)

Thanks again, Richard :)