Shoe Fitting And Orthotic Modification Techniques To Optimize Patient Biomechanics

This post covers the common steps I use in shoe wedging for severe supination or pronation issues when custom foot orthotics are not adequate enough to affect the desired control or positioning. 

Take the case of a patient who had complications from an ankle fusion, which left her right foot in varus. This had terrible ramifications for her foot and the rest of her body. For this patient, I split the midsole of the shoe with a 10- or 11-blade scalpel, going about two inches deep and within an inch of the toes. Then I stretched the shoe apart to make sure I achieved adequate cuts. I proceeded to employ ¼ inch Korex or grinding rubber that I purchase from JMS Plastics Supply to form my beveled wedge. Leaving the opening in the shoe separated, I glue both the wedge and shoe, and then let them dry for 20 minutes. At this stage, I place the wedge into the shoe and remove the excess material. Super glue seals any gaps.

In other cases, even if the orthotic itself is adequate, fitting the device into the shoe requires some decision-making.

For instance, when I am fitting a wide orthotic device, such as an inverted device, I place my fingers along the distal medial edge and make sure it is still sitting on the base of the shoe. I do not want it to hang up on the edge as that will tilt the whole orthotic device and jam up the first ray.

If that is the case, you have two choices. You can narrow the entire orthotic plate medially and lose some correction. Alternatively, you can take off the distal medial corner only, similar to a first ray cutout, which maintains the original support. 

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine.

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.