Can Adding Stiffness to the Front of a Shoe Solve Certain Forefoot Problems?

My retired partner, Jane Denton, DPM is known worldwide for the Denton modification for oversupination. She continuously used the metatarsal stiffening technique I’m describing here, using 1/16 to 1/8 inch thickness of outsole material. In my experience, chronic pain in the forefoot may find benefit from this shoe modification. When patients tell you that they feel better as the shoe stiffness increases, this may be something that a shoe cobbler can add to a more flexible shoe. I find this should take place on both sides, even if the pain is only on one side, as with many shoe or orthotic modifications we make. We can always remove the added material if it does not prove helpful, or after the need for the increased stiffness passes.

The material thickness used should be 1/16 to 1/8 inch only. This modification may increase someone’s odds of falling due to separating the foot from the ground. Thus, the patient should break this in gradually, and the clinician should keep this in mind when weighing risks versus benefits. In general, however, I find that patients who receive benefit from this modification are pleased that they find relief and that they can wear their “normal” shoes.

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. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com. 

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