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Aug 8

Written by: Larry Huppin, DPM
8/8/2011 1:47 PM

I spoke with a ProLab client today regarding a patient who is having trouble with her new Cobra orthotics. They had been made to treat pain associated with Morton’s neuroma. Whenever she wore it in her shoe, she felt like her foot was slipping out. When she tried it with a larger shoe, she felt like her foot was slipping excessively in the shoe.

The doctor had sent the shoe to the lab when he had the orthosis made, so the orthosis did fit the shoe very well. The only problem occurred when she put her foot into the shoe.

This is an issue that you should warn your patients about. Even when a shoe is sent to the lab and the orthotic is fit directly to a particular shoe, there is still no guarantee that the patient’s foot will then fit into that shoe. I warn all of my patients that I cannot guarantee that new orthotics will fit into any shoes they currently own, and it is likely they will have to get new shoes to work with the orthotic devices.

One study I read a number of years ago stated that about 80% of Americans wore their shoes too small. If this is the case, it is unlikely that an orthotic will fit into those shoes.

On further discussion with our client, it seemed like this was not the issue. This patient spent a number of hours at a shoe store trying on the orthotics with many different shoes and still had trouble. I asked if she might have an extremely narrow heel and he stated that she did. This is another type of patient who sometimes has trouble keeping the shoe on when you place anything inside the shoe.

In this situation, our goal is to make the Cobra orthosis absolutely as thin as possible. This doctor does not have a grinder in his office so he is going to send the orthotic back for adjustment, but if you have a grinder available this adjustment only takes a few seconds. My recommendation is to simply grind the EVA of the heel portion of the Cobra orthosis and then grind the polypropylene at the heel so it is extremely thin. Infact, the lateral portion should be almost paper thin. We can remove a small amount of EVA from the arch to further decrease the bulk of the orthosis. This should allow her to fit more in the shoe and decrease the heel slippage.

Finally, if this is still a problem you can peel up the Vinyl and foam layer on the interior of the dress shoe. Even in dress shoes that do not have removable insoles there is usually a layer of Vinyl and foam that takes up about 1/8 inch of thickness on the interior of the shoe. Simply removing this can provide enough room so that the orthosis sits lower in the shoe and foot does not slip out.

If you are ProLab client and have any questions about orthotics for dress shoes, please contact one of the ProLab medical consultants.

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