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Aug 15

Written by: Larry Huppin, DPM
8/15/2011 1:58 PM

 I had an interesting consult call this morning. A client from the Midwest called in and said that she had a 14-year-old patient who suffered a metatarsal stress fracture while running in minimalist shoes. She convinced him and his mother to go back to a standard Brooks running shoe after the stress fracture occurred and he did fine for about six months. He then decided to try minimalist shoes again, and once again developed the stress fracture. Both the patient and his mother are insistent that he will continue using minimalist shoes. They think this is the best way for him to be a successful collegiate athletic.

Our client understands that these patients are quite unreasonable. Some people will do quite well with these shoes, but others have a tendency to develop forefoot problems including stress fractures. Our client spent a tremendous amount of time to try to convince them to go to a regular shoe, but they are quite insistent that they are going to continue with the minimalist one but would like to try some sort of orthotic device.

Personally, I don’t think I would try to make them an orthotic for minimalist shoe because I think it is doomed to failure. However, our client states that she has spent a lot of time educating her patients and even had them sign forms stating that there was absolutely no guarantee that the orthotics would work in minimalist shoes. They still want to proceed and she wishes to try and come up with a prescription for them.

In the past, we have prescribed a number of orthotics for racing flats, another type of shoe where the patient is primarily running on their toes. I decided to recommend a device like those we use for racing flats.

What we recommended was a polypropylene orthoses with:

  • shallow heel cup
  • standard width
  • minimum cast fill to conform close to the arch of the foot in order to transfer pressure off the ball of the foot
  • no post
  • Sport cover to the sulcus in order not to take a room in the toe box
  • cover to be glued posterior only in order to be able to add or modify metatarsal pads and metatarsal bars
  • 1.5-mm Poron extension to the sulcus for cushion
  • metatarsal bar.
I am afraid that this device will not be comfortable in the minimalist shoes or it will move around in the shoe because of the lack of structure of the shoe but I think this is probably the best that we can do for this type of shoe. If I hear back as to whether this is successful I’ll let you know in a future blog.

ProLab clients are encouraged to contact a ProLab medical consultant at anytime if they have questions regarding their patient’s orthoses.

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