Previously, we introduced the concept of pairing custom foot orthotics and shoe gear. One component of shoe construction that has a profound impact on the functionality of a custom foot orthotic is the heel height of the shoe. In today’s society, fashion and style has the greatest impact on most people's decision making process when selecting shoes. However, with the ever increasing awareness of general good health and wellbeing, many people are opting for a more comfortable and possibly less fashionable shoe or boot. Still, creating an orthotic that functions properly in a wide variety of shoe types presents a challenge to the lower extremity practitioner. Variation in heel height is a primary example of this.
Even when dealing with athletic shoes, heel height variation exists. Running shoes may be categorized by the term; “heel to toe drop”, which defines the difference between the heel and the forefoot height of the shoe, and generally varies from zero to 12 millimeters. Also, the term ”stack” is used which is the overall thickness of the platform of the shoe. An excellent You Tube video from RunRepeat explains this very well.
The Ultimate Guide to Heel to Toe Drop
The same concepts can be translated in discussing non athletic shoes with a much greater variation possible. In terms of our orthotics, the heel height greatly affects the pitch or sagittal plane angulation of the device as well as the foot within the shoe. This can consequently affect various common pathologies we encounter in our practices such as plantar fasciitis, arthritic conditions, tendinopathies, as well as ankle, leg, knee and back problems.
A discussion regarding the type and configuration of the intended shoe to be used with the orthotics should be done before ordering the orthotics from the lab. Generally, there is an acceptable range of one inch (25 millimeters) heel height variance (one half inch above and one half inch below) for the orthotic device to be effective in a particular shoe. If the intended shoe has a heel height greater than ¾ inch (20 mm) you should designate that fact on the orthotic order form and the lab can modify the device accordingly.
There are some workarounds to try to expand the range of shoe heel heights an orthotic will tolerate. The use of a heel elevator can sometimes allow the orthotic device to be more tilted forward in a higher heel shoe or boot. Heel elevators are available in 4, 8, and 12 mm in height.
Heel Elevator – KevinRoot Medical
Please note this is different from a heel lift. Heel elevators work well in work boots and western boots, and helps avoid teeter-tottering of the device on a slanted surface. .
Using a more flexible frame material will sometimes allow the device to bend more within the shoe, however you may lose a little motion control and create squeaking. A little powder in the shoe or paraffin wax on the orthotic edges should fix the squeaking. Generally use less arch fill (allow the medial arch to remain higher) in a higher heel shoe. Avoid using a frame filler. If the shoe has a moderate to high heel then you should consider an intrinsic rearfoot post or no rearfoot post at all. In the forefoot consider using a metatarsal wedge or other padding on the orthotic extension.
Varus Metatarsal Wedge – KevinRoot Medical
Metatarsal Bar 1-5 – KevinRoot Medical
Dancer's Pad – KevinRoot Medical
Taking the time to assess the patient’s needs, and articulating reasonable treatment goals will go a long way in preventing errors in your treatment plan. Know how to use the tools you have at your disposal, and imagine success in all you do!
