In prior posts I discussed the relationship between functional orthotics and various types of shoe gear. Heel to toe drop, stack, and shoe lasts, and how they affect the performance of our orthotic treatment plans was highlighted. In this post I would like to add a few more aspects to this often overlooked relationship that can either act synergistically to enhance our treatment plans, or work at cross purposes to impede our success in achieving optimum biomechanical control of lower extremity pathology.
Years ago I attended a lecture on running shoe evaluation. The lecturer was presenting the results of a research study of thousands of runners and selecting the best running shoes.. The first 28 minutes of the 30 minute presentation consisted of technical data, complete with complex charts and graphs. Finally, at the conclusion of the presentation the speaker announced that the most important factor in selecting the best running shoe was …..drum roll…. personal comfort! The lesson is patient subjectivity is a critical factor when evaluating how to address the shoe/orthotic relationship. Some people prefer stability and rigidity, others want that barefoot feel. This preference often has little to do with their actual biomechanical situation.
Shoe evaluation should be performed whenever orthotic or other biomechanically based treatment is planned. Look for longitudinal stability by judging the ease at which you can manually twist the shoe, like wringing out a towel. Place the shoe on a counter top, toe downward and push downward to bend the shoe. Does it flex easily, or not? Does it flex at the level where the metatarsal heads should be, or does it bend in the midfoot? Place one thumb inside the bottom of the shoe and the other thumb on the outside of the shoe and push them towards each other. Is there give, demonstrating resilience of the midsole or not? Is the counter broken down or the outer sole worn down? It only takes a few seconds to do all this, yet provides very useful information.
The diagrams below show the basic anatomy of a typical athletic shoe. It is provided by www.shoeguide.org which is a very useful resource when shoe recommendations are needed for a variety of situations. Another valuable resource is the shoe guide from the American Academy of Podiatric Sports Medicine AAPSM Footwear – Running, Training, Toning & Walking Shoes Familiarize yourself with the components of a shoe so can recommend to your patient how to be an informed consumer when they are at the shoe store or when ordering shoes online. Learn about insoles, midsoles and outsoles, counters, lacing systems. Writing a shoe prescription when necessary as well which current models of shoes might best suit your patient’s needs. Have a check list to hand out to the patients with your recommendations. Tell them how to fit their shoes, to check for proper length and width. Advise them to walk in the shoes for a while, on various surfaces to evaluate them properly. Offer to check the new shoes for them if they seem unsure. Spend a little time in local shoe stores, if possible, and learn what is available to your patients.
