Orthotics
Orthotics are devices that allow a part of the body to function better.
Orthotic devices can be divided into ones that:
- Cushion the foot & reduce impact (accomodative)
- Relieve pressure
- Control deformity (corrective)
Patients with supple feet generally have more rigid orthoses to control deformity (corrective inserts); patients with rigid feet have soft accommodative orthoses to provide cushioning.
Cushioning orthoses
Can use Spenco (rubber, closed cells filled with nitrogen bubbles); Plastazote (closed cell thermoplastic foam, fairly fragile) or a viscoelastic material such as sorbothane.
Pressure relieving orthoses
These work by depression of the orthosis under an area of prominence, or by providing support adjacent to the area of pressure.
Control of deformity
Posting can be used for patients with a supinated or pronated forefoot when the heel is neutral. Essentially, if the forefoot is in varus a medial wedge is used; if the forefoot in valgus a lateral wedge is used. This allows the subtalar joint to function in a neutral position.
Shoes
Patients with cavus feet need a shock absorbent shoe with soft uppers.
Patients with a supple flatfoot deformity need a shoe with a rigid sole & a long counter to support the foot.
High fashion foot wear
A 2cm heel ↑ forefoot pressure by 22%; a 5 cm heel ↑ forefoot pressure by 57%.
A man’s shoe typically conforms to the shape of the foot.
A woman’s shoe is usually narrower than the shape of the foot. One study (Frey) found that 88% of women wore a shoe that was an average of 1.2cm narrower than the foot. Societies that are barefoot do not have an ↑ in forefoot problems in women.
Women’s sports shoes should be the same width as their foot, & dress shoes should be no more than ½ & inch narrower.