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Dress shoes often present the most challenges for both the practitioner and the patients. You can improve your success rate when using orthotic therapy with dress shoes by becoming knowledgeable about types and characteristics of shoes that complement orthotic therapy. This will allow you to assess the probability of successful orthotic treatment with the patient's current shoes.
Have patients bring in their dress shoes for assessment before ordering orthoses. Are they appropriate for orthotic therapy, or are they contributing to the problem? Do they have a removable liner, allowing the orthosis to fit into the shoe? If you have any doubts about their shoes, advise your patients that, although you can make orthoses fit inside their current dress shoes, there is no guarantee that their feet will fit in the shoes with the orthoses. Discuss alternative dress shoes that will allow them to continue their orthotic therapy, and provide a resource for orthotic-friendly dress shoes, such as ProLab's Shoe List. Tell your patients that we recommend that you send their shoes to the lab when ordering dress orthoses, to ensure proper fit. A clear understanding and reasonable expectations by your patients before ordering their dress orthoses generally results in satisfied patients.
How do you manage the orthotic patient with less than "optimal" footwear? Any tips?
Having worked in a CBD practice where the patients worked in the type of jobs where high heeled court shoes were mandatory dress requirements, I have battled this phenomenon (along with, doubtless, legions of my colleagues). I find the court-style orthotic of some value, but I suspect there is a huge element of placebo involved, as I cannot really rationalise how a foot cramped in the high heeled and laterally squishedposition can really function at all!
I have tended towards encouraging plenty of stretches of the posterior muscle groups, and the use of well constructed runners (preferably with orthoses) whenever the court shoes are not required (at home, weekends etc).
It is interesting how many patients will opt to continue with killer footwear and then add surgery to reduce deformity. It's the whole body image thing, kind of bullemia of the feet really. Vanity and peer pressure is a powerful force indeed - about as strong as any aberrant biomechanical force that passes through the foot.
It's certainly easier than it was with the current trend of fashion trainers. I have found alot of my clients are happy to where these shoes to or from work. Most fashion trainers fit an orthoitc that would normally go in a runner quite nicely.
Newalk have a new thong that I have been getting quite a few pt's to try instead of Havaiana's for those living in warmer climates. (Quite common in Sydney to see people wearing their thongs to and from work at the moment)