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Hi all,
Would appreciate your opinions on my query. What type of trainer would be recommended for a patient who has been prescribed orthoses to stabilise foot function. Orthoses were posted to control excessive pronatory forces. Most specialist sports shops recommend a neutral shoe. I however suggest a stability shoe to hold the orthoses properly. My reasoning being that since the orthoses works in 3 dimensions (apparently), the shoe must be able to hold and allow maximum effect of the device.
However this has created conflict with shops and even physios! What are other peoples opinions? I have asked respected pods about this before, but haven't yet received a definative answer. I look forward to some replies,
Regards
Footsoldier
As a mere student I would qualify my answer based on my level of understanding however here are my 2 cents:
It is important to find a shoe which will compliment the control that the orthoses is trying to provide, however I would stop short of saying it has to be either a neutral or "pronation control" type of shoe.
Certainly the standard wisdom which was preached to running store staff used to often be always put an orthoses in a neutral shoe. In my time working in a running store, before going back to study podiatry, I heard this constantly in the technical training we received from shoe manufacturers. At our store we are lucky to have a good video analysis system available (good in a retail sense but not necessarily clinical) and an excellent podiatrist who we work with, from this we have seen many customers with orthoses perform better (i.e. pronate less excessively) when put in a control type shoe, however that is not to say that every customer who has an orthoses get a control shoe.
In answer to your question I don't believe there is a definitive answer just a best combination of shoe and orthoses for each patient. I have certainly seen it written, including here in the arena http://www.podiatry-arena.com/podiat...ead.php?t=4136, that the suggestion that all orthoses wearers should be given neutral shoes is not universally correct. In fact there is a wide gap in the properties, (i.e. stiffness and support) between different neutral running shoes so again I would argue that there is no way to just universally recommend a shoe type.
Regards
Euan
The Following User Says Thank You to Euan McGivern For This Useful Post:
I usually let my local sports store fit the shoes, beacuse their knowledge and expertise with sporting footwear far exceeds mine, and just because one brand does a neutral running shoe, it doesn't mean that another brand's neurtal running shoe is going to feel or function in the same way. Each foot is different and you have to find which shoe will suit this particular foot + orthotic combination. That being said if you have an appropriately prescribed orthotic under a foot, and then add extra correction from a sports shoe (be it medially, lateraly, midfot rearfoot wherever), it will change the function of the device. Certainly some people will require more correction when they are active than with every day activity, and its these people who may require extra posting from a sports shoe, however generally speaking, a neutral running shoe is probably the best way to go. Interstingly enough, I found that with my last pair of running shoes, I had to make a couple of adjustments beacuse I was finding that I was being overcorrected my my orthoses in the running shoes, and was experining pain when running.
Hope this helps?
__________________
Adrian Misseri
B.Pod.,M.Hlth.Sci.(Pod.)
You know.. we could just cut it off.....?
The Following User Says Thank You to Adrian Misseri For This Useful Post:
Each foot is different and you have to find which shoe will suit this particular foot + orthotic combination. That being said if you have an appropriately prescribed orthotic under a foot, and then add extra correction from a sports shoe (be it medially, lateraly, midfot rearfoot wherever), it will change the function of the device
The device will 'change function' all the time, with variations of surfaces, slopes, carrying things, having a sore shoulder, etc. etc.
Is there a shoe that is a constant for every step / stride? Does the shoe provide 'correction'?
Comfort is king - I don't see how a retail store knows more about that than the Patient... the first thing they ask "is it comfortable?". What is the real value of this "expert fitting service"?
Teach your Patients what to look for with footwear fit, and don't be suckered by the marketing...
That is a very tough question which has been answered in many ways. I take neutral with a grain of certain salt because the perfect shoe is much like the perfect wave to a surfer. The perfect shoe this year made in one factory may perform differently next year, made at a different factory. (quality control/materials/design etc etc) Comfort and function are very big things to seek. Does the combination of the shoe and orthotic provide symptomatic relief and afford desireable function?
I am pondering this most every time I fit a patient with the shoe and orthotic (I am a pedorthist so I provide both).
I have experienced that being too dogmatic about staying away from either stability or motion control footwear for patients wearing "pronation controling" orthotics has sometimes set them up for ...I won't say failure...but they do not get the best of avaiable options...and therefore they might never get the best relief. Until they try it anyway and find that I was wrong....
Consider the weight of the patient, the severity of their pronation, activity Listen to them when you ask the questions, "Do you still feel like you are moving in the direction that makes your symptoms act up? A little? A lot? Do you feel over corrected? If you had the perfect support, where would it be compared to where you are now? " Some people can answer this becasue they display trustworthy intuition, and others have not a clue. So I watch them walk and look to see if there is undesireable motion. Trigging the orthoic with a temporary adjustment can make a huge different for some folks.
Best of luck to you.
Sincerely yours,
Freeman Churchill
The Following User Says Thank You to Freeman For This Useful Post:
Good question....and it depends on individual circumstances.
If a patient is heavily pronated with a high supination resistance they will probably be OK in "motion control shoes".
If they have low supination resistance it may lead to excessive lateral wear and even peroneal symptoms. So they may be better suited to a neutral shoe.
It also pays to have some knowledge on sports shoes as to how much force the shoe is going to provide. Not all motion control shoes are the same.
In my opinion there is no "rule" its all individual.
That is a very tough question which has been answered in many ways. I take neutral with a grain of certain salt because the perfect shoe is much like the perfect wave to a surfer. The perfect shoe this year made in one factory may perform differently next year, made at a different factory. (quality control/materials/design etc etc) Comfort and function are very big things to seek. Does the combination of the shoe and orthotic provide symptomatic relief and afford desireable function?
I am pondering this most every time I fit a patient with the shoe and orthotic (I am a pedorthist so I provide both).
I have experienced that being too dogmatic about staying away from either stability or motion control footwear for patients wearing "pronation controling" orthotics has sometimes set them up for ...I won't say failure...but they do not get the best of avaiable options...and therefore they might never get the best relief. Until they try it anyway and find that I was wrong....
Consider the weight of the patient, the severity of their pronation, activity Listen to them when you ask the questions, "Do you still feel like you are moving in the direction that makes your symptoms act up? A little? A lot? Do you feel over corrected? If you had the perfect support, where would it be compared to where you are now? " Some people can answer this becasue they display trustworthy intuition, and others have not a clue. So I watch them walk and look to see if there is undesireable motion. Trigging the orthoic with a temporary adjustment can make a huge different for some folks.
Best of luck to you.
Sincerely yours,
Freeman Churchill
Freeman:
My thoughts exactly. You are a wise man, Freeman.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
In addition to Freeman's excellent response, I have a couple more things to consider. It's true that the shoe fitter is enlisted to ensure that any midsole bias does not interfere or dramatically color the intended performance of the prescription orthotic. Most often fitting with a neutral shoe will provide adequate results, but as Keven states this is not always the case.
My greater concern is over the behavior of the shoe after the patient leaves the shoe fitter. At their base level, athletic trainers function through strategic destruction. Their midsoles absorb impact forces, and over time compress due to these repetitive forces. Alignment of the midsole varies due to the needs of the wearer. Saucony is a great example, as they have four different models, all providing identical upper patterns and TPU shanks, but with varied levels and locations of medial midsole bias. As the shoe is used and ages the lateral rearfoot column of a stability or motion control shoe will deform into rearfoot inversion, especially if the orthotic device has adequate stability considerations.
So it's not simply the fitters responsibility to assess fit of the shoe. careful consideration needs to be made to forecast how the shoe will perform with a prescription device over time.
__________________ Jeremy Long C Ped
Smoky Mountain Foot Clinic
The Following User Says Thank You to Jeremy Long For This Useful Post:
What type of trainer?
Linear Mode
