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I have a 55 year old male patient with a lot of athritic pain in the pelvis and hips, scoliosis of the spine, slight leg length difference (5 mm). His doctor has diagnosed myofascial pain, and prescribed him painkillers.
I am looking at a casted orthotic, with very slight heel raise to address the LLD. The patient is in a lot of pain, but no noted foot pain or callus. My patient asked, "What are the best shoes for my feet?" Suddenly I'm lost for words...are there shoes best for cavus feet?
So far he does not have a lot of foot pathology, the lesser digits are retracted, but can be flexed at each joint. The first ray is dorsiflexed. But which type of shoes would be best?
Pes cavus is difficult because most quality shoes have extended heel stiffener down the medial side not the lateral side.
Dont shop for a brand as each style will vary rather let your client know what to look for, even better refer them to the right shoe store with staff that really know what they are selling.
Three things he should look for
Because the lesser digits are retracted and the Hallux dorsiflexed he will need a deep toe box.
He will need a fairly stiff heel counter to help support that pes cavus foot/ankle
The sole unit, if he can find one needs to be a solid unit(to the ground) along the lateral side at the mid foot, you dont want a separate heel or a scalloped out shape at the midfoot as we are after added support in this area.
With regards to sports shoes, I'm really liking the Asics Cumulus for cavoid feet at the moment as it doesn't have that "crash pad" type design built into the lateral heel couter area. This means it provides a pretty stable heel strike platform with (usually) a fairly nice pronatory moment from that lateral heel at heel strike, unlike something with aforementioned crash pad technology, which tends to collapse and leave the patient (even more?) laterally unstable.
One other thing to consider is Dorsal compression from the shoe, make sure is a lace system but also there is room for the foot, epecially if you adding any sort of device to the shoe which will take up room in the shoe.
Essentially, supinators need shock absorption. Advise thick, crepe-like soles that absorb - not rebound like rubber.
Given that this guy is 55, arthritic and scoliotic I think it unlikely that this guy is going to be interested in sports shoes as such - but if they shock absorb they might be just what he needs.
Further, if the cuboid is taking this guy's weight, the last thing he needs is something hard beneath it. Rather, it is actully better suspended between heel block and 5th met head - simple offloading.
Essentially, supinators need shock absorption. Advise thick, crepe-like soles that absorb - not rebound like rubber.
Given that this guy is 55, arthritic and scoliotic I think it unlikely that this guy is going to be interested in sports shoes as such - but if they shock absorb they might be just what he needs.
Further, if the cuboid is taking this guy's weight, the last thing he needs is something hard beneath it. Rather, it is actully better suspended between heel block and 5th met head - simple offloading.
Things may not be as clear as that regarding shoe foot interface.
We discussed this in the Leg Stiffness thread High arch feet have a higher leg stiffness ie less shock absorption.
The CNS works to regulate leg stiffness, when the foot comes in contact with different surfaces of different surface stiffness it will regulate the leg stiffness through muscle function.
So a higher surface stiffness will lead to a reduced leg stiffness through increase knee, high and or ankle flexion.
The reverse is also true a softer surface stiffness through CNS regulation will lead to increased leg stiffness.
There lots of info in there if your intersted, this of course assumes that the patient has the ability to regulate his leg stiffness, which having reduced ROM may mean that he cannot and soft will work.
Also leg stiffness as discribed by Simon Spooner " is the new Black" so understanding of the subject is growing and the time and things are not totally clear, but is something to think about.
I have a 55 year old male patient with a lot of athritic pain in the pelvis and hips, scoliosis of the spine, slight leg length difference (5 mm). His doctor has diagnosed myofascial pain, and prescribed him painkillers.
I am looking at a casted orthotic, with very slight heel raise to address the LLD. The patient is in a lot of pain, but no noted foot pain or callus. My patient asked, "What are the best shoes for my feet?" Suddenly I'm lost for words...are there shoes best for cavus feet?
So far he does not have a lot of foot pathology, the lesser digits are retracted, but can be flexed at each joint. The first ray is dorsiflexed. But which type of shoes would be best?
From the responses it has been implied that cavus = laterally unstable. I would agree that there is a trend, but you should certainly ask the questions and assess STJ axis position before you try and treat lateral instability. I usually recommend shoes based on STJ axis position. Those with medial axes should have anti pronation shoes and those with lateral axes should not. Most anti pronation shoes will have a mechanism to shift the center of pressure at heel contact more medially to reduce pronation moment. (i.e. dual density midsole)
In answer to the patient's question, my immediate response is get ones that fit. The advice about high toe box for contracted todes and lacing that will allow expansion over the instep. The instep is especially important if you are going to add a lift.
Is it the first ray or the first toe that is dorsiflexed? If it's the toe, use a deep toe box.
Essentially, supinators need shock absorption. Advise thick, crepe-like soles that absorb - not rebound like rubber........
See personally l would disagree with that, no offense meant, that is what your orthosis should be doing, as you have said in the later part of your post,
"...Rather, it is actully better suspended between heel block and 5th met head - simple offloading. "
The reason l say this is the sole compounds that have the ability to "shock absorb" mostly have a life expectancies that wont survive a heavy supinators and can often add to the instability that this client may well have.
If you look at a shoe of a supinator you will find the sole side wall has a lot of crease lines along it at the midfoot, lining up with the cuboid, as it has been compressed over time, the heavier the client the worse this gets.
This is what my experience has shown me, but you may be right?
Best footwear for pes cavus feet?
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