using custom orthotics: a question

Has anyone told you that your heel is narrow? My superfeet insoles are smaller or shorter than the regular foot bed and slide back and forth easily in the empty shoe, but is held tight with no play when the shoe is on.

No… but Ive never asked anyone for their professional opinion on my heel, although I've had my feet examined. Relatively speaking they are narrow… but I'm wearing the orthotics in the same shoes I've been using. So it's just strange to have this issue suddenly come up and have my heel slip around.

I have custom orthotics which have a relatively slippery leather surface on top and I have not noticed any significant slippage. I wore them last summer on the Wonderland Trail with Montrail Continental Divides without incident. Have you tried using the marathon lacing system which helps to pull the heel in more effectively?

Maybe this is what Dave refers to:

http://outdoors.webshots.com/album/560037058HbALMt

Hmmm. Well, right now I’m doing the lacing for a high instep and have the laces through the very farthest possible eyelet but I might have to do the loop lacing lock too.

Which means I definitely need longer laces!

lacing examples

Yes, the loop-lacing lock is what I mean by the marathon lacing system. I'm glad you had a picture because I have been thinking about how to explain the process in words… I really like the system and find that it also helps keep the laces tied although a double-knot will do the trick also. I have never had to get longer laces in order to use the system.

What is the top surface of your orthotics? I've seen plastic, leather, and fabric. Mine are fabric with a neoprene foam layer – similar to a Spenco insole. When I first got them they had just the plastic skin on top, and that was slippery. I talked to my podiatrist, and he suggested adding the fabric/foam skin. I have to have the top skin replaced every couple years, but it works very well.

…

Despite your shallow shoe working better, overall more heel slip indicates a need to buy shoes w/more attention to heel cup. I've been wearing custom orthotics for ~20 years now, and always take them w/me to try on shoes/boots. Despite having a deeper heel counter, some shoes still slip more. Boxier heels, cups that don't cup as much, less effective lacing, and so corth. General contour of the heel counter. Not so much of a brand thing as a personal foot-fit thing…

Another option is to re-train your feet to not need orthotics. After being prescribed orthotics due to Patellar-Femoral syndrome (knee pains), I bought various different orthotics depending on my shoes. Initially they seemed to help, but after time, everything started to flair up again.

Last summer I went to a different doctor (MN Vikings Sports doc) and he looked at my issues as more of a muscle imbalance than a need for orthotics, prescribed some PT and sent me on my way. This sent me down a road of research on why the muscle imbalance?

At the time, I was unable to run more than a 1/2 mile without severe pain or hike more than 6 miles without relying heavily on my trekking poles.

Late last summer through my research, I discovered that maybe it was my shoes and how I am walking and running that is causing the issues. Here are a couple articles that I came across:

http://nymag.com/health/features/46213/
http://treklightly.blogspot.com/2009/12/painful-truth-about-trainers-are.html

Last fall I started running and training in a minimalist shoe that offered no support, no structure, and no padding. I bought a pair of Vibram Fivefingers, put them on and went for a 3 mile run with no pain. Granted I was forced to run very different than I used to, but that was the whole idea. My calves were super sore and my achilles were really tight for about a month during this transition, but I could deal with that kind of pain. The minimalist shoes were allowing my feet to function the way they were designed to.

It didn’t take too long for me to realize that my orthotics and structured shoes were not allowing my feet to function properly. They were like casts for my feet. In fact, wearing the orthotics and stiff shoes quickly became very uncomfortable as my feet got stronger and wanted to be able to move. I have since discarded all my orthotics, and rarely wear a shoe with a raised, padded heal.

I do hike in a pair of Inov8 295’s with the insole removed, but they have no arch support and have a minimally raised heal. I wear them primarily for the traction as there are not very many options out there for a minimalist shoe with traction.

That’s my food for thought. Wouldn’t it be nice not to have to wear the orthotics??

+1 on the minimalist footware

every since bailing on the orthodics and inserts and moving toward less cusioned shoes and eventually to the VFF KSO's I have not had any knee pain.

I will stay away from them for the rest of my life! I also convinced my 63 year old father who has been in orthotics for longer then i have been alive to bail on them and he cannot believe the difference! If we were meant to be wearing shoes we would have been born with them on IMO.

cheers!

I've really struggled with shoe fit for a while now. Not a cheap dilemma!

The inserts are the foam ones with a layer of almost vinyl looking plastic on top.

I do think I need to shoe shop more. Bummer. But I will be playing with the lacing. Not sure why my laces are so short – maybe it's a mizuno thing?

And Jeremy: while barefoot does intrigue me I want to see how these work because if my arches do collapse, then that is directly contributing to the muscle imbalances. I can try and strengthen certain areas but as long as the arches keep collapsing, I'm still going to have an imbalance in how the muscles are used. So it's a tough call. I don't really know how I'd prevent the collapse.

I did PT and we did a lot of strength exercises. In an ideal world I'd be able to come up with the perfect strength regimen… but for now I don't have the time to try barefoot. I hear it takes a long time to transition carefully.

I’ve worn orthotics for years now and when I started I had the same problem. The fix that I found was that my orthotics were made wrong for what I did in them.

Most Podiatrists build orthotics with a wide heel cup for heel striking while walking in street shoes or running (in the really bad form that we see in Nike commercials). I sent mine back several times, arguing with doctors who had little to no idea about what they were doing. I finally sent myself to school to learn how to build custom foot beds for ski boots. After building skiers custom foot beds for several years I had another pair of orthotics built for my running shoes. This time though I was armed with knowledge. The doctor I found did not have a raging ego and was willing to listen to what I knew and understood. I have sense had a pair made that supports my fore foot (I am fore foot varis) but also reduces pronation, supports my instep and have a nice “narrow” heel cup so my shoes can do what they’re supposed to do.

In short, my advice to you is; find a Podiatrists who is a runner with bad knees (preferably also a skier, they understand the hell that is heel lift). With any luck he/she will just need to take the excess material off the heel.

> because if my arches do collapse,
Ah, but that never happens to anyone who can walk more than a mile or two. Your feet are just not built that way!
The whole Nike 'arch support' concept is a total biomechnical farce. It's pure marketing spin and has no place in any walker's real life.

Cheers

Angela,

Yes, you definitely need to transition slowly. I started out walking around my house and yard barefoot all of last summer and then when I bought my vibram fivefingers last fall I went for a 3 mile run which was way too far! My foot muscles and calf muscles were very sore and my achilles were strung tight for a very long time. I am used to it now for the most part although I still can feel my feet getting stronger as I increase my miles. I put on 32 miles of running last week in my fivefingers including a 14 mile run on Saturday and I feel great!

Whenever you are sitting around, take your shoes off and do various foot exercises to strengthen your feet. If you keep building up your foot strength, I think you will find your orthotics will become uncomfortable as well.

Yes, it will take time and you will need to be patient, but the delayed gratification will be worth it! I feel like a kid again going around barefoot all the time!

You're not alone.

I wear orthotics and haven't found boots that lock the heel down and feel comfortable. I've tried on 50-100 pairs of boots, taken home several to try out inside at home and taken them back, and had several that I've tried out on the trail and not had those work out. (Thanks, REI, for letting me return them.)

I have a pair of Merrell light hikers now that fit pretty well, except that the foot rubs against the top, causing circulation to be cut off. This happens in as little as 15 minutes. I also have a pair of Zamberlans that I hike with once in a while off trail. They fit the best out of all the non-light boots that I've tried, but the top of my foot still gets bruised. My toenails also get somewhat beat up. Maybe the foot moves around in the boot more than it should.

I've tried having the boots on really tight and much less tight. I've also experimented with some different lacing techniques.

I wonder whether the stuff going on at the top of my feet is because the orthotics cause the foot to ride higher than what the boot is designed for. I'm thinking about investing in custom boots, e.g., Esatto or Van Gorkum.

I have a pair of inserts from good feet. I have to use a foam insert over them and take out the insert in my trail runners.

I also have a pair of merril trail barefoot shoes.

I have found that I simply cannot wear the barefoot shoes for long miles. For whatever reason the bone under the connection of my little toe to my foot starts to hurt severely around 12 miles, then it gets worse from there the next day.

If I wear my insoles, I dont get that pain.

As far as my feet getting stronger, I agree the barefoot shoes are great, and I wear them at work and around town, but just cant put the miles on them.

Great reply's everyone. It is funny how we want to custom this and that. I am in same boat.

I really like the idea about how natural our feet are alone with no issues and put them in shoes and all of a sudden problems.

This has also been a long tedious process for me to find insoles that save me knees. Still looking around. trying sol now and if not than custom orthotics or try the VFF approach.

from what I understand people did not have problems when not using shoes.