Correcting common foot problems

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dw
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Re: Correcting common foot problems

#276 Post by dw »

Paul,

Not to confuse things too much, if I were you I double check the heel to ball measurement as well. I like, and always feel more confident, using 8/12th (Sabbage) of the SLL rather than 7/10's. So I know or measure the length of the last and divide it by 12. Multiply by 8 and that's the spot that should socket on the center of the medial ball joint on the foot print. This nearly always means that I am gonna use a little longer last...which will affect the short and long heel.

Combine that with removing or simply relocating the instep girth build-ups so that it is not on top of the cone and you can sometimes surprise yourself at the way the heel measurement and the long heel measurement can be increased without throwing off the instep girths. Which in turn may mean that you won't need any heel build-ups.

That said, sometimes building up on the sides of the heel is indeed the only way to alter the short (and long) heel. But it has to be indicated...or at least "allowed." If the the last, with or without the build-ups on the side of the heel, overhangs the tracing, I would be cautious...actually I would be suspicious is what I would be.

Even if you make the tracing with a tracing device (nevermind a vertical pencil) the last should never be wider than, or overhang, the tracing.

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Re: Correcting common foot problems

#277 Post by paul »

DW,

I guess I just have to admitt I've been using lasts too short. Too many have needed to be built at the heel. On OLGA, I've been plugging in a number 20mm over the heel to toe measure, and building up from there. Clearly too short.
It's plain to see that has been part of some of my problems. That extra length would be reflected in the heel measurements. I compared another pair I'm about to do which I have as a 9.5B and it could've (should've) been 11A. I'll make that change for work going forward.

I understand a buildup should not extend outside the tracing line, and I do try to keep inside that line with fittings. Again, admittedly this pair we're looking at does creep over the line a little,
11089.jpg

I can see this would create too much room in the heel.

It also makes sense to me that moving the instep girth buildups under the arch when called for, will maintain the heel measurements, long or short.

I meet with the customer for remeasure this afternoon, and will reacess what I've done.

Rather than be discouraged by this significant error in my choices for last size, I'll just be thankful to be corrected.

This has been helpful.
Thank you very much.

Paul

So you see boys and girls, there's way more to this than meets the eye.
As my old friend says, "too soon old, too late schmart".
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Re: Correcting common foot problems

#278 Post by fred_coencped »

Paul,
The flat foot can splay up to 2 sizes in length,more or less.Supporting the foot statically and dynamically will block unwanted motion in the entire foot,ankle ,knee and hip.
The cowboy boot,I view as an entire different animal then the shoe,but weight bearing or even horse back riding as an IN Line activity,like skating,skiing or bikeriding ,if weight bearing forces are on an overcompensated medial column or pronated foot,then the foot in my perspective is a loose bag of bones.

If the foot is held in a neutral or mildly supinated position then the foot structure is more solid and rigid.Ant the foot can adequately pronate and resupinate in the gait cycle.I view the medial heel and lateral arch support as integral functional foot structures.

The cowboy boot removable orthotic only requires 3/4 length without extra depth in the last.Or in the case of a full length device extra depth in the last.Lateral ,medial and transverse arches are supported and especially the medial heel.Metatarsal issues do require full length and extra depth in the last in balancing the forefoot.especially with the higher heel heights and weight pressures on the ball of the foot.

I would like to caution extra arch length in compensating for the splayed foot.Arch length and foot length measurments,sitting and standing will reveal itself.
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Re: Correcting common foot problems

#279 Post by dw »

Paul,

This is why I've always said that "being a bootmaker is dead easy--it's just muscle memory; being a fitter is where it gets hard."

It is a balancing act in three dimensions...a change in one dimension will affect the other two just as surely as it does in carpentry or geometry. In fact, thinking about geometry provides an insight--we are not ever just dealing with a length or a girth, etc., we are dealing with volumes. IE....length times width yields the area but length times width times depth equals volume. Thinking about modifying a last in terms of volume is the key, I think.You have to deal with, and juggle/balance, a number of parameters all at once.

But there is an element of over-thinking that can creep in as well...as in this case, where although the OP admittedly probably posted his question in the wrong discussion, the crux of that question was about fitting the last to the foot. A point the OP reiterated.

Just because one has a hammer does not mean that all problems are, in fact, nails.


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Re: Correcting common foot problems

#280 Post by dearbone »

DW, likewise i say "Shoe making is easy" and even pattern cutting can become second nature,But fitting the foot,that is selecting the correct last for the foot from measurements that can produce well fitted shoe/boot is the hardest for me and as a bespoke maker,taking measurements out of necessity is most important,so i take as much time as possible to measures,take imprint,take a picture/s of the feet if necessary and study the foot.
I really like the "Hammer and nails" analogy.Image

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Re: Correcting common foot problems

#281 Post by paul »

Fred, Thank you.
I will contemplate the cautions you mention.
I think I understand what you describe regarding CB orthotics. I've seen them before. I will talk to the customer about them.

DW,
I think I get what you're saying here too. And I think that's what I've wrongly done building on the sides of the heel section at times.
I've often done the same thing up in the forepart to get volume. But then I suppose here it's a good thing, where as in the heel it could cause slippage in the heel, if not too much slack over the instep. Thank you.

Nasser,
Thank you too. I have taken a few pics of customers feet and should make a habit of it. I can see it's benifit. I've definetly got to start spending more time was unusual imprints such as this one.

Paul
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Re: Correcting common foot problems

#282 Post by paul »

Well Friends,

By now I am well into the footwear for my flat footed friend. Image

The second fitters met approval last Monday, and I've gotten started on his order. It's been a slow go around home this past week however, as my wife has had some medical issues. All is well now, and I can get back to work and get these done.

It would indeed appear the customer has a "healthy flat foot", as DW described his own. I was all very open about the challenges of fit with this customer. He's a prominent heart surgeon here in Arizona, so I found it easy to just be frank. He assured me that he has no issues with his feet at this time. I explained that my Pedorthist friends were concerned he may have issues in the future, and he will keep that in mind. I explained that applying attempts at corrections was outside my current scope as a bespoke bootmaker, I just wanted to make a comfortable pair of boots for him. He is comfortable with that and told me that he felt very good in the fitters.

Lengthening the heel-to-ball by adding to the back of the heel, and moving the instep buildups to under the arch, were very helpful. But a conversation with Spider Daley, formerly of Paul Bond Boots, produced another key to this quandary for me. He suggested that since there is often a lack of muscle tone in the flat foot, he finds success pulling the tape a little tighter when measureing, as one would for fat feet. So I reduced the instep measures by a bit and removed the buildups from around the heel section. I also reduced the throat measure on the top patterns by additional 1/4".

So I'll continue to continue and will share the results in the Gallery in a week or so.
Thanks once again to all for the help and support on my journey to be the best boot maker I can be.

Paul
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Re: Correcting common foot problems

#283 Post by courtney »

I have been experiencing pretty much chronic pain in my neck for years now.

I have been to a podiatrist, osteopath, a little to a chiropractor, and now I am seeing a chiro again tommarow.

the osteopath said I have tilted hips and need to wear heel lifts to compansate which I did for about a month, I didnt get to the height he recommended yet which is 7/16". I just took them out last weekend.

when I saw the chiro today for a consultation and they asked why I took them out, Which is because I assume tommarow they're gonna say I should put them back in.

So, my question is, Would lifting the heel 7/16" not mess up my feet putting all that pitch on my metatarsals?

If it would be better to have a full sole lift what do you think would look less awful, building extra depth into the shoe or having a taller sole on the outside of one shoe?

Any comments greatly appreciated.

Courtney
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Re: Correcting common foot problems

#284 Post by large_shoemaker_at_large »

Courtney
I to have severe neck pain. Can't sit an last shoes for 15 minutes till an arm goes numb.

I finally got to see a nerosurgeon. Disc and vertebrea C 3,4,5 are mussed up. A fusion is inevetable ( oh fun).
It may be the position we shoemakers work in.

Go get an xray done.
For what it's worth I took a nasty hit and run off my bicycle and got rear ended 3 times in 3 years. So It all adds up.

Add a lift out side the shoe if you must. If the twisted hip is a true issue the body does not care the tilt of the heel.
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Re: Correcting common foot problems

#285 Post by fred_coencped »

Courtney,
Assuming your chiropractor and osteopath are correctly diagnosing an "LLD"[leg length discrepancy].It is anatomical,acquired or possibly congenital.The pelvic rotations may be anterior on one side and posterior on the other.Is there a tilt at the sacral base?Is there scoliosis and compensation in the lumbar,thoracic and cervical vertebra?Understanding fully your diagnosis is very important in helping yourself.

Cranial Sacral therapy would be my suggestion.for you as a second opinion.You will probably find with the pelvic rotational torque at the sacral base is where the LLD is originating and your chronic neck pain is manifesting.There is a cranial pulse or wave through the cerebral spinal fluid from the cranium to the sacrum.Any kinks or compression in the spinal column will affect more then just nerves.

Answering your question,yes lifting the heel 7/16" internally will put additional weight on the metatarsal heads and lift your foot out of the shoe,it is too much.And adding the 7/16ths lift to the outside heel will drive the back of the heel into your achilles tendon,material is needed under the ball of the foot.The amount is subjective.

You should build up slowly about 1/3 of the total at a time for 1 month .By the 3rd month to arrive at your goal,only the age old method of trial and error remains.For instance if you prefer the pitch of your shoes to remain equal,your lift is on the outsole.If the 7/16" is under the heel and the ball,your foot and the shoe will not flex and a rocker sole is incorporated on to the forefoot.Therefore the front or distal aspect of the shoes sole is reduced from the ball,fulcrum or treadline of the build up to about 7/32nds at the toe or less.It is important to consider the angle of progression to determine the line where your foot rolls forward at heel lift.

Normally a shoe can tolerate a 1/4" internal heel lift without the foot lifting out of the footwear like a piston.As an alternate approach to arrive at 7/16ths",if the remaining 3/16ths is added in the heel and ball and deminished to 0" at the toe you will still have a rocker sole but with some flexion.This may be an appropriate formula.

If you were to make a shoe,your overall formula could look like this,7/16" at the heel ,7/32" at the ball and 0" at the toe.Or you could add 1/4"full length spacer to your last and add the rest to the outsole to your preference.

Consider how your body got to where it is,whatever pathway you can take to Unwind your body,such as physical therapy,Body Work such as Rolfing,Osteopathy,Cranial Sacral,etc.Try Yoga or Tai Chi and most of all get the best diagnostic insight before settling on the heel lift and supporting something that may make matters worse.There may be other bio-mechanical issues at large here in your feet not yet discuused.

Best Wishes to you and I hope this helps.

Fred
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Re: Correcting common foot problems

#286 Post by relferink »

Courtney,

It's not completely clear to me if you have heel lifts on both heels, I think that's what you have based on your description, or just on one side.

If it is on one side and to compensate for a leg length discrepancy I would recommend a full shoe lift, heel to ball with the toe "rolled". This to prevent the Achilles tendon from tightening over time and to keep the pressure on the metatarsal heads normal.

However if the heel lift(s) are meant to "tilt the hips" you should stick with the heel lift as it's impact on your posture is probably what the doctor is after. As for the best way to do it, unless you wear a boot you will have to add it to the outside of the shoe, short of making your own shoe over the buildup.

I would in general caution against the use of heel lifts without any form of a custom orthotic or footbed to stabilize the foot. A "side effect" you experience when lifting the heel is instability in the ankle, if you try to adjust any misalignment in the body the last thing you want is instability in one of the joints along the way.

Without knowing enough about your specific case I can only go on my prior experience and have found that the "basics" need to be addressed before anything else, check and correct leg length discrepancies, excess pronation or supination, the position of the knees manifested in bow leggedness (sp?) or knock knees. If the problem is diagnosed to originate from the hip an orthopedic surgeon or Physiatrist (non surgical) would be my first choice for advice.

Hip rotation and tilt is a very complicated subject matter with major functional implementations, easy answers are not always readily available and sometimes trail and error is the only way. Considering that you wore lifts for a month before discontinuing makes me think they were not doing much for you or you would likely have continued cause "it felt better than without".
Check with your Chiropractor if he/she thinks that a month should have given you an indication, if so look for other possible causes.

Rob
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Re: Correcting common foot problems

#287 Post by courtney »

Brendan, Fred, Robert,

Thank you so much for your input!
I will have to re-read these posts a few more times to digest them.

The lift is only on one side. Today I went to the Chiro and they showed me xrays of my hips with markings that indicated there was something like 3/4 difference I dont remember exactly.

I have a lift in now that is about 1/2 in.

when I wore them before i had about 5/16" which was 2 lifts sitting on top of my orthotics. I took them out cuz I was hoping they would say I could straighten my spine out and correct the leg lentgh. they did'nt say that.

I took my orthotics out and just have the one lift in which is less annoying.

As far as I know my hips are not rotated just one is lower. They said I was probably born with the short leg.

Anyway I will read these again and thank you.

Courtney.

Also, I just recieved the HCC list with my dues envelope and I was happy to see my name but I am not Ms. I am Mr. just to clear up any confusion.
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Re: Correcting common foot problems

#288 Post by jask »

Courtney, The leg length discrepancy is a difference from one legs length to the other- spinal manipulation will never change the fact that one leg is longer.I have done many external shoe lifts over the years and 1/2 to 3/4 is really easy to conceal on many types of footwear- more importantly you will find that the strain on your legs hips and spine that you now have to live with will no longer be an issue.I have had many patients that could adapt to additions of 1/4" per week with no problems or discomfort.
If you are unsure try this- pick up a cheap pair of waffle sole sneakers with an eva midsole and a piece of cloud or eva midsole (1/2&#34Image
You can either use a heat gun and try to soften the glue bond on the sole or just cut it away as close to the sole as you can, rocker the front of the lift as Robert described and glue (it first to the shoe than the lift to the sole, don't try to glue both faces at one go..)
a couple tips the tapered front of the rocker does not need to go to the very tip of the shoe - it can be held back 3/8ths to 1/2" from the front.
the start of the taper should be under the 1ST met head or ball of the foot and the transition does not follow the line of the met heads...(it should be perpendicular to the long axis of the shoe, otherwise it will force your ankle/midfoot to roll the wrong way after heel off )
it really helps to have a vice when you cut off the sole- if you secure it with the toes pointing down and start the cut at the heel you can then grab the sole with a pair of pliers and lightly pull while you continue to cut away through the eva just above the sole.
give it a try, for very little time and money you can feel what it is like to have your hips and back in proper alignment!!
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Re: Correcting common foot problems

#289 Post by fred_coencped »

Courtney,
A band saw with a 4X4 held to the sole of the footwear enables a pretty even cut on an athletic shoe,add your build up with the forefoot rocker bottom and replace original outsole,add your orthotics and you are ready for your test drive.Try to keep the heel as broad based as best you can for rearfoot stability.Maintaning a lateral flare also stabilizes the foot, leg and hip during midstance as the hip is externally rotating and the foot begins to resupinate from heel lift to toe off.

Whatever your line of progression that is natural depends on the available internal and external range of motion in the hip.7 degrees external angle is generally considered normal.Most lasts are about that.The trial and error routine will tell you.

For your build up 55 durometer soleflex is light and dense enough,but for heavier clients,65 durometer is better to overcome compression.

Fred
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Re: Correcting common foot problems

#290 Post by courtney »

Jask,
It sounds like you are giving me some real good information, but I got alittle confused when you said

"pick up a pair of waffle soled sneakers with a eva insole and 1/2" crepe midsole"

Could you try and say it again so I can make sure I understand?

Thank you so much,

Courtney
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Re: Correcting common foot problems

#291 Post by jask »

sure!
I am talking about the inexpensive sneakers that have a thin tough outer sole with a soft spongy midsole of EVA material similar to this:
http://www.shoemall.com/assets/product_images/styles/medium/621606GAR1R.jpg
because the tough wear surface of the sole does not wrap up around the sides it is easy to see where the layers are and cut them apart.
once you have "skinned" the sole from the soft midsole you can then add your build up ( grind the taper for the rocker before you glue the build up on..)and then reglue the wear sole to the added material. The added material can be any form of soling crepe but EVA types like Cloud are light and easy to work. if you do not have any material like this, most well stocked shoe repair shops should be able to sell you a single soles worth.
Fred is right about the bandsaw trick but I would not recommend this to anyone who has not done a few of these first, the saw is unforgiving and some shoes have VERY little material under the ball of the foot.
Fred, my preferred method is to use a cast saw to make the cut just above the sole from the heel forward to the toe or the ball if it is really thin I then slip a skiving knife in to cut the narrow strip in the middle and end up with a very flat and even cut that allows a pair of lifts/rockers/wedges..etc in about 15 min.
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Re: Correcting common foot problems

#292 Post by fred_coencped »

Jask,Courtney,
Cloud is too soft,45Durometer for a lift and is unstable.And the bandsaw cut works well for me from the start of many build ups.
Soleflex is a EVA/SBR blend and forms easily with heat and a 1/2" build up will form nicely to the forefoot to maintain the original toe spring of your shoe.Convection ovens are excellent about 300 degrees F and a heat gun is ok too.

Sometimes I will replace the original outsole with a compatible unit sole or sheet material to provide a more stable wider rear and midfoot sole.

Fred
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Re: Correcting common foot problems

#293 Post by last_maker »

For those of you who are interested in calcaneal posting ( meaning lifting either the inside of the heel or the outside to create a balanced foot for shoe making) on your lasts or orthotics, and examining forfoot valgus or varum as a possiblity to shoe fit problems and posting the forfoot area, here is very interesting artical that I discovered. Check it out!

http://view.mail.presentelearning.com/?j=fe6615707367037e7717&m=fefb117077610c&l s=fdef16777d6605757112717c&l=fee91d79766c0d&s=fe2217757d60047a771379&jb=ffcf14&j u=fe5f1d727166007e7110


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Re: Correcting common foot problems

#294 Post by courtney »

So, my latest quandry.

I made a soleflex heel lift that tapers from about 1/2" at the heel to about 1/4" at the ball and close to 0" at the toe. Like Fred said.

This is resonably comforatable and fits in my high top sneakers fine.

I have been working on some new chukka boots that are almost ready to be lasted when I realised my new lift will not fit cuz i didnt have it when I started these.

So, my question is,

How would I go about making this fit?
I am thinking I should add extra lasting allowance to my uppers, tack the lift to the last,
then add my insole on top of that.

My main question is though, like Rick posted about following the curve of the back of the last.

If I make the lift angled at the heel curve, then the insole following this it seems like thats going to be a pretty big curve under with the 1/2" heel lift.

Hope this makes sense,

Courtney
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Re: Correcting common foot problems

#295 Post by fred_coencped »

Courtney,
The lift I described should be on the outsole.I recall you had orthotics and with an internal lift added you are well passed the extremes for your foot to have enough room.

In the case of your chukka boot.in essence your lift becomes a spacer.The net difference on your last become 1/4",heel to ball and especially with the chukka boot you should be ok with the back heel curve and also with the toe spring.You should also concern yourself with sufficient depth for your orthotic.

And naturally your last allowance is increased.

Make another lift/spacer for the last bottom,perhaps add the additional 3/16" to 1/4" seperate spacer to accomodate your orthotics left and right.

Generally tack your insole and spacers all at once and trim.For the back heel curve just follow the back heel curve on the last.Don`t overtrim or undercut.Try to follow the heel seat.

You might try your lift on the outsole with the full 1/2" under heel and ball.And 1/8" at the toe for the rocker sole.

Question,viewed from the side ,what is your ankle range of motion in dorsiflextion.E.G.with your foot flat in standing to what degree can you bring the lower leg forward,before the heel lifts 10 degrees, 20 degrees etc?This is also relevant for an even gait in determining the rocker bottom sole.

Fred
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Re: Correcting common foot problems

#296 Post by courtney »

Thanks Fred,

I took the orthotics out since all they were doing was giving me arch support and filling up space in my shoes. I figure I can add arch supports without them.

I would guess adding to the out sole would really be to go, but I would like to hide the build ups as much as possible.

In the xrays they took they said measuring from the ground to the top of my femur I had a 21mm differance.

so I may have to add to the insole and outsole eventually.

My knees and legs dont really have much curve or anything to make me think that straightening them out would fix the LLD.

As for the question, I have no idea.
My foot does stick out{pronate?}

So with the 1/2" wedge insole lift and no orthotics, do you think that would be okay?

It seems fine in my high top tennis shoes.

Thanks again,
Courtney
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Re: Correcting common foot problems

#297 Post by courtney »

Also, with the full 1/2" rocker outsole I know Jask said start the taper under 1st metatarsal head.

Does that mean exactly at the point of the joint?

Courtney
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Re: Correcting common foot problems

#298 Post by jask »

Courtney,it is not critical but it should be as close as you can eyeball to the center of the 1st met joint (better it be a little behind than ahead if need be)
The tapered lift you are describing above is a wedge and would be appropriate if you had a limited range of dorsiflexion, unless that is the case,in the long term it is not the best solution and the only reason it is tapered is the lack of room in the front of the shoe. With a wedge, although your heel is now elevated closer to the ideal position your forefoot is left "reaching down".
My suggestion above was for something quick and cheap you could try to test the difference a full length lift would make, as Fred pointed out cloud is a low durometer material and not ideal for long term use.
If you are creative you can incorporate a combination of internal and external lifts. Keep in mind that a lift of 21mm will result in an inflexible sole.
I have built lifts over 5",though most are far less. I have added lift internally and externally and combinations that split the lift tend to "hide" the lift better than a full internal lift that leaves the modified shoe visibly larger than the other.

(Message edited by jask on April 03, 2010)
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Re: Correcting common foot problems

#299 Post by courtney »

Thanks Jask.

The 1st met joint is the big toe right?

Courtney
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Re: Correcting common foot problems

#300 Post by jask »

Yes! that is right.
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