Correcting common foot problems

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Re: Correcting common foot problems

#26 Post by dw »

Rob,

Just curiousity...those are nice screen caps--what is the program you're capturing? It almost looks like some sort of cad program. Is it a "freebie?"

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Re: Correcting common foot problems

#27 Post by jenny_fleishman »

Rob, re lateral arch. When my feet are non-weight-bearing, I do have a noticable lateral arch, which seems to match my first foam impression castings (about a 3/8" rise at the highest point). I did another set of castings yesterday and will unmold them later today and see if they are the same.

My lateral arches do come down to meet the floor when I am standing. Is this typical--for the lateral arch to be high at rest, and flatten completely when standing? Contoured shoe insoles that rise along that lateral arch have caused me discomfort in the past. Thanks.

Jenny
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Re: Correcting common foot problems

#28 Post by relferink »

DW,

The software is not quite free. The setup is developed for the foot orthotic industry. I would estimate a full package with 3D optical scanner and CNC milling machine, CAD software as well as gait analysis hardware and software to run in the neighborhood of 75 to 100 grant, give a take a few bucks. It's made by the German company Paromed. There are only 2 of these systems in the US and 1 in Canada as far as I know. It's much more common in Europe and possible in the far east.
The local company I do some work for obviously works with it and if nothing else it does make great screen caps. I just knew I had these screens and they show the point fairly well.

Since it's German it's probably over-engineered and uses proprietary formats so there is no (easy) way to port the data in a program like auto-CAD or something much more reasonably priced. One other drawback on spending that kind of cash on computers and software, it's outdated before the ink on the check is dry. Image


Jenny,

It's not uncommon to have a lateral arch when non-weight bearing and have that come down to the ground when you stand up. In fact it's a sign of potential problems in the forefoot and heel if one does not get that lateral arch down. The specific point that would usually cause the most trouble is called the base of the 5th metatarsal. In the center of the lateral arch, on the outside of your foot you can feel a bone that sticks more or less out from the rest of the skeletal structure. In some people that bone is very prominent. To much pressure there would cause a lot of discomfort.
The cast should be made in such a position where the alignment of the bones and joints is at it's most favorable position. To discuss that specific position seems to be straying from the subject but you basically want the foot and lower leg aligned as much to a neutral position as possible. No artificial curved up arch, not much rolling in or out.

It's very rare to have a foot that has an arch as in the post before with the high lateral arch. I would not say impossible but the odds of hitting the lottery are probably better than finding a foot that is truly like that.

Once you have your molds are you going to modify them before molding the orthotic? I would suggest to at least create a little expansion room. What I mean by that from the lateral ball to the front of the medial heel you fill up some of the rounding on your mold. This will give the soft tissue under your foot a place to go to once you put full weight on your foot. Don't make it square but add some plaster on your mold there to accommodate the soft tissue. More important under the heel than at other places. Also on the ball, if the center is noticeably dropped compared to the 1st and 5th metatarsal head you may want to flatten this off and add metatarsal support to keep it from falling to much. You can do this in the mold by taking it out of the plaster of stick a metatarsal pad on after you molded the orthotic.

How did the second set of molds come out? I took some pictures of the grinding angle to smooth out the orthotic. I'm short a couple pair of hands trying to take these pictures but here it goes.
4118.jpg
the top of the mold (botom picture, top grinding service of the orthotic and grinding wheel should all line up. As long as you poured the mold on a level service gravity will make sure it's perfectly perpendicular. (maybe not so perfect if your plaster is clumpy) Hope this explains it, don't really know how else to take the picture. It would be much easier to show in a movie but don't have the extra hands right now.

Rob
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Re: Correcting common foot problems

#29 Post by relferink »

Fitting shoe:

This is a new customer for me with existing lasts from a shop that went out of business. I do not know the last maker but have seen room for improvement on other customers from the same shop. After checking and adjusting the measurements on the lasts I want to make a fitting shoes to see if the shape and balance beyond the measurements is good.
Since all I have is the lasts, no patterns I stared making a footbed to the last and than a quick and dirty pattern, it's only for a fitting shoe that will be discarded after a week or so and chances are the last and footbed needs adjusting before making my final patterns.

I make a lateral and medial pattern since the last is so asymmetrical, almost like a club foot. But used only one forme for medial and lateral.
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Now I have to decide to go for a blucher or balmoral. decided on the blucher since that is what the shoe will be and it's a little more challenging / interesting to show. (that choice may come back to bite me in the Image).
4134.jpg


If deciding on the balmoral this is all you need for a pattern. Cut out the 2 halfs, sew the front and back closed and last. For the balmoral I have to make some more detailed patterns.
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Cut from scrap or cheap-ish leather, again they are only going to be worn for a week or so and start assembly, it's basic with few parts. Make sure you mark the underlay precisely.
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Re: Correcting common foot problems

#30 Post by relferink »

Lasting, this is where the pictures may get a little confusing, I've used the clearest pictures , regardless if they were from the left or right, they are mostly in chronological order. I put enough talcum powder on the last so It will come out easily, the last is not particularly smooth, to hard to get the last nice and smooth and changes in the last in between pairs are not uncommon, if they are nicely smoothed it gets hard to modify.
Lasting: the upper on the last, keeping the heel up about ½”. Not an absolute measurement. It's more what feels right. Make sure it's straight on the last and tack down the toe.
4142.jpg
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Tack down the medial and lateral ball and pull down the back to the desired hight. Tack it down so it won't slide.
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Now you want to make sure the upper lays closely to the last. The 2 curtail points, the vamp point and the closing line (no picture, sorry) you should be able to “snap” the closing line so that it snaps back tightly to the last.
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4149.jpg


Here would you normally lace up the shoe. I did not. No reason other than laziness, you can get away with it on a fitting shoe, don't do it on the final shoe. If you had opted for the easier balmoral style upper would have been sewn shut and the lace opening cut open later so you would not have to worry about this.
Finish tacking down the upper and glue it down. I use the grinder to smooth it all over.
4150.jpg
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New cut out the toe box out of a piece of scrap leather. I just cut this free-hand. Glue with all purpose contact cement on the toe. No further re-enforcement needed for the fitting shoe.
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Make a pattern for the heel counter, glue up the heel counter. Use a solvent based counter, not particularly firm. Use a paper towel to take excess solvent away. Lay on leather counter and glue to the shoe. Since the leather counter is a little larger than the re-enforced counter it will glue to the shoe and hold everything in place till the counter dries and sets.
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Now the counter needs to dry overnight. As the counter was drying I re-enforced the eyelets.
The next day the shoe can be finished. I purposely did not put a shank in this shoe. If any torque develops in this shoe as it is worn I need to know, a shank would not make it clear within a week if this were to happen. This is not standard, other fitting shoes do get shanks.
Build up the heel, and put a walking sole on. Un-last and cover the orthotic. All done except for some decent laces in the shoeImage
4164.jpg
4165.jpg
4166.jpg



Rob
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Re: Correcting common foot problems

#31 Post by dw »

Wow!! Great photo essay Rob!! What a great contribution. This isn't my territory but I know quality and earnestness when I see it. Thank you, thank you thank you...on behalf of everyone here on this forum and especially on behalf of Admin who loves guys like you who give as much or more than they get!!

Good on ya!!

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Re: Correcting common foot problems

#32 Post by jake »

Rob,

Let me second D.W.'s comments. This was great! Thanks for sharing it with us. I know it will be instructive for many.
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Re: Correcting common foot problems

#33 Post by tomo »

Thanks Rob,
Do you use staples because they hold in the cork better or because it's quicker?

When you do the actual shoe, will the pattern you have now need to be made larger, because the outer will actually go over all this wont it?

You certainly make it look easy!

I don't envisage that I would ever work on a foot that was way out there, but the little things you pick up from looking at work like yours is priceless.

Thanks for taking the time to put it together Rob.

More power to y'awl.
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Re: Correcting common foot problems

#34 Post by jenny_fleishman »

Rob, that was a great fitter shoe tutorial!

I didn't quite understand the orthotics posting, though. Re my own molds...the second set came out pretty much like the first, with a lateral arch about 3/8" high. If the lateral arch should flatten when weight bearing, should I build up the casting to remove the lateral arch from it?

I am working on remaking my lasts at the moment, and had a hitch when putting together my grinding station, so I am not set up yet to grind orthotics.

I am finding I have to go to plan B or even C after plan A fails, with a LOT of things these days. Slowing me down quite a bit Image!

Jenny
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Re: Correcting common foot problems

#35 Post by paul_k »

WOW! Rob. That was great, too!

I would have liked to see that a few years ago. I remember talking with Georgene McKim about such a tutorial. Thank you. I'm sure alot more readers will appreciate it than just those who express it.

PK
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Re: Correcting common foot problems

#36 Post by shoestring »

Robert,
Nicely done very good instructions,this is icing to the cake of lesson's learned these last couple of days.

Ed
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Re: Correcting common foot problems

#37 Post by relferink »

Thanks to all for the nice comments on and off the forum. It's far from a perfect little project but I intended to show that the fitting shoe does not have to be hard to put together and is valuable to evaluate how the lasts fits and the shoe will function. Even if dealing with a non-orthopedic customer, the last needs to fit and this is a great way to check that. What I really like about doing this little bit of extra work over just checking the fit is that it shows functionality. One other way to check the last fit is by foil fitting, not sure I ever posted a picture so here it goes,
4169.jpg

Since with my customers each and every situation is unique, more from a functionality point of view than from a shoemakers stands this is not a typical fitting shoes, I would normally be more inclined to go the the even simpler balmoral style as I described but thought it would not make for such an interesting presentation since it's so simple. Another challenge with this customer specifically is the shape of her feet. If one's not careful you end up with a shoe that looks like a banana, heel and toe pointing in and the center of the foot pointing out. Makes for a very ugly shoe so finding the compromise between esthetics's and functionality is somewhat challenging here. From the initial fitting I noticed both shoes need a little more lateral wedging. The customer will wear the shoes for 2 weeks and give me a lot of feedback.
especially on behalf of Admin who loves guys like you who give as much or more than they get!!

Here I have to disagree with you DW, besides of all the wonderful people I have met through the The Crispin Colloquy, I have learned, been inspired and challenged myself through postings on the forum. I'm glad I can offer a little different perspective as a shoemaker. My initial interest in the forum had to do with a deep dark desire to someday make myself a pair of nice boots. Not sure when I will get to it but more important than that I've been made to feel very welcome on the forum as a bit of an odd duck here and I'm greatful for that. Image

The challenge really is getting used to having the camera handy in the shop, find the extra hands to take the picture while doing the thing I want to photograph and figure out what pictures are relevant. Also how to make up for the steps I forgot to take pictures off. Than there is the time factor, by the time I sit down and read all the post and try to reply to the ones I feel I have something to add to it cuts into my beauty sleep (and it shows Image )

Tom, the staples are for a number of reasons. As you can see my first 3 to 5 tacking points are with nails, than I switch to staples. Not so much for the hold on the cork, both nails and staples could easily pull loose from the cord and I often go through the cork to the last. With a staple gun I find it easier to create a wrinkle free feather line. What I do (and here I should post a video, may get to that some time in the future) is place the staple gun on the feather line on a pipe in the leather, press down the staple gun and slide it in about ¼ inch in. Than I staple it down. The flat “mouth” on the staple gun helps me hold the material down and pull -push it in a way I can't with my pinchers. The staple will also hold a piece of material about ½ inch wide. A nail only that specific spot. I also find that the staples have less tendency to rip the leather if you apply to much pressure from the opposite side, with very sensitive leathers or if your patterns are less than perfect.

The actual shoe pattern will not be larger, just more precise. This type of forme making is fairly crude. I know plenty of people that use it, some who's work I admire but for my liking and on a last that's this asymmetric I'll probably use the paper tape method as described by Frank Jones in the book “The Pattern Cutter's Handbook” and elsewhere on the forum. The size will not be all that different. I do make allowances for the thickness of the heel counter and take some off for the lining. Just to be clear this fitting shoe is discarded, I do not just use it for lining and put an unlined upper over it, could work and I will do that if it is a very complicated case of re-enforcement of the counters and buildups etc. mostly on a high top last but not here.
BTW how did you make out on those steel toes? Found any in the sizes you needed?

Again, thank you all for all the nice comments. Next time I may try it in the new video format.

Rob

(Message edited by relferink on June 05, 2006)
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Re: Correcting common foot problems

#38 Post by relferink »

Jenny

Yes, building up the lateral arch somewhat is probably a good idea. You don't have to make it totally flush from ball to heel but 3/8th sounds to much. It's hard to give you an exact measurement, it's all proportional and after you do it a lot you know what to look for. As for the modification to the mold, it may be easier to rasp down the heel. Once you start adding plaster it is easy to loose track of the model you started with. By taking down the heel you have to maintain the shape as much as you can but don't risk loosing the the shape all together. You will also prevent the arch from ending up much to high. A plaster rasp should make this not to hard to do.

What are you changing to the last that would warrant a remake? Is it not something that can be modified? I think not having access to a grinder may be hurting your efforts. If you have a basic shape that is good in the last but need modification it seems easier to modify than start from scratch. I realize you can only put so much into machinery and there are ways to do it by hand but it's very labor intensive and slow.

Hope this helps you allong

Rob

(Message edited by relferink on June 05, 2006)
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Re: Correcting common foot problems

#39 Post by jenny_fleishman »

Rob, I'm posting a response to the last issue on One "Last" Question thread.

Am working on the grinding station. How to get that up and running in my lifetime Image.

Jenny
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Re: Correcting common foot problems

#40 Post by tomo »

I'm not sure if this is the right topic for this but it's a place to start.

Seeing the picture of Lyle's wife's feet made me think that were always discussing lasts and fit but we rarely see pictures of feet with someone saying these feet are xxx or they have a high instep or the arch is such and such, do you know what I mean?

It would probably need to be done by the more experienced members as they'd know what example constituted what.
DW when you guys were talking about Rossi and LOMA and fit in relation to the last this week my head was fairly spinning (BTW what is LOMA?Image)

I think the last photo we had of feet were those ones from Guam of that little kid - might be wrong here.

Now getting back to Lyle's wife's feet, it's amazing (to me) how close the shape of the last is to the foot ie in profile. I'm NOT saying there's anything wrong with the feet or that Lyle suprised me by doing a great job - which he did, I think for the first suck of the Kumara he nailed it pretty damn good actually.

Just a thought.

More power to y'awl
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Re: Correcting common foot problems

#41 Post by paul »

I agree with Tom!

That was all a mouthful to chew on last week!
Tom, LOMA is Line Of Muscular Action. I guess we could say, it's the center line of energy from heel to toe?

But, that doesn't sound in line with something else I've heard. And it relates to my observations about the shape of the shank used in Allen Edmonds Dress Shoes.

Their shank is actually a hard fiber shaped like a heel seat with a lateral extension. Kind of the shape of the hand peace sign with the fingers closed. It's intension is to give support to the lateral arch.

And that's because, I've been told, at heel strike, we land on the outside back portion of the heel, then roll forward to the base of the fifth metatarsul, then across to the ball and toe off from there.

Now that seems more like an angeled S, than a line. So I wonder about that. Maybe it should be called, the SOMA?

Could somebody straighten this out?, so to speak.

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Re: Correcting common foot problems

#42 Post by dw »

Paul, Tom,

The line of muscular action is just that...and one of the most descriptive phrases that I have ever heard applied to any subject.

When you think about it...think about the words and what they mean...no point by point record of movement in the foot is implied. Rather, a "vector" of impetus is described.

"Line" is, in fact, in this instance, a synonym for "vector" or "direction." (This is a common usage of the wod "line"...as in "line of flight." )

"Muscular action" refers to the coordinated result of all the muscles of the foot acting in concert, as the initial touch of the heel begins the action of taking a step.

So "Line of Muscular Action" (LOMA) really refers a process that may have many separate aspects but, in the end can, indeed must, be seen as a "gestalt."

Hope that helps...it's the best I can do at 4:30 in the morning....Image

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Re: Correcting common foot problems

#43 Post by dw »

Thinking further about this, I would note that the LOMA, as I find it, may only be applicable to functionally "normal" feet. I would suspect that while the concept is valid, some modifications may be in order with severly pronating and supinating feet.

Beyond that, I also suspect that while a pedorthist or orthopedic doctor may have something...some concept or theory...that is analogous to the LOMA, as I understand it, it is perhaps most applicable for the fitting up and modification of lasts.

Remember that regardless of complex the motion of a foot during gait, the foot is articulated. The last is not. The last can never recapitulate the action of the foot. So the LOMA needs to...indeed it is all that it can do...capture the essence of the foot movement. The essence, and nothing more.

Ultimately, all I use the LOMA for is to help line up the last on the footprint.

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Re: Correcting common foot problems

#44 Post by tomo »

Thanks DW that makes it clearer.
When you say
>Ultimately, all I use the LOMA for is to help line up the last on the footprint<

I see how this ties in with what you were saying earlier in the discussion with Lance and Bill.

More power to y'awl.
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Re: Correcting common foot problems

#45 Post by dw »

Tom,

One caveat, though...I don't guarantee this to work with all lasts. Now, I think the models I use are relatively close to...or maybe it would be better to say "appropriate for"...a functionally normal foot. I explored this issue with E.J. McDaniel a number of times. But a last with less swing--more "clipping"--would not line up with the LOMA. And a last with more swing--like a Munson--would probably not, either.

It does make an elegant sort of sense though when you assume that the Line Of Muscular Action goes right from the center of the heel between the first metatarsal and the second.

That said, I understand...and hope that I have conveyed...the idea that, while all very serendipitous, the LOMA may indeed be one of those very Victorian artifices that just happily work out for those who believe. Image

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Re: Correcting common foot problems

#46 Post by dw »

All,

I have a question for Robert or Sean or anyone who may have insights into common (or not so common) foot problems.

I have a customer who has been with me for over twenty years. He recently ordered another pair of boots. I modified a brand new inch and five-eighths heel last because I could not find his old last and after twenty years or so I felt I could fit him a little better than I did originally.

I sent off fitters models and he called me yesterday. both boots fit fine ...little or no slippage at the back of the heel, no slack over the foot. But he is complaining about one issue.

He says that he feels like the first (big) toe on his left foot wants to move towards the lateral side and cannot. Yet it easily moves over when he pushes on it and he feels he has enough room for all his other toes. He says the toe sort of "aches," centrally, in the first metatarsal joint and towards the dorsal (top) surface. He does not think the sensation is truely pain nor that it will increase with wear. But he is concerned because the right boot does not have this issue nor do any of his previous boots.

I am at a loss to see where the problem is. The heel to ball length on the last is correct, I believe (maybe even a tidge long), and the footprint/insole has been religeously respected. there is plenty of room widthwise for all the toes and depthwise as well.

If any of you pedorthic or orthopedic gurus has any insight, I would welcome the feedback.

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Re: Correcting common foot problems

#47 Post by relferink »

DW,

This is probably one of those situations that is very easy to spot when the customer is walking in front of you but may be hard to do over the phone or on the web. I'll give this one a shot and I hope I'm the first one to get to this. (I think I may stand a chance since I don't have to compete with DW on this one Image)

The first thing that comes to mind is pronation. With a different last you may have more room in the medial arch or the last may be slightly wider in the arch area allowing the foot to roll in (pronate) more than the original last. The measurements can still be right on but as you know there are many different shapes that can account for the same circumference measurement. What this does to the 1st metatarsophalangeal joint (MPJ) and big toe is put pressure on the joint, causing it to function slightly out of alignment. The joint in this position is not as easily movable. Once the customer is walking and needs to bend the 1st MPJ it "locks up" and the only place to go for the foot is around the toe. The gait line will go medially of the big toe putting pressure on the toe to press this to the outside.
If the customer wears this for some time he would probably develop a nice "pinch callus", that's a callus on the medial bottom side of the big toe and probably over time a good size bunion.

I assume the fitter has a much more flexible sole as the boot will have. With the heavy grade of insole you use the boot will probably be stiff enough that it does not become in issue since the boot will not bend enough at the metatarsals to get to the point where the joint "locks up".
If the customer is not easy accessible I would put a little arch cookie in the mail and instruct the customer to try this in the fitter. It will probably not take all the aching away but if it feels better you know your on to something. If that is the case my suggestion would be to modify the last by creating more of an "arch" in the last and make up for this on the cone to keep your measurements.

Did you change the heel height at all from the old last? A different height can also put pressure on a joint that is compromised to begin with. A simple test of this joint that by the way has damage in a large percentage of the adult population is to have the customer stand in front of you. If you can freely move the toe up the joint is in good shape. If you run into resistance the joint is likely damaged. This test has to be done weight bearing, once the weight is off you can always move the joint unless it's fused. You can not test this on yourself. Even if you could reach your big toe when standing your position makes the test invalid.

DW, As you put it so elegantly "your millage may vary" so here it is right back at you. Based on what your customer described no other thought come to mind as of yet.

Hope this helps.

Rob
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Re: Correcting common foot problems

#48 Post by dw »

Robert,

Thank you. That's exactly what I was looking for. I'm not sure that it's the answer--he's in Canada and I haven't gotten his fitter's model back yet, but it just so happens that he is printing wider in the the shank on the right foot than on the left. So your answer seems to fit. I've seen feet like this before but I've never had any comments or complaints before...or after...making boots for a customer like this.

Much appreciated. I am gonna try two things: opening up the last a little under the arch on the left foot and perhaps balancing the foot to the outside a tiny bit so that the weight will shift slightly to the lateral side...what do you think?

BTW, this whole post was extremely informative...I'm glad you're with us.

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Re: Correcting common foot problems

#49 Post by relferink »

DW,

If things around your shop go the way they go with me the minute you finish that boot you'll find his old lasts. Would be an interesting comparison to have.
I'm not sure that the comparison of the left and right foot or the print is really a good indicator, was it not the left foot that was symptomatic? If the left foot pronates more than the right you would expect to see a wider print on that foot all other things being equal. Like I said with the heavy insole you use there is probably noting to worry about.
Worse case scenario is that you have to stiffen up the whole sole to keep all movement out of the joint. A full steel shank in between the insole and outsole would do the trick for that. You will have to check your toe spring and make sure the boot will roll off over the toe. If it doesn't have enough toe spring and is stiffened with a full shank the customer is going to feel like they are stopped half way through their gait cycle.

I definitely agree with taking a little off the last under the arch, for the balancing to the outside, you would have to do a lot in order to make a real difference but than again, like so many of these solutions, a bunch of tiny tweaks is often more effective than one major adjustment.

Glad I could help.

Rob
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Full Name: DWFII
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Re: Correcting common foot problems

#50 Post by dw »

Robert,
was it not the left foot that was symptomatic? If the left foot pronates more than the right you would expect to see a wider print on that foot all other things
being equal.


You're absolutely right...I don't know what I was thinking when I wrote that about the prints. Now I'm virtually back to square one because it seems apparent that the left foot (the problem foot) does not pronate to any degree...especially by comparison to the right foot.

I am thinking that the heel to ball length could be a bit too long. I've never seen this cause a problem before and I don't know how it could create the symptom he's having, but I think I have to start there. I do know how I ended up with a heel to ball length a little too long but it violates one of the central "rules" I use to fit. So, that's the first thing I have to address.

If you have any other ideas, let me know. I understand that you shooting in the dark not having the foot to actually look at. But at this time, neither do I. I have measurements and footprints from the last time he was down and I think they are accurate but this one niggling issue that I've never seen or heard of before...

[sigh] well, that's what makes life interesting, I guess.

Tight Stitches
DWFII--Member HCC
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