Correcting common foot problems

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Re: Correcting common foot problems

#301 Post by paul » Sun Apr 11, 2010 11:10 am

Just by way of closing this subject out for myself, and anyone else who's been following my travails...

...Here is the fit I got for my flat footed customer.
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He is happy and comfortable with his fit. He told me he spent all day in them in Phoenix one day last week, and was very comfortable.

Thank you again for all the help and positive thoughts from those of you who contributed.

Now to remember all the lessons from this one.

Back to the bench,
Paul

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Re: Correcting common foot problems

#302 Post by dw » Sun Apr 11, 2010 11:25 am

Paul,

I can't see anything wrong with the fit on those. I bet he's happy as a clam.

Good on you!

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Re: Correcting common foot problems

#303 Post by paul » Sun Apr 11, 2010 11:53 am

Thank you DW,

Your comment is very encouraging.

I've adjusted my perspective on Sabbages "12th section", as you've pointed out.

Now if I could just make sence of the significant discrepancy in the heel to ball measure to which you've refered, I'll feel like I'm back on track.

Right now I'm quite confused on that.

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Re: Correcting common foot problems

#304 Post by jask » Sun Apr 11, 2010 9:35 pm

Congratulations! and thanks for sharing the experience and lesson.

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Re: Correcting common foot problems

#305 Post by dw » Mon Apr 12, 2010 5:43 am

Paul,

Well, since I raised the issue in your mind, I feel responsibility to clear it up. PM me or call, I'll try to clear it up for you.

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Re: Correcting common foot problems

#306 Post by courtney » Mon Jul 26, 2010 8:39 pm

Has anyone watched / made orthotics as shown in the hcc video? I havent seen it but am wondering how hard it is and what tools are required?

I have some orthotics but am wondering if in a proper fitting shoe if they really need to wrap around and cup your foot?

I would like to make some that dont make the shoe wider to accomodate them.

What do you guys think?

Courtney

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Re: Correcting common foot problems

#307 Post by jask » Mon Jul 26, 2010 10:05 pm

I have not seen the video but can give you some input on the design and manufacture.
Generally orthotics do not need to wrap around..they should come out to a point that is approximately even with outer edge of the foot ( if you were to drop a plumb line along the edge of the foot- that would be approximately right..) there are exceptions- people with severe bio-mechanical problems..the sort of people who roll off the outer or inner edge of footwear, causing the uppers to shift over the outer edge of the sole... those people usually need footwear modifications as well as orthotics to really see improvements.
I do not know why you wear orthotics, Courtney. Generally the wrapping around and cupping of the bottom of the foot creates a very stable platform, the increased contact area allows the forces to be better distributed and allows material to be added or removed below the sole to control position, motion, and specific forces.
I know that all sounds kind of generic and vague but each foot is different and well made orthotics will be designed to allow the user the most function and comfort.
A well made orthotic should be easily accommodated in a customers regular lace up shoe, for a slip on it might add a half to a full size to the shoe.
and, with womens shoes?... forget about it!!! most of those are destructive to normal foot biomechanics. Years ago one of the better known commercial foot orthotic manufacturers came out with a line of orthotics that women could wear in "business dress shoes" - tight slip on 1.5-2" heel.They looked like a Maori fishhook or a plastic qustion mark with a wide base.Useless, utterly and totally useless... but lots of Ladies with prescriptions from their Doctors, would go in search of a cure for those sore feet and not be willing to give up the footwear that was causing so much of the problem.
So , I guess my point is that if you arbitrarily remove material you may find the orthotic is not able to do what was intended. A well made orthotic should be able to fit into custom or commercial footwear without too much difficulty for most people.

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Re: Correcting common foot problems

#308 Post by courtney » Thu Sep 09, 2010 8:47 pm

Jask, realized I never said thanks for responding to my post. Thank you.

I started thinking that making my own orthotics is probably not a great idea and out of my scope.

Today I tried to build up my lasts and shove them in my last/best pair I have made to accomadate the orthotics I have. Didnt work, first I broke the shoehorn then I broke the shoe[img]http://www.thehcc.org/forum/images/old_smilies/sad.gif"%20ALT="sad[/img]

Oh well, live and learn.

I need orthotics but I,m pretty sure that alot of the pressure I was feeling on my lateral joint was from the holdfast and welt popping up higher in the insole, I guess no welt or a thicker insole would help with that.

I would love to see a Pedorthist but my insurance wont cover it, I have Davis theraputics close to me, I guess they are highly regarded?

I know the orthotics I have help but I dont have tottal confidence in the guy who made them, He didnt notice my LLD and gave me more cortizone shots in my painfull cunifore bump than I guess I should have had cuz I got a yeast infection skin rash{I'm not a girl, and it wasnt that kind.}

He made a sts cast while I was sitting, Is that a good way to do it?

He never asked about the shoe it was going in or the heel hight. Should he have?

Is a Podiatrist fine to make orthotics, and Does anyone know of any recomended ones in the San Francisco, Marin, Sonoma Area?

Thanks to anyone who reads this.

Courtney

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Re: Correcting common foot problems

#309 Post by hunter » Tue Nov 09, 2010 9:22 pm

i'm a first timer with a needful question. can anyone try and explain to me how to put a leather CROW walker together. this might take some time ... what i'm doing is 1.from a plaster cast cover cotton stocknett 2-3 layers then lining leather. next 1/8" plastizote then pull 5/32 poly pro let cool cut off and trim to size. add new 1/8 plastizote glue than post the poly pro with crepe to balance outflare ect. put back on cast streach outer leather and finish with soling now hheres the problem if the is a lace up with a 1 pc tongue and vamp how can i have the foam lining through the whole job. i did leave out a step first theres a removable insole before the lining leather. if some one can point me in some type of direction that would be most helpful or maybe we can kick it around and come up with an idea

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Re: Correcting common foot problems

#310 Post by jask » Tue Nov 09, 2010 11:41 pm

HI Terry
Two options are to build the crow walker as a clamshell or bi-valved design; build it to the point you are at,replace the anterior foam with a full thickness new section and then remold over everything. Trim the anterior shell with 1/2-1" of overlap and use straps and loops to secure the two sections.
The other option is to have an anterior opening with overlapping "lapels" - when you block the lining leather- overlap the two front edges about 3-4", glue your plastizote over these and use several layers of stockinette before vacuum forming to avoid heat compression of the plastizote. drape form the plastic with an anterior seam- but do not apply vacuum until the anterior section has been stretched out to thin it, center the seam, vacuum,and when trimming out cut the anterior opening along this seam line with 1/2 to 3/4 opening allowance. Your outside leather can extend over these lapels to cover the tops of the lapels and these can be trimmed to overlap several inches.Combined with exterior straps this creates a "tubular" style Ankle Foot Orthosis that can often be accommodated with (oversize) off the shelf footwear.
I would recommend using a copolymer plastic to avoid the notch sensitivity and cold weather cracking problems of polypropylene.

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Re: Correcting common foot problems

#311 Post by antons » Sat Jan 01, 2011 1:31 am

Happy New Year to everyone.
I have some footproblems and I got a pair of orthopedic shoes with an orthotic inlay. They look ugly but they are reasonable comfortable and wide enough for my big toe. This was done by a company in Holland wich must have relations with Mr. Elferink, because of the same name.

When I found this forum I decided to make my own footware. I started making wooden clogs, with great succes: they are wide enough and have a good footbed, wich I constructed from the orthotic.
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Then I produced my first pair of shoes.
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I made a plaster copy of my orthotic footbed and together with a plaster copy of my foot I constructed a plaster last. Then I copied it in a polyurethane last.
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The shoe fits good, but I have pain in my lateral frontfeet when I'm walking. As you can see at the black spots on the photo of the orthotic, the maximum pressure is indeed on the lateral front side.

My questions are:
1. how should I correct the footbed of the last?
2. What effect will this correction have om the movement of the big toe?

Thanks for any help.

Anton

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Re: Correcting common foot problems

#312 Post by fred_coencped » Sat Jan 01, 2011 9:57 am

Anton,
It appears to me,there may be a bio-mechanical dis-advantage in your 1st metatarsal phalangeal joint.Any dorsiflexion less than 70 degrees is considered to be hallux Limitus. In gait you may be avoiding pain in the 1st mpj because at heel lift the 1st metatarsal must plantarflex and your foot shoud recover from pronatory motion and re-supinate.

Often there occurs an Abductory twist at heel lift where a person will shift their heel medially and forefoot laterally because of a lack of available motion in the 1st mpj and avoiding pain in the 1st mpj.Your question of the affect on your big toe represents a clue.At the propulsive phase of gait we need to have about 60% weight moving over the main stabizer of the forefoot ,the big toe and about 40% across the lesser toes, more or less.

This will shift weight laterally.Clogs are designed with extra toe spring and piston-ing action in the heel,usually requiring less motion in the metatarsal joints from heel lift to toe off.

Without knowledge of a relevant bio-mechanical assessment it is too difficult to advise you on your correction of your orthotic.I suggest you consult your maker.

I will often pre load the 1st mpj with a tapered lift under the hallux[big toe] that slightly plantarflexes the 1st metatarsal and naturally dorsiflexes the hallux.

Hallux Rigidus is another story, so please advise of degrees of motion in the 1st MPJ,ok. Photo`s of your feet and video [on a Tredmill], in gait would be helpful,Barefoot and with shoes with orthotics, 3 views, from the front,back and side. I`d be happy to evaluate

In the case of forefoot valgus,the forefoot is everted on the rear foot,I will lower the head of the 1st MPJ, encouraging plantarflexion of the 1st metatarsal at heel lift.Again this is the phase of gait where the foot re-supinates.

I find many clients with weak plantar flexors and the lateral arch flattened from the calcaneo-cuboid to the distal head of the 5th metatarsal, therefore requiring lateral arch support.I think it is difficult for us humans wearing stiff soled shoes since early childhood to maintain good foot and overall general health as pains in the feet are reflective of the holograms of our Being.

My personal metaphor for all of us is do we fall forward or step forward through life? A heavy heel strike along with other factors are leading to too much back pain, knee and hip replacements etc. Its been said Step Shock may be a contributor to Aging.

Your efforts in last and shoe making are very admirable,I hope this info helps.

Fred

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Re: Correcting common foot problems

#313 Post by jask » Sun Jan 02, 2011 11:12 pm

Happy New Year to you as well.
I am curious how old the original orthotics you are working from are? between materials breaking down and changes in your foot it may be that you are working from impressions that no longer reflect the biomechanics of your feet.
The picture of your footbed shows a lot of contact wear under the calcanius and lateral forefoot but very little through the midfoot,suggesting a rigid high arch.Without assessing or knowing more about your foot and history it is hard to make suggestions-why do you have relief for your big toe? do you walk toed in? or are your knees turned in? do you tend to wear out the lateral heel of your shoe?
I also think your foot is a good candidate for a cushioned sole, and I would certainly want to add material through the midfoot and heel of your footbed to increase contact and weight distribution under the metatarsals.

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Re: Correcting common foot problems

#314 Post by antons » Mon Jan 03, 2011 1:13 am

Goodmorning Fred and Jask,

It took me some time to understand your professional language. But with the help of Google I had succes.

@ Fred:
Weak Plantar Flexor: No.
Hallux Rigidus : No
Forefoot Valgus : I'm not sure, maybe some.
Hallux Limitus : Yes. Left 60 degree, right 55 degree.
I'll go back to the maker, but first I try to understand the bio-mechanics myself.

How can I measure Forefoot Valgus?

@ Jask:
Yes I have a very high arch. As the photo shows, I can even slide a rule under my foot, when standing on it.
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The orthotics are no older than 3 months and I used them 30% of the time. They have already a support for the high arch, but I don't feel this.

I don't walk toed-in and my knees aren't turned in. But I do wear out the lateral heel of my shoes.

Next week I'll try to make a video.

Anton

(Message edited by antons on January 03, 2011)

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Re: Correcting common foot problems

#315 Post by fred_coencped » Mon Jan 03, 2011 8:04 am

Anton,
Regarding your last.
I think there will be some discussion and disagreement.I feel your last does not match your foot shape and you last should follow your foot. The 1st metatarsal joint should be built out for the 1st mpj.
I would ascess a functional hallux limitus and insure your 1st mpj is plantar flexing from heel lift to toe off.

Also,you are right, a rigid foot structure and high arch.Generally medial heel wedging will block overpronation and is about 90% of the job of the orthoses.

Remember if the big toe fails to dorsiflex at heel lift,jamming the 1st mpj will result.

Walk barefoot slowly and observe.Best to ask your maker regarding forefoot valgus.To evaluate, you have to load the midtarsal joints,in a sub-talor neutral postion and observe the head of the 1st mpj from a anterior or posterior view,the 1st mpg will be lower than the lesser mpj`s.This is performed by a skilled person with a pretty thorough knowledge of bio-mechanics.

I think the hallux wedge will assist and medial heel wedge will bring the ground up to the heel,blocking over eversion of the calcaneous,insuring re-supination and insuring the 1st metatarsal plantarflexes at heel lift.As I said the head of the 1st mpj may have to be lower on the orthoses to encourage motion in the joint.Pre-loading the 1st mpj with the hallux wedge is a good start.

You probably have a supinated sub talor joint and forefoot valgus,in my opinion.Your rear foot or calcaneous[heel bone] cannot evert and that alone creates overpronation and the failure of your foot to re-supinate.

Your heel is everting in the photo and your 1st mpj reveals some enlargement,although mild.your 2nd toe is trying to help the 1st and your 5th toe looks inverted.Lesser toes doing too much,the 1st metatarsal is the main forefoot stabilizing factor.

I would guess your orthotic may not have metatarsal arch support.A high arched foot like yours likes metatarsal support and forefoot cushioning.I find the lateral arch is where support is needed because of a plantarflexed 5th matatarsal.

Good luck,
Fred

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Re: Correcting common foot problems

#316 Post by jask » Mon Jan 03, 2011 10:58 am

Good Morning guys
Anton, what Fred is saying is that you have a biomechanically complex foot! (we all do, but in your case this is even more true.) and they need more orthotic support than the footbed above is providing. If the footbed exactly reflects the surface of your orthotics,I would say they do not provide support for a high arch (in terms of midfoot contact and weight distribution)and have no way of knowing if they provide cushioning or shock reduction or if the orthotics offer any functional correction in terms of wedging or posting under the heel or forefoot. I would not recommend any heel wedging without a more thorough review of your foot, as you already exhibit a restricted heel range of motion.
If you were to stand in damp sand with your foot flat and your knee above your big toe, the impression you leave would better reflect the contact support your foot requires than what I am seeing in the footbed picture, however, it would be painfully excessive if you were to copy it and use it without modification. Your foot requires the contact pattern to be increased, the heel to be controlled, the forefoot to be balanced to correct for excessive lateral loading, and the entire orthotic to (in my opinion) be made of a cushioning or semirigid material.
So to start, try to imagine that your foot could "drop in to" those dark areas on the footbed- or conversely, that the non-dark areas could rise up to meet your foot and leave "wells" in the dark areas that would allow the heel and metatarsal heads to drop to a relatively lower position than they can right now.
To start i would turn those footbeds over and look at the area between the heel and fore foot- adding cushioning through this area to evenly distribute the pressure under your midfoot is the place to start. Orthotic manufacturers have a wide array of materials that are not normally available to most people but if you can use a material similar to a light EVA midsole that would work best. I might start by placing the footbed on your bench and looking at it from behind- stack a couple of thin coins ( about 1/8th" ) under the medial forefoot and look at the empty space that is now below your footbed- this is the area you want to fill, and you want that flat surface that the bench represents to remain flat and smooth when the added material is finished.
I hope that made sense but please ask questions, if you have any.

I also would suggest that only using your orthotics 1/3 of the time defeats the purpose, are they not comfortable? or do they not work with your existing footwear?

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Re: Correcting common foot problems

#317 Post by antons » Mon Jan 03, 2011 5:04 pm

Dear Fred and Jask,
Thank you for your fast responses. I've to read this very carefully to understand this all. I'll come back with comment and more info in one week.

I can answer the question of the 1/3 usage of the orthotics now. The the rest of the time I wear my selfmade clogs and my selfmade shoes and boots, all based on the same footbed.

Anton

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Re: Correcting common foot problems

#318 Post by antons » Sun Jan 09, 2011 2:59 am

Dear Fred and Jask,

As you can is the the orthopedic shoe not really elegant.
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The orthotics provide some support for the high arch:
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The footprints show: left neutral and right foot high arch
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Re: Correcting common foot problems

#319 Post by antons » Sun Jan 09, 2011 3:13 am

Here are some stills of the footvideo.
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(Message edited by antons on January 09, 2011)

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Re: Correcting common foot problems

#320 Post by antons » Sun Jan 09, 2011 6:39 am

Good Morning Fred and Jask,

I uploaded the footvideo to Youtube. You can find it here:

http://www.youtube.com/watch?v=GlboBIb_6T8

Awaiting your comment.

Anton

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Re: Correcting common foot problems

#321 Post by fred_coencped » Sun Jan 09, 2011 11:33 am

Bravo Anton,First I got to see the stills of the video,analyzed it the best I could,then got to see you on you tube,most excellent work.Your walking with the shoes and foot orthotics is very helpful too!

From your Harris Mat Foot Prints,I assume these are weight bearing on both feet.
Right Heel is more neutral than left, but slightly more inverted or in a varus position. Midfoot, I agree the lateral arch is more pronounced,and the forefoot is more weight on the 5th metatarsal head and on the 2nd met head.

Left Heel is everted and in valgus.In the midfoot, the lateral arch is flat and the 3rd,4th and 5th met heads show more pressure on the lateral forefoot.Notice there is less pressure under the 1st mpj.

Bi-laterally,Tibial Varum means the lower one third of the tibial bones curve inward. This shows the foot is in an inverted position in relation to the leg and increases the required eversion motion in the rearfoot to get the feet on the ground on a flat surface.So the foot because of the tibial varum and rear foot varus,bi-laterally will reach their end range of motion just in standing on a flat surface.Since the lower leg progresses forward prior to heel lift the foot is moving into over-pronation and does not re-supinate at heel lift.

I made 3 pages of notes on each of the 9 still frames.Condensing it for you in relation to the video,very similar patterns occur bi-laterally, barefoot and in shoes with your orthotics,I assume.

The sequence of events is
More Lateral Heel Strike than what would be considered normal because of an inverted calcaneal position.[Varus or inverted heel]
Feet move immediately into pronation and continue from heel strike through the entire gait process ,failing to re-supinate at midstance to heel lift.
At heel lift the body is moving over the medial column of the foot and excessive force is brought to bear on the 1st MPJ.
The foot at toe off failing to re-supinate is affected by the ground reaction force and exerts dorsiflextion of the 1st metatarsal when it is absolutely necessary for the 1st metatarsal to Plantarflex and stabilize the forefoot.This is the point of Havoc and disorganization in the entire foot.
At the toe off phase of gait the foot abducts and spins outward on the 1st metatarsal head avoiding Pain in the 1st MPJ.Usually callousing occurs on the medial Hallux and the 1st met. head.The heel moves medially and lifts pre- maturely.I always see an inverted small toe as it is reaching for the ground and overcompensates.So the baby toe can`t do its baby share of work.

All of this dis-organization is affecting directly the knee as the alignment between the knee and the foot deviates.Study the video,as the knee moves forward and the foot abducts at toe off there is strain in the knee. Continuing upward the hip joint and lower back are affected clear up to the base of the skull and the cranium itself.

This is why as a reflexologist and pedorthist, I view the foot as an important key to our health and well being. It is a holistic approach to good health. I can say a lot more about posture, walking and heels in our shoes, but will save you a lengthy discourse for now.

Anton,your left foot orthotic needs more medial posting than the right. Mostly this will help balance the rear and midfoot to set up the forefoot balance and allow the foot to resupinate. The Hallux wedge will also help preload the 1st metatarsal to plantar flex and stablize the forefoot.
I hope this helps you,Fred

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Re: Correcting common foot problems

#322 Post by antons » Tue Jan 11, 2011 2:48 pm

Hello Fred,
Thank you for your extensive answers. Your assumptions about the footprints and orthotics are correct.

Do I understand it right, that when I place a Hallux wedge and medial posting on top of the orthotics, the left valgus heel and the right varus heel will be corrected to a neutral (normal?) position?
If so, how long should I wear these compensations?

I went to the maker of the orthotics, but he had another solution. As you can see, he placed a metatarsal pad, 5mm thick on both orthotics.
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He proposed to try this out for 3 weeks and then evaluate. I must say that this is much more comfortable and the pain in the forefoot is reduced.

But is this a final solution?

Or is it neccesary to place also the wedge and the medial posting.

Anton

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Re: Correcting common foot problems

#323 Post by antons » Thu Jan 13, 2011 1:38 am

Dear Jask,

Can you please clarify this passage?

"To start i would turn those footbeds over and look at the area between the heel and fore foot- adding cushioning through this area to evenly distribute the pressure under your midfoot is the place to start."

Does this mean that the compensation should be UNDER the footbed? As you can see, the maker did make a compensation on top.

Please clarify.

Above modification is more comfortable, but I still can't walk more than 1 mile and I'm never without pain, even when I stand still. And even when I stand still barefooted.

Anton

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Re: Correcting common foot problems

#324 Post by jask » Fri Jan 14, 2011 9:54 am

Sorry for the slow reply Anton,
The maker has placed the material on the top as a trial, a method to determine if it will be effective in your case. It should have been built into the orthotic when it was made, without the abrupt transitions.

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Re: Correcting common foot problems

#325 Post by antons » Sat Jan 22, 2011 1:55 am

Hi Fred and Jask,

I followed your advices and I made and placed the Hallux Wedge first. I found the website, with an very instructive roentgenvideo, but they don't sell to Holland.

The direct result is that the pressure on the forefoot was reduced and also the pain. And I have the idea that the forefoot valgus is considerably less. I'll make a video to show.

So thank you for your advice.

But I still can't walk painfree. I'm considering to start all over again by making a plaster modell of my foot, apply compensations, mould a polyurethane last, etc etc.

Can you show me a place where I can find information on the right procedure to get the right footbed to cure my problems? Then hopefully I can make comfortable shoes.

Should I integrate the hallux wedge in the last?

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