Robert ,Your answer seems simple ,clear and practical.The altenative for extra depth via spacers and a seperate insole/ foot orthoses is in my opinion even more practical with a standard last bottom .However building a non- removable footbed seems awfully daring for obvious reasons,so practicality aside ,footbed modifications internally isn`t feasable .I think lilke you I would be more at ease to be able to modify the orthoses.So why would anyone want to build a shoe or boot with a non removable orthoses,Ijust don`t know.But I would like to know just for personal preferance and the wearer.I understand your simple explanation of attaching the corrections for a removable footbed .But my question here remains if the varying thcknesss would make any differences in the bottoming work ,inseaming pegging and wiping with varying thicknesses of insoling leather ? And you are right about the "leather build up pieces coming loose over time",so thanks for your input it is much appreciated to mull these matters over with someone of your calibre and experience.And by the way Sean ,Hibernation ,you must have Bear Energy .Your 2 cents would be welcome too,.I am curious if you are a shoe/bootmaker.I saw from your profile you are a C.Ped.Are you going to the symposium and have you ever gone to the PFOLA conventions.That is the Podiatric Foot Orthotic Laboratory Association,in San Diego ,convention.I probably will go next year,. There close to the HCC AGM.Look forward in getting your opinions,Thanks Fred

Fred,

The insole you use should be uniform in thickness, varying the insole thickness is going to make the inseaming very difficult, if not imposible as the channel needs to be evenly in depth and strength.
So if you build your postings intrinsic to the last you end up with an uneven bottom, even the bottom out with the cork, ideally your last with cork orthotic would be similar in shape and contour to a “regular” last bottom. Next you add a uniform thickness insole and bottom as usual. When pegging you will go through the orthotic, once the last is out, take out the orthotic carefully and rasp the bottom of the boot as usual.

I've used non removable orthotics for mentally retarded customers that live in group homes where one or more of the residents are know to strip apart anything they can get their hands on, if they get the orthotic out of the shoe it will be destroyed in no time. One time back home we worked for a customer who would take the orthotics out and start eating them. Not sure what the attraction was but the staff much preferred he keep his appetite for the regularly served meals. We made everything non-removable and added a “safety lock” around the ankle that would prevent the shoes from coming off without a special “key” held by the staff.

Rob

Hi Fred and Robert,

In answer to your question, I generally go to the Canadian Pedorthic conferences. I have been to PFOLA a few times. The best was in Chicago 8 or 9 years ago. I spoke with Kirby. I liked him because he thinks more like a Pedorthist than a Podiatrist. ( I meant that as a compliment... I hope he wouldn't take offence) PFOLA is in San Diego this year? You don't have to ask twice, I'll be there! I actually know the president of PFOLA quite well. My new partner trained with him in Halifax, Nova Scotia 12-15 years ago before he had all the letters behind his name.

My bootmaking experience is quite limited. I took DW's course in January. My skills are pretty green with the actual hands on part but my understanding of foot mechanics, gait analysis, and shoe modification are at high level making me an experienced beginner, if that's possible:P

Now, back to the boot question. My answer is VERY specific to the Dress Wellington. I would do things much the same as Robert if it was a shoe, a Western Packer, or even a Dress Wellington with a zipper ( I can see DW cringe as he reads that last one.)
Why are you going custom? What is the level of deformity/assymetry. What are the symptoms? Your answer may change my response.

If if assymmetry in feet is the main problem I would likey modify the last with minor orthopaedic changes/buildups. My biggest concern with a removeable footbed is is getting the boot on or off. If the medial longitudial arch is too high then how how do you account for that? How much more would you add to the Short Heel measurement to allow the foot to enter/ exit the boot. The number would be huge, giving an unnecessarily odd looking boot and a poor fit particularly over the instep!

I would also go much more conservative in met pad height with a Western boot than a shoe. If it is too high then getting the boot on and off would prove difficult and possibly be painful for the customer. Wow, I'm being gloomy here... The dropped 1st met accomodation would be easy though:0) I would build up the plantar surface of the last the same way as a bunion on the medial surface and balance it with leather/ cork like Robert explained
.
If the customer has met pain you could do a leather rocker sole in the boot. I have done this a few times on stock boots with great success.

Fred, I think your topic will open up lots more questions. Perhaps we should bring in some of the Western bootakers and see what their experience has been with put-onability and removeability of western boots with orthopaedic correction. DW? Paul? anyone?

Sean

"Extra depth" Western Boots is the one thing that kicked me into my quest to become a boot maker.

In the early eighties I worked for Western Boot Service in Auburn California, Gold Country. We had boots shipped from all over the country for repairs. One fellow had extra depth boots made by Tony Lama, with leather covered cork insoles. I thought that was soo cool.

I myself have only made one pair for such an insert.

That's not much experience to base any opinions on. However my customer has no problem getting into them. ANd I will say, that rather than use the insert on the last while lasting, I made a stacked leather buildup so as not to plug the cork full of tack holes.

I'll follow this discussion for what I can learn,

Paul

Robert and Sean ,'Put-anability',coined by Sean ,that is pretty derned useful,After contemplating some useful strategies ,here is a little background,my client is an 80 year old male,X paratrooper,with mis matched sizes 10and1/2 and 12,sub-talor varus, forefoot valgus,with limited 1s/t metartarsal mobility dropped 2,3&4 mets.,and the5th plantar flexed.I have casted George non weight bearing for foot orthotics,intrinsicly casting the metatarsal support in the process rather large,balanced the forefeet by dropping the 1st metatarsal joint ,locking the mid-tarsal joint by holding up the lateral column distal to the 5th MPJ,while maintaining sub-talor neutral.(All this with 2 hands tied behind my back and standing on one leg).Fabricatered his orthotics in 4 seperate laminations with deep approx.22 -25MM heelcups and high lateral flange .The materials otto bock lite,reinforced with 1.8 fibre glass material proximal to mets.,and balanced with 55 durometer soleflex with cream cow top covers.He came with V.A.made pink plastozote useless you know whats with OK mismatched P.W. minor shoes.I encourged him to find a pair of Brookes Beast and he was able to get them in AlburQuerque mis matched and I am amazed,so voila fitted his orthotics and he adjusted to the met supports in seconds.Also I casted him for custom sandals in STS socks .I have prepared his sandal last ,made the insoles and made the trial fitting with packing clear tape and cork bottoms.the atustments needed were only in the lenth.So I will begin the sandals shortly.I would like to prepare his cowboy boot lasts now.So here is where I am at now regarding cowboy boots ,after said discussions,after modifications to the last wetforming english kip ,either tacking and strething to the last sides or casing and vacuume press.I have done this with alcohol and H2O many times so Robert`s suggestion is good .I feel 55 durometer cork would be durable and easy to re-balance.I think with the english kip,thermal cork and insole ,pegging with 1/2'' and 5/8th`s pegs would be doable ,as far as inseaming/channeling ,I see them both as doable too.So what do you think?Put-onability,for my 1st pair of cowboy boots ,removability?So Robert,Are you familiar with the Blake inverted modification?I worked for Arnie Davis in San Francisco for a few years and attended some workshops @ ccpm,from'99toalmost02.I met and know Drs Kirby and Sherer.I have attended 2 PFOLA conferences Miami Beach and Vancouver and wish I could meet you in San Diego,its not to late I think .The flyer is right in front of me somewher in one of those piles!Are you sharing a room? I have also been to Pro-Lab for the 25cent tour.One day I would like to visit Precision Intricast I think in Prescott.Hey isn`t that where Paul lives.Ok ,Fred

I'll look into that, Fred.

Hey, can you link a glossary to your posts? My heads spinnin'. But I'm glad you're with us too!

Paul

hey Paul,If you are interested,the Pedorthic Footwear Association carries some excellent materials in the library on the subject of bio-mechanics.And to Robert and Paul my reference to the Blake inverted I lost my mind for a second there ,I did mean to address Sean, and I am not exluding that particular subject to Sean. I guess I meant to give Sean a little background,[more personal stuff] .Anyway I do hope to here from all of you .Paul,I am trying to give reference to some medical terminology and would gladly include a glossary if I could .I am developing computer skills slowly ,trying to absorb DW`s tutorials and stay in business.Varus is latin for inverted and valgus synomonous with everted.They are movements associated with motion on 3 planes called pronation and supination .I think in the book published by the Pedorthic Footwear Association ,Arnie Davis`s chapter on the subject of biomechanics is by far the most interesting.The book is titled Introduction to Pedorthics,and it has a glossary .I think Sean and Robert would agree that what Arnie has said to me withot a thorough understanding of bio-mechanics one would be lost.And he went on to say that foot orthotics,I would find,to be very interesting.And whats really funny he said was Last Making is like a bottomless pit. I found that to be a challenge and very inspiring.Anyway Peace My Friends ,your newest brother ,Fred

Paul, Lots of fancy terms... if I showed you in person you would realize that its all just common sense made to look confusing. DW and I understood eachother perfectly we just had different names for things. I'll speak in English ok? I like your idea of using a cork buildup to keep the cork from looking like swiss cheese!

Fred, Just looked up PFOLA... not this year. My new clinic opens on the 14th. It would be bad to miss my opening week of work.
Now, it sounds like you are going ahead with the thermal cork/leather insole. I've been trying to get my head around this topic before you brought it up, so please let me know how it works out. How much are you planning to add to your initial foot measurements on the pattern to insure a good fit? It easy (sort-of)to get the fit right while the boot is on. Now that you have explained the foot type we are dealing with, I'll let you know that a rigid foot like this needs more room to get into a boot. I know this from personal experience. I have rigid plantarflexed 1st (big to joint sits lower than than the lesser joints)and bad ankle flexibility. The put-onability issue still plagues me...

Robert, How do change your patterns for a person doing a custom shoe with/ without an orthotic. I know you mostly do shoes but any ideas with a pull on boot?

Sean

OK, guys...

I thought it might be interesting to explore some of the possible causes of common foot complaints. Presumably, there may be more than one but...

For instance, say a foot is functionally normal...

The customer goes to put on a shoe (or boot) and complains of an ache under the medial arch. What might be at the root of this?

Or say they complain of an ache under the lateral arch...again, what could be causing this?

There are a multitude of such minor "grumbles" that we might hear or see as makers that if we understood what the possible causes were we might understand what the remedy is.

Tight Stitches
DWFII--Member HCC

DW,

Good question but harder to answer than you may think. Without more specific details than an ache in the arch it is not even realistic to speculate.
There are a couple of common problems such as flat feet, they come rigid and flexible. The rigid type you have to take for what they are, just accommodate the shape, a flexible flatfoot you can “ply” into a better position.
An other type, opposite to the flatfoot is a cavus foot, high arch, often you see a lot of calluses under the metatarsal heads. Your also likely to see a higher muscle tone with a foot like this and the midfoot is rigid. More often than not the foot has a tendency to bear weight on the lateral side of the foot. Careful with this foot type and slide on boots, the foot will not easily go into the boot!
Within just these two foot types you can have the same symptom with a very different cause, consequence and solution. Even feet that appears to function normal can often be qualified to a more or lesser degree in a category that will explain a range of possible problems that can come up.

If there are more specific cases, please put them up here and you may get some opinions. I'll certainly will do my best giving my when I can get to it. It's probably not a good idea to get into many “what ifs” as it would only be speculation. Even with a specific case it can be hard enough to figure out what goes on if one can not examen the foot in person but has to rely on someone else's observations.

DW, I'm sorry I can't be more helpful as the idea is great to get a listing of possible complaints with solutions.

Rob

All,

Fred, this sure is an ambitious project to take on, specially for a first pair. How much of the correction do you expect to get from the orthotic? If you need more correction in the form of high counters and/or ankle reinforcement I would consider an envelope construction. You would take an ankle height last, put the lining and re-enforcements and than just pull an upper without lining over that, western boot style or any other style.
If you go the route of the envelope shoe / boot you can also add to the length of the small foot over the lining to make the boots look more similar in size. Not so much a functional issue but the customer may really like both feet to look the same.

From your description of the foot type I'm wondering if your customer has a rigid midfoot. If so, a slide on boot will be a problem and you may have to resort to a zipper, even it it's going to be a western style boot. (do I hear someone hyper ventilating in the background and where does that teeth grinding sound come from?) For other foot types a boot with a contoured orthotic should not be a problem to get into as long as you keep a close eye on your measurements when making the last and don't make it to tight. Also make sure your orthotic is firm enough to keep it from getting pushed forward when the foot goes in the boot.

In my experience I would discourage a customer who needs orthotics to get a pull on shoe or boot. Simply because the foot is more prone to move around on the orthotic once inside. For a custom boot this may be different. As my customers generally not qualify or not want a pull on boots my experience with them only goes back to my school days and even that is tainted by my bad memory.
I do not give any extra allowance in my patterns as I make my patterns over the last with the orthotic attached. I make a copy of the last and orthotic, get to a mean forme and base my patterns on that. For a boot I do build up the upper cone of the last and the back over what would be the closing line on a shoe.

One point that Sean brought up and is very useful in a western style boot is the rocker sole. Most custom boots are stiff enough that you get a rocker sole effect anyway but you can always add some to that. The benefit is that you immobilize the foot, once it's in the boot you can probably get away with less aggressive correction compared to a regular shoe / sneaker with an orthotic.

Blake sounds vaguely familiar but the Blake inverted modification does not directly ring a bell, I'll have to look that one up. It's probably one of those thing you know when you hear it but my brain is letting met down. (again)

Arnie Davis does very nice work, I spoke with him on the phone a few times when I was working for a company locally that used him for some custom shoes. It was a no-win situation but considering the circumstances he did very well. I may have seen the PFA book “introduction to pedorthics” once but don't own a copy. Arnie would be a good person to write the biomechanics chapter. When did you work for him, for how long and what did he teach you? He is right that lastmaking can be a bottomless pit but isn't that the same with shoe and bootmaking?

Sean is right on that the terminology is commons sense made to look confusing. If you are slightly mechanical inclined and give yourself some practice you can figure out most things going on in gait. One thing I do before going into heel postion and metatarsal drops is a functional evaluation and determine the type of foot. Looking at the foot as a functional unit, not just at the heel position or the metatarsal position or even the range of motion in the joints, with foot typing you have a very good idea of the foots function and limitations you will find. From there you can go deeper and define the degree of limitation and even deeper go into angles of the heel etc.

Sean, what are the books used in the Canadian Pedorthic education? It strikes me that that Canadian pedorthic system is better organized and provides a more thorough education to turn out a more useful degree when it comes to practical applications and custom shoes. Not that I speak from experience as I have not taken courses on either side of the border but I have worked with Certified Pedorthists from both sides that gives me that impression.

Paul, the cork is very forgiving towards tack holes, pegs may be a different story when you work with Thermo cork. I like to work with the ground up cork in sheet form. It is more forgiving than the thermo cork and offer the customer more shock absorption but will maintain their shape very well, better than EVA's as long as they are secure in the shoe and do not move around.

Fred, I won't be going to the PFOLA, I've used up my travel budget for the year. Not that I would mind going to San Diego but I rather wait till we have a couple of feet of snow on the ground here. That way I get to enjoy the lovely weather and great temperatures even more. Besides I'm not interested in becoming a volume orthotic lab and the crowd there is certainly not as nice at the Cordwainers were!

Wow, if only I didn't have to do any work I would be able to keep up with the discussion. I think this was about all I had to say on this topic. (so far) hope it's kind of clear. If not ask!

Rob

Robert,Thanks for your thoughtful concerns and and input .I started in 1972 learning to design the last from a 3rd generation orthopedic shoe maker ,who survived the holocaust,Sehmour Askanazi.He was one mentor for 2o years.....Old school puts it mild .During those early years,green and naive,I deided to persue my goal to be a craftsman.In the early 70's I made better then 1 thousand pair of custom sandals made to the foot as us "hippies" did in those early days during a resurgence of the crafts movement.I had learned pattern making and design through various institutions and employment and started making shoes and boots.I have made a few pair of wellingtons by building up the cone and tops of the last for the short heel fit.I had not any knowledge of a crimp board.I decided to learn bio mechanics and anatomy for years before making custom footwear.Until 1995 I I decided to persue Pedorthics.I learned further newer tecnologies ,theory's and tecniques @ Davis Shoe refining assessment skills in bio mechanics and orthopedic and shoemaking knowledge through great experience,though I found it extremely difficult and humbling to both be a fledgeling and employee.Now I am truly hard core unemployable,I admit.But I am competent in my endeavor to build the cowboy boots we are discussing.I have yet to decide one of two approaches.One,add a 5mm spacer for the custom insole or two,modify the last and risk the obvious subsequent lacking ability to adust an intrinsic customized innersole so to speak,.To respond to ankle plantarflexion ,it is there for for "put onability". DW,responding to your inquiry,I would like to add that flexible deformitys do lead to fixed deformitys and in my experience a normal foot is a rarity.While normal compensation is required on a flat surface overcompensation does lead to dis location within bone and joint structures.This condition will lead to stretching and tearing of softer tissue structures apparent in all of the arches in the foot.As cadence increases so does unwanted over compensation.Heel spurs,plantar fasciitis,bunions,metatarsalgia,neuromas,etc,result.Muscle contractions result from overfiring,and stay excessively contracted,and can not relax.I do think there is a connection here to a condition now called "restless leg syndrome".I have much to say regarding my personal thoughts in these matters of bio mechanics ,foot posture ,how we stand and walk.Because walking is really standing on one leg and standing on one leg is really sitting on one leg.More simply put our bones or skeleton support our bodies not our muscular system.The latter waste energy,just as step shock probably is a contributer to agiing.So as to "grumblings" from a customer of this or that I think finding the causes are directly linked to foot mechanics and structure.So DW,what are your thoughts Of the orthopedic cowboy boot last and,or the extra depth cowboy boot to accomodate a rigid 1st metatarsal phalangeal joint with rearfoot varus[inversion] whose foot has to excessively evert to be planted on the ground?This scenario is very common.I encounted this sort of foot in my early sandal making days and it scared me from pursuing footwear.I love making shoes ,boots ,orthotics and all sorts of external shoe/boot modifications.Anyway,thanks for your interest and contributions to this area of interest And yeah yeah,Robert I have to get to work too!Peace,Fred

Fred,

I feel I need a glossary now as well, or maybe an index would be more useful. The amount of info you cramp in a couple of lines is overwhelming. Try to come up for air as you type!
Nice Resume, a lot of experience with some impressive teachers.

I'm not sure you understood me correctly, when I make an orthotic on a custom last is is removable from the shoe. Working with spacers has never given me a desirable result. I know it is done so maybe this operator is at fault for not getting it to work. As long as you don't cement the insole to the orthotic it will be removable once the shoe / boot is ready.

For “put onability” the flexibility of the midfoot is as important as the ability of the ankle to plantarflex. With a more rigid midfoot I would definitely make a fitter model to see if your customer can get his foot in.

How do you make a Wellington without a crimping board?

I'm still digesting the rest of your post and may come back with more questions later.

Rob

Robert,Hi, again ,I think I sent an E mail to you off the post by accident.Just responding on this post for interest of others who might be following this discussion,you have helped me in your responses a good deal.The use of the spacer clearly is creating extra depth in the cowboy boot.The custom orthotic would be fabricated from a seperate casting and inserted into the boot.Also fitting a trial boot is absolutely a given.The 5mm spacer at the bottom of the tradional last would be removed and the custom footbed/foot orthotic inserted into the trial boot/fitter and I usually build a wedged cork bottom.On the subject of mid foot flexibility and ankle plantarflexion I understand and appreciate some pretty notable differences in peoples feet.I just bought some crimp boards from our good friend Dick Anderson and am concerned of the sharpness of the leading edge,because of the collagen fibres naturally want to spread omni-directionally as in what I see as natural, opposed to getting hung up on a fairly sharp point,so I wonder if a more rounded edge might be different,sort of easier to spread wrinkling .I am looking forward to some trials and tribulations.When I made wellingtons on a built up last,the cone was built up at least an inch and it was pretty easy to form the Teju lizard vamps.Maybe the lasting part was a little tricky but the shafts were straight and I did a full welt too. A glossary ,an index I don,t think so....I promise to get proficient with a little digital nikon and keep you posted.But because of your help and Sean I am beginning to feel comfortable now to finalize my approach into the abyss.Thank You, Fred

Fred,

I appreciate your sense of zeal when you approach a new task. Unfortunately, I tend to over think all the possible scenarios in my head causing my projects to go slowly. When I finally get down to it, I find that I've made a mountain out of a mole hill. Try to throw some spaces in your posts... You present so much good information but it gets overwhelming when its all in one place.

Are you making a Full Wellington or a Dress Wellington? Sorry, maybe I'm not paying close enough attention.

One of your earlier comments on biomechanics was interesting. You'd think step shock would cause all sorts of issues but the newest studies show just the opposite! Check out studies by Beno Nigg at the University of Calgary. It gets into vibrational tuning of muscles/ bone density etc... Very interesting but not so applicable to what we do in every day practice.

Rob,

A Canadian Certified Pedorthist is apparently quite different from the American system. There are currently 2 streams of study in Canada. 1/A 1 year post Degree (Kinesiology) diploma which includes co-op style lab and clinical component. This is fairly new and is offered at the University of Western Ontario. or 2/ a Kiesiology degree and a 2 year apprenticeship under a C.Ped (C) With both you have to pass a written and practical exam with the College of Pedorthics. (a regulatory body not a place) I actually graduated under the old system where it was any University degree and a 3 year apprenticeship. There is a Mastercraftsman designation. They are few and far between and most of them came from Holland, Italy or Germany and were grandfathered into our association. They tend not not share much info which is why I took DW's course. I was so impressed with his attention to detail and all of the old textbooks he has read. DW knows more about feet than 95% of the people in my industry but he might deny it:P Some of the info being presented in conferences today are based on stuff written by shoemakers of the 18th and 19th century! There is so much good info to be re-learned!

Glad we got this part of the board a little busier,
Sean

Well... it appears this side of the forum has dried up. Fred, I AM really interested to see how your Welly's turn out. Incorporating orthopedic correction in this style is very interesting for me.

DW, I appreciate your attempt to open up this part of the forum to "Correcting Common Foot Problems". I propose a topic that is more specific to get the orthopedic and non-orthopedic crowd involved.

THE most common foot problem I see is plantar fasciitis. It makes up at least %50 of my customer load for foot orthotics and it is caused by many different factors, in many different foot types.

Plantar fasciitis is actually an easy word when broken down into English. Plantar is the bottom. Fascia is connective tissue and "itis" means inflamed. The person usually has severe heel or arch pain particularly in the morning or as the day progresses.

I know how I deal with this issue but I'd like to open it up to everyone...

Sean

When I started experiencing this, I put in a metatarsal support pad and that seemed to clear it up. Is this one of the approaches?

Sean,Thanks for your interest,followup and support.It has been worthwhile discussions with both you and Rob.I will keep you informed on my progress.OK
On plantar fasciitis,lets say prevention or blocking any abnormal motion in the rear foot is about 90% of controlling forefoot pathologies.Therefore I think medial wedging is a given,most of the time,for flat or high arched feet for different reasons.
Rick,I suspect an Apex heel wedge would help you and is worthy of a try.Naturally you can fabricate a wedge out of leather, cork or rubber with your talents.And if the met pads help,that shows us that your metatarsals like some support because they are dropping.I find many clients loading their big toe joint at heel lift,not only stressing the MPJ[Metatarsal phalangeal joint],but also overstretching the medial slip of the plantar fascia.

The fascia originates at the heel bone on the bottom of your foot.5 bands attach at the distal tip of the heel bone[calcaneous]to each toe.To locate the medial slip pull your big toward the knee and palpate the tendinous like tissue that will pop out from the base of the 1st matatarsal head to the base of the heel bone[this attachment to the heel bone is where the"heel spur"is developed,hence heel spur synrdome].

As the heel lifts off the ground and the forefoot is loaded hopefully with about 60% of our weight on the big toe and the remaining 40% across the lesser toes.

This is where the faschii stretches over and over.So imagine the medial slip receiving pressure from the insole of your shoe or from the surface of a footbed or foot orthotic.This is when a plantar fascia groove is necessary to relieve pressure .

Another small matter is the importance of the 1st metatarsal bone to plantarflex at heel lift so the big toe dorsiflexes 80 degrees,otherwise the MPJ will jam and the foot will angle laterally due to pain avoidance in the big toe.This will affect the whole kinetic chain,knee,hip and back.

I hope this small effort is helpful in continuing this discussion in bio-mechanics,Thank You Sean,DW and Rob.

Rick,Could you say more like about perhaps callouses or how your shoes wear out?

Sean and Rob how do you cast for plantarfasciitis?I use plaster splints non-weight bearing,loading the lateral column,locking the mid tarsal,holding the sub-talor neutral,and depending on the levels of rigidity/flexibility of the 1st MPJ will plantarflex the 1st metatarsal,balancing the forefoot to rearfoot relationship, and form the metatarsal arch before the plaster sets up.

The modifications include medial arch fill,medial skive,lateral expansion and for plantarfasciitis a build up for the plantar fascii groove.

Fred















""

There we go!

Rick, that is what the kind of thing I had in mind. A metatarsal support pad is usually used to deal with forefoot issues such as a neuroma or 2,3,4 met head pain/callusing. It can prove helpful with plantar fasciitis though, because, as Fred mentions the p.fascia has a slip that goes from the calcaneus to each of the toes. Your pad is likely changing the angle of pull on the fascia and is relieving your symptoms:>

I'll throw out a simple cause first... wearing a shoe with incorrect heel to ball fit..

Fred,
I use semi non-weight bearing foam box a lot but also use a non weightbearing slipper cast aswell (particularly with my lab clients) You can put a beautiful P.fascia accommodation into the foam onto the plaster positive or into the shell too if you'd like. It all works for me, just a different approach.

Cheers,
Sean

Sean,Do you fit ready made shoes?I generally find clients fitted too small in ready made shoes.And I have my opinion in regard to the Brannock in measuring heel to ball.Of course nothing is perfect but we still strive for perfection.

So the question I pose for the forum for sitting and standing measurements in view of static vs.dynamic is this.Where does the distal point get measured at the ball of the foot?Is it at the apex of the medial side of the 1st metatarsal head?Is it at the joint space at the dorsal aspect where the Hallux meets the metatarsal head?


I see this as an important consideration in shoe making as well as shoe fitting for ready made shoes.

Since the forefoot flexes at the joint line ,then the shoe follows the foot.I think my answer to my question is obvious,but would like to here from others.

I recently cast a client with pretty severe laxity with the foam box after casting with splints.What was really lost in the foam box casting was the lateral arch and especially under the calcaneal-cuboid joint.

I have seen the placement of a pre-fab metatarsal support into the foam box prior to pouring the plaster and don`t like that idea very much when you can really get the metatarsal support very accurately during non wt. bearing casting with plaster.

I think the foam box is Ok for something like pes cavus or a rigid foot structure.You just lose manual and visual contact with the foot,so I just avoid it.I keep Bio-Foam boxes for another reason,for forming the toe boxes for custom shoes on a plaster last.
best regards,Fred
PS I am not a shoe store and I refer clients to several stores.
I would love to know how to capture the foot with the laxity,because that one is a real challenge.Non weight bearing doesn`t allow for the foot widening or elongating.
My best approach so far is placing the foot with the plaster splints on a 1 inch casting foam pad, early in the casting process for semi wt. bearing,any suggestions are welcome!

Sean, all,

I am pleased that you have gotten the ball rolling again in this topic. Very interesting discussion.

Luchesse always said "if you're gonna fit 'em wrong, fit 'em long." That came to mind immediately, Sean, when you observed that a lot of plantar fascia was caused by an improper fit in the heel to ball measurement.

Of course, I am more a "by-the-seat-of-the-pants" maker than an orthopedic technician of any sort (so take all this with a grain of salt), and as a result, I do not recognize all the terminology...a lot of it but not all. As an aside, I think that this topic might get a lot more attention and a lot more by way of interaction if some of the more obscure terms were defined in parentheses for a time.

I have, more by good fortune than studied intent, had pretty good luck fitting feet over the years. Of course I do not deal with many abnormal feet. That said, I do not care for the Brannock device, either. But I do use a pedograph so that I have a weight-on outline and footprint. I take girth measurements weight-off, and feel that the more data that can be collected from the foot the better--I now take a long heel measurement two ways.

So as for the medial ball joint is concerned, I find the center of the joint on the medial side (sometimes locating it on the dorsal, or top, surface first) and then try to trace or calculate its declination as far under the foot as I can without disturbing, or taking the weight off the foot.

As Fred suggested the foot flexes in this joint...and under the foot rather than on top or at the side...and this is a critical bit of information in my view, especially since the angle of the joint tends to be farther forward on the dorsal surface than it is on the plantar surface (under the foot).

Without that information, the heel to ball measurement can be off almost a size...approx.5-8mm...in my experience. And I suspect that could be a problem.

But running parallel to all this and begging the question, is how often a shoe might be fit fine in the medial heel to ball dimension and be off in the lateral heel to ball dimension? And how that affects such things as plantar fascia?

Tight Stitches
DWFII--Member HCC

DW,Not knowing you personally and only through your writings as an incredible and generous mentor,I am really delighted to here this perspective of the lateral arch brought to bear on shoe fit,admitting I have not put the lateral column into question. And now I will.

Also,though I am trying to bring medical terminogy into laymans terms ,I will try harder and will be happy to explain to the forum as such in the future.

How would the parabolic curve of the MPJ`s affect walking,jogging and running activities?

This question immediately brings the Mortons Toe to light.This is where the 1st metatarsal is short and the 2nd metatarsal longer so the parabolic curve comes to a point and the 2nd metatarsal takes up the load of the 1st metatarsal.Then the curve crosses the 3rd,4th and 5th,presenting the arrowhead shape.

Now a mortons toe extension under the 1st MPJ and Hallux[big toe] is the remedy to allow the big toe and joint will take up its lions share of loading the forefoot across all 5 metatarsals. So back to your question,my simpleton answer in the moment is the shoe has to allow lateral arch to flex at the 5th metatarsal joint.

I will add to this later OK.,Fred

DW,
That is a good comment on the angle of the medial ball joint. I had never considered it before! I'd better take that into account. I have been using a pedograph recently. My partner has used one for years. That along with using one in your course has convinced me to use one in my practice.

The lateral heel to ball measurement does get ignored on a Brannock... How does it affect the plantar fascia? hmmm ok, if the shoe fits too SHORT lateral heel to ball it would decrease the support on the lateral column of the foot and could strain the lateral slip of the p. fascia. If the lateral heel to ball measurement is too LONG then it is impossible to keep the foot in a good alignment. In a "normal" foot the person would externally rotate the foot (turn out) to make push off easier placing more strain on the medial arch and p.fascia. (I actually use this technique for young children who intoe. Stiffening up the lateral forefoot of the shoe makes them turn their foot out into a better position.)

Fred, I don't sell ready made shoes but I see the problems of poorly made/poorly fitting shoes every day. Another cause of plantar fascia strain that I see is dress/casual shoes with a weak or non-existent shank! I'm not talking about cheap shoes either. A lot of the European "comfort" shoes are made this way.

I'm not going to get into casting/ orthotic design here... I'm more interested in causes related to shoe making or shoe fit to make this post applicable for more people on the colloquy. Let's explore that later, ok?

Sean

DW,Fred,or Sean,

For those of us that's not quit up to speed as we would like to be at fitting and the use of terminology could a drawing showing some of the fit points mentioned here be done.Fitting is must have knowledge to become good at shoe building I welcome this discussion.

Ed

Sean,DW,Ed
Sean,The Pigeon Toe wedge place under the 5th MPJ[Little Toe,aka metatarsal phalangeal joint]to the distal tip of the 1st or big toe[hallux] will rotate the foot externally and stiffen the lateral aspect of the shoe to create a sort of hill for the foot to climb.Is this basically what you are referring to in stiffening the lateral column?

DW,I always take pedograph prints for custom shoes for every type of foot.Those I call Static prints.Many of my clients require casting so the landmarks are naturally accountd for.And I will always account for the 5th Mpj when designing ,modifying factory last,thanks to your insight.
Also in regard to pedograph prints I find very useful info from making Dynamic prints,from heel strike ,mid-stance into toe off in how the foot moves and distributes pressure.This step usually confirms both the bio-mechanical evaluation and gait analysis.This is part of my process for custom foot orthotics and orthopedic shoe last as a standard.

Ed,I am just catching up on basic computer skills and starting to use a digital camera and cultivating my ability to post photo`s and will look into a scanner to post illustrations although I just realized I could probably photo a sketch with my current armamenture.

Can anyone comment their experience on that point?I`d like a scanner anyway.

Thanks,Fred