Rob,
Maybe I didn't read your analysis carefully enough or maybe I just don't have enough backgrounding to read it carefully enough to extract any valuable info from it; but I have made boots for people who do not show any of the symptom you mentioned above yet insist on plenty or room for the big toe.
If I were to encounter another customer like that--no glaringly obvious problems--how would I go about altering, modifying or "fixing" the rear or midfoot sections of the last to prevent clipping?
I know I can add a buildup to the lateral forepart but that's not what you are talking about, is it?
Tight Stitches
DWFII--Member HCC
Correcting common foot problems
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paul
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Re: Correcting common foot problems
Can I stick my toes in here?
If I'm understanding what I'm reading, I have pictures of how I dealt with it.
Please correct or comment on anything any of you see.
Paul
If I'm understanding what I'm reading, I have pictures of how I dealt with it.
Please correct or comment on anything any of you see.
Paul
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erickgeer
Re: Correcting common foot problems
Geri,
You probably already know these guys, but I Sachs Sons is the local shoe repair finder:
637 W Roosevelt Road
Chicago, IL 60607-4911
Phone: (312) 666-0091
Fax: (312) 666-9108
They have many types of sheetgoods, but since they are geared to shoe repair, and not orthopedics, your selection is perhaps not as specific as the sources Brendan and Rob gave you. They have quite a bit of leather (not all good) and soling and various bits and bobs- sanding belts and replacement trimmers for you finisher.
Erick
(Message edited by erickgeer on February 28, 2008)
You probably already know these guys, but I Sachs Sons is the local shoe repair finder:
637 W Roosevelt Road
Chicago, IL 60607-4911
Phone: (312) 666-0091
Fax: (312) 666-9108
They have many types of sheetgoods, but since they are geared to shoe repair, and not orthopedics, your selection is perhaps not as specific as the sources Brendan and Rob gave you. They have quite a bit of leather (not all good) and soling and various bits and bobs- sanding belts and replacement trimmers for you finisher.
Erick
(Message edited by erickgeer on February 28, 2008)
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relferink
Re: Correcting common foot problems
All,
Yes Paul, please stick your toes in. Thanks for posting those pictures, they make for a nice sample.
I take it you don't have a picture of this customer's feet. I don't have any on my computer to show clearly what I mean but I'll try to get my point across anyway.
For the sake or argument we have to establish that there is such a thing as an “ideal foot”. This is the foot where all 28 bones in each foot line up in the position they function most efficiently. This is referred to as the subtalar neutral. If the foot is in less than an ideal position it causes access wear on joints and over time painful problems can develop. Many people with less than ideal feet do function well, often without any problems or pain early on. Once pain develops simple adjustments will no longer be sufficient and drastic changes need to be made.
The question comes up, do you need to do anything to improve the foot position and function if it doesn't hurt?
A pedograph of a healthy foot looks like this:
Paul, without being able to see the entire pedograph of your customers foot I selected on out of my stash. I believe these feet are structurally not all that different.
Sorry for cutting off the heel. My scanner isn't long enough.
Compared to the “normal” pedograph the big toe on this one comes in more medially. Noticeable is the mild medial bulge at the toe and the increased pressure in that spot. If you inspect the customers foot you'll see a nice size callus in that spot, just on the bottom edge of the toe. If you put a ruler along the medial side it is nearly “baby straight”.
Quick background info: this foot over-pronates. Due to this there is some damage in the MPJ 1 joint and the big toe has limited mobility.
Back to Paul's customer. In your last selection you choose not to push the toe in. You added to the toe medially as well as to the area of the 5th metatarsal to account for the shape of the foot. Pushing the toe over in this case may have caused discomfort for your customer.
I won't go into if this is a good decision or not as I can not win such an argument. The boots are beautiful. I'm sure the customer is thrilled with them and they should be comfortable based on the insole shape. I'm not out to change that. I just want to point out a slightly different approach.
The risk you run catering to the foot the way Paul did is that you end up with a last that is shaped like a banana. I'm unable to find a suitable image to show what I mean. It's the last that is inflared at the toe and often build up on the lateral midfoot. Paul's last shows a little of that. (Sorry Paul, no offense meant but I think you can see what I mean)
Now let's approach this differently and go back to the pedographs. To the trained eye the pronation is also visible at the base of the heel, in the marked area.
The heel bone rolls in and this is where the proration originates.
If you offset this pronation in the rearfoot at the moment of heel strike you can make a noticeable correction with a small wedge. Compare that with waiting till the foot is in mid stance and fully pronated you will need a stiff plastic orthotic to hold back the full body weight and than some. By correcting the access pronation going on in the foot there will be less stress on the big toe and it in turn can be pushed in (in moderation) without a problem.
Look back a couple of posts at Brandan's post and you see a way to adjust the last. There are a number of different approaches to counter pronation but when you incorporate these in your last the foot will straighten out closer to the “ideal” pedograph and you need to worry less about making an odd shaped insole pattern look decent.
I hear DW's point that he pushes in the toe anyway without a problem and I can't argue with success. Back to the question, do you need to do anything to improve the foot position and function if it doesn't hurt? That'll be up to each and every one individually to decide.
The point I'm trying to make is that if you can aid the functionality of the foot, why wouldn't you. In the process you make your customer more comfortable and the appearance of the shoe / boot better.
It really is not a black and white situation, it is closer to bringing your product from good to better.
This matter is probably less complicated than I make it sound. I find it hard to put into words. If anyone has anything to add to make it clearer please jump in or if there are questions, please ask and I'll try to answer to the best of my ability.
Rob
Yes Paul, please stick your toes in. Thanks for posting those pictures, they make for a nice sample.
I take it you don't have a picture of this customer's feet. I don't have any on my computer to show clearly what I mean but I'll try to get my point across anyway.
For the sake or argument we have to establish that there is such a thing as an “ideal foot”. This is the foot where all 28 bones in each foot line up in the position they function most efficiently. This is referred to as the subtalar neutral. If the foot is in less than an ideal position it causes access wear on joints and over time painful problems can develop. Many people with less than ideal feet do function well, often without any problems or pain early on. Once pain develops simple adjustments will no longer be sufficient and drastic changes need to be made.
The question comes up, do you need to do anything to improve the foot position and function if it doesn't hurt?
A pedograph of a healthy foot looks like this:
Paul, without being able to see the entire pedograph of your customers foot I selected on out of my stash. I believe these feet are structurally not all that different.
Sorry for cutting off the heel. My scanner isn't long enough.
Compared to the “normal” pedograph the big toe on this one comes in more medially. Noticeable is the mild medial bulge at the toe and the increased pressure in that spot. If you inspect the customers foot you'll see a nice size callus in that spot, just on the bottom edge of the toe. If you put a ruler along the medial side it is nearly “baby straight”.
Quick background info: this foot over-pronates. Due to this there is some damage in the MPJ 1 joint and the big toe has limited mobility.
Back to Paul's customer. In your last selection you choose not to push the toe in. You added to the toe medially as well as to the area of the 5th metatarsal to account for the shape of the foot. Pushing the toe over in this case may have caused discomfort for your customer.
I won't go into if this is a good decision or not as I can not win such an argument. The boots are beautiful. I'm sure the customer is thrilled with them and they should be comfortable based on the insole shape. I'm not out to change that. I just want to point out a slightly different approach.
The risk you run catering to the foot the way Paul did is that you end up with a last that is shaped like a banana. I'm unable to find a suitable image to show what I mean. It's the last that is inflared at the toe and often build up on the lateral midfoot. Paul's last shows a little of that. (Sorry Paul, no offense meant but I think you can see what I mean)
Now let's approach this differently and go back to the pedographs. To the trained eye the pronation is also visible at the base of the heel, in the marked area.
The heel bone rolls in and this is where the proration originates.
If you offset this pronation in the rearfoot at the moment of heel strike you can make a noticeable correction with a small wedge. Compare that with waiting till the foot is in mid stance and fully pronated you will need a stiff plastic orthotic to hold back the full body weight and than some. By correcting the access pronation going on in the foot there will be less stress on the big toe and it in turn can be pushed in (in moderation) without a problem.
Look back a couple of posts at Brandan's post and you see a way to adjust the last. There are a number of different approaches to counter pronation but when you incorporate these in your last the foot will straighten out closer to the “ideal” pedograph and you need to worry less about making an odd shaped insole pattern look decent.
I hear DW's point that he pushes in the toe anyway without a problem and I can't argue with success. Back to the question, do you need to do anything to improve the foot position and function if it doesn't hurt? That'll be up to each and every one individually to decide.
The point I'm trying to make is that if you can aid the functionality of the foot, why wouldn't you. In the process you make your customer more comfortable and the appearance of the shoe / boot better.
It really is not a black and white situation, it is closer to bringing your product from good to better.
This matter is probably less complicated than I make it sound. I find it hard to put into words. If anyone has anything to add to make it clearer please jump in or if there are questions, please ask and I'll try to answer to the best of my ability.
Rob
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dw
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Re: Correcting common foot problems
Rob,
What would the correction on the last look like? And exactly where would it be placed? What would the last, or a bottom paper, look like placed correctly over the print?
On a separate tack, what are you seeing on the pedograph that is telling you to make this correction?
For instance, at least on my computer, the subtalar neutral print seems to be printing hard on the first toe, not printing the fifth toe at all, and printing hard again on the medial heel...just about where you have the red circle on the other print. And the foot seems to be very close to being pes cavus.
At the same time, the pronating print shows slightly darker at the medial edge of the first toe, not printing the fifth at all, ever so slightly darker maybe, under the first met head and not significantly darker in the area circled.
So what are you seeing that tells you what you've got and how to deal with it? Or is it just my monitor?
Tight Stitches
DWFII--Member HCC
What would the correction on the last look like? And exactly where would it be placed? What would the last, or a bottom paper, look like placed correctly over the print?
On a separate tack, what are you seeing on the pedograph that is telling you to make this correction?
For instance, at least on my computer, the subtalar neutral print seems to be printing hard on the first toe, not printing the fifth toe at all, and printing hard again on the medial heel...just about where you have the red circle on the other print. And the foot seems to be very close to being pes cavus.
At the same time, the pronating print shows slightly darker at the medial edge of the first toe, not printing the fifth at all, ever so slightly darker maybe, under the first met head and not significantly darker in the area circled.
So what are you seeing that tells you what you've got and how to deal with it? Or is it just my monitor?
Tight Stitches
DWFII--Member HCC
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dw
- Seanchaidh
- Posts: 5830
- Joined: Wed Jan 01, 1997 10:00 am
- Full Name: DWFII
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Re: Correcting common foot problems
Rob,
Frankly, I don't know where to post this...Al has some good comments over in One Last Question that apply to this discussion as well as to the whole idea of lasts and last shapes.
But since you posted your pedographs here perhaps this is as good a place as any....
The following image is a pedograph from my own foot. It looks remarkably like your "pronating" print above.
But again, for the last 35 years, I have been wearing boots that by the standards that we seem to have before us, slightly clip my great toe--perhaps as much as a quarter inch if I were to lay a bottom paper over the print. I have no callus on the bottom or side of my toe nor on my heel. Or if I do it is so slight as to be hard for an ignorant (meaning lacking knowledge) person such as myself to feel. I have no discomfort and do not notice the toe touching the inside wall of the boot although a quick feel of the foot inside the boot clearly indicates the toe is snuggled up nice and cozy. I think it is also clear enough that after 35 years there is little or no lateral migration of the great toe. I do not walk bowlegged or with a gait that might be thought of as compensating for pronation.
But even more telling, I think, is that I generally wear a hole maybe slightly to the medial side of the treadline on my outsoles...along what I would call the "line of muscular action."
I'm not sure what I'm asking with this image but I would like your thoughts...especially as to the way it compares with your pronating print above.
Tight Stitches
DWFII--Member HCC
Frankly, I don't know where to post this...Al has some good comments over in One Last Question that apply to this discussion as well as to the whole idea of lasts and last shapes.
But since you posted your pedographs here perhaps this is as good a place as any....
The following image is a pedograph from my own foot. It looks remarkably like your "pronating" print above.
But again, for the last 35 years, I have been wearing boots that by the standards that we seem to have before us, slightly clip my great toe--perhaps as much as a quarter inch if I were to lay a bottom paper over the print. I have no callus on the bottom or side of my toe nor on my heel. Or if I do it is so slight as to be hard for an ignorant (meaning lacking knowledge) person such as myself to feel. I have no discomfort and do not notice the toe touching the inside wall of the boot although a quick feel of the foot inside the boot clearly indicates the toe is snuggled up nice and cozy. I think it is also clear enough that after 35 years there is little or no lateral migration of the great toe. I do not walk bowlegged or with a gait that might be thought of as compensating for pronation.
But even more telling, I think, is that I generally wear a hole maybe slightly to the medial side of the treadline on my outsoles...along what I would call the "line of muscular action."
I'm not sure what I'm asking with this image but I would like your thoughts...especially as to the way it compares with your pronating print above.
Tight Stitches
DWFII--Member HCC
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fred_coencped
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Re: Correcting common foot problems
Happy Leap Year Day from the land of enchantment!!
Greetings,I have been Busy!
Firstly Rob,I think your post are excellent and noble to the cause.Bravo.I have to give you the worthy respect and consideration you deserve ,OK.
DW,and all others concerned with foot pathologies,it is not my intention to have anyone "drink water from a fire hose",ever or confuse anyone either.
Starting with the pes cavus foot that has to reach its end range of pronotory motion just to get flat on the ground and continues into pronation throughout the gait cycle is considered abnormal.That foot may only partially supinate or because of a forefoot valgus where the forefoot is everted on the rearfoot require a depression in the insole under the 1st mpg and hallux to enable the foot to function normally, and this could be in conjunction with a rearfoot medial varus post,or medial heelwedge[same thing]Pronation and Supination is motion on 3 planes,The transverse plane is inversion,eversion;the sagital plane is dorsiflexion,plantarflexion and the transverse plane is adduction and abduction.Pronotory motion inludes eversion,ab-duction and dorsiflexion.Supinatory motion includes inversion,ad-duction and plantarflexion.
The 1st metatarsal and the 5th metatarsal both pronate and supinate as does the sub-talor and mid-tarsal joints in ordinary walking and running at differing phases of the gait cycle.The 2nd,3rd and4th metatarsals move on the sagital plane dorsi flexion and plantarflexion.
'
Now if the pes cavus foot functions in pronation throughout the gait cycle along its medial column to the toe off phase and the foot rolls off 90 to 100% off the big toe then the forefoot is being over exerted and the foot fails to supinate and leaves the ground in pronation as what I refer to as a loose bag of bones opposed to a .rigid foot structure as a pes cavus foot generally is defined .Callouses etc etc occur ,and also jamming will result,hallux limitus and eventually hallux rigidus will occur.Also this foot does not need any arch support because of a strong medial arch.I have found the foot needing more lateral and metatarsal support and forefoot cushioning to help the metatarsal heads.
At the toe off phase of the gait cycle the foot should have begun to supinate at the mid stance phase of the gait cycle.That is when the foot starts its propulsive phase and begins to Supinate.At supination the metatarsals plantarflex and lock up against the rearfoot tarsal bones,the cuboid bone at the base of the 5th metatarsal and the 3 cuneiforms,medial middle and lateral.
Both Brendon and Rob have indicated the medial calcaneal wedge effectiveness to even the loading across the forefoot.I agree.
It is critical that the 1st metatarsal plantarflexes at this last phase of the gait cycle so the hallux can dorsiflex 80 degrees.Remember that the 1st metatarsal pronates and supinates and plantarflexion,inversion and ad-duction are 3 planes of motion that define supination.
When giving the medial calcaneous support 90% of forefoot function can be achieved to balance the forefoot where 60 to 70% from the heel lift,toe off phase of gait is at the 1st mpj[metatarsal phalengeal joint] and the remaining 30 to 40% across the 4 lesser toes.
Addressing "pinching the toe"on custom lasts.I also practice this process in last modifications in custom last and orthopedic last.First for the pes cavus foot metatarsal support supporting the distat metatarsal neck regions or transverse arches helps to create a snug shoe in the midfoot and forefoot ball and toe areas.
Second,assuming with bringing the ground up to the medial heel in any fashion and the forefoot now is balanced to roll over across all 5 metatarsals ;what should happen to the 1st metatarsal is this.The 1st metatarsal plantarflexes,inverts and ad-ducts[Supinates] as does the 5th metatarsal.
I generally will pinch the big toe mid way between the lines of the foot tracing on the pedograph print and the actual tracing line of the foot via a perpindicular stylus,so the pinching of the toe starts at an adjacent line from the head of the 1st metatarsal or met head to the distal medial tip of the "great toe".
In contrast,what would happen to the flat foot when the foot is AB-Ducted and rolls over the medial forefoot when the hip is externally rotated? This is an important consideration for all shoemakers?In that scenario I would more likely leave the big toe area roomy and invert the entire medial column and prod the foot toward the lateral side as Brendoon suggested for Geri.
Al,"King of Swing",That fits you!You mentioned the medial heel lifting higher than the lateral heel and that is a supinatory moment at heel lift as the metatarsals are plantarflexing in the normal foot so a heel wedge or Varus heel post will block unwanted excessive eversion of the medial heel and promote normal inversion of the heel at heel lift and if the 1st mpj supinates it inverts laterally away from the distal medial side of footwear ,hence legitimizing pinching the last.I sure hope to have transmitted some palatible information today,.Especially supporting Rob, Brendon,Al and the rest of us. OK Hoping you all have a peaceful bonus day.
,Peace,Fred
Greetings,I have been Busy!
Firstly Rob,I think your post are excellent and noble to the cause.Bravo.I have to give you the worthy respect and consideration you deserve ,OK.
DW,and all others concerned with foot pathologies,it is not my intention to have anyone "drink water from a fire hose",ever or confuse anyone either.
Starting with the pes cavus foot that has to reach its end range of pronotory motion just to get flat on the ground and continues into pronation throughout the gait cycle is considered abnormal.That foot may only partially supinate or because of a forefoot valgus where the forefoot is everted on the rearfoot require a depression in the insole under the 1st mpg and hallux to enable the foot to function normally, and this could be in conjunction with a rearfoot medial varus post,or medial heelwedge[same thing]Pronation and Supination is motion on 3 planes,The transverse plane is inversion,eversion;the sagital plane is dorsiflexion,plantarflexion and the transverse plane is adduction and abduction.Pronotory motion inludes eversion,ab-duction and dorsiflexion.Supinatory motion includes inversion,ad-duction and plantarflexion.
The 1st metatarsal and the 5th metatarsal both pronate and supinate as does the sub-talor and mid-tarsal joints in ordinary walking and running at differing phases of the gait cycle.The 2nd,3rd and4th metatarsals move on the sagital plane dorsi flexion and plantarflexion.
'
Now if the pes cavus foot functions in pronation throughout the gait cycle along its medial column to the toe off phase and the foot rolls off 90 to 100% off the big toe then the forefoot is being over exerted and the foot fails to supinate and leaves the ground in pronation as what I refer to as a loose bag of bones opposed to a .rigid foot structure as a pes cavus foot generally is defined .Callouses etc etc occur ,and also jamming will result,hallux limitus and eventually hallux rigidus will occur.Also this foot does not need any arch support because of a strong medial arch.I have found the foot needing more lateral and metatarsal support and forefoot cushioning to help the metatarsal heads.
At the toe off phase of the gait cycle the foot should have begun to supinate at the mid stance phase of the gait cycle.That is when the foot starts its propulsive phase and begins to Supinate.At supination the metatarsals plantarflex and lock up against the rearfoot tarsal bones,the cuboid bone at the base of the 5th metatarsal and the 3 cuneiforms,medial middle and lateral.
Both Brendon and Rob have indicated the medial calcaneal wedge effectiveness to even the loading across the forefoot.I agree.
It is critical that the 1st metatarsal plantarflexes at this last phase of the gait cycle so the hallux can dorsiflex 80 degrees.Remember that the 1st metatarsal pronates and supinates and plantarflexion,inversion and ad-duction are 3 planes of motion that define supination.
When giving the medial calcaneous support 90% of forefoot function can be achieved to balance the forefoot where 60 to 70% from the heel lift,toe off phase of gait is at the 1st mpj[metatarsal phalengeal joint] and the remaining 30 to 40% across the 4 lesser toes.
Addressing "pinching the toe"on custom lasts.I also practice this process in last modifications in custom last and orthopedic last.First for the pes cavus foot metatarsal support supporting the distat metatarsal neck regions or transverse arches helps to create a snug shoe in the midfoot and forefoot ball and toe areas.
Second,assuming with bringing the ground up to the medial heel in any fashion and the forefoot now is balanced to roll over across all 5 metatarsals ;what should happen to the 1st metatarsal is this.The 1st metatarsal plantarflexes,inverts and ad-ducts[Supinates] as does the 5th metatarsal.
I generally will pinch the big toe mid way between the lines of the foot tracing on the pedograph print and the actual tracing line of the foot via a perpindicular stylus,so the pinching of the toe starts at an adjacent line from the head of the 1st metatarsal or met head to the distal medial tip of the "great toe".
In contrast,what would happen to the flat foot when the foot is AB-Ducted and rolls over the medial forefoot when the hip is externally rotated? This is an important consideration for all shoemakers?In that scenario I would more likely leave the big toe area roomy and invert the entire medial column and prod the foot toward the lateral side as Brendoon suggested for Geri.
Al,"King of Swing",That fits you!You mentioned the medial heel lifting higher than the lateral heel and that is a supinatory moment at heel lift as the metatarsals are plantarflexing in the normal foot so a heel wedge or Varus heel post will block unwanted excessive eversion of the medial heel and promote normal inversion of the heel at heel lift and if the 1st mpj supinates it inverts laterally away from the distal medial side of footwear ,hence legitimizing pinching the last.I sure hope to have transmitted some palatible information today,.Especially supporting Rob, Brendon,Al and the rest of us. OK Hoping you all have a peaceful bonus day.
,Peace,Fred
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relferink
Re: Correcting common foot problems
All, (caution, this is a long one
)
First of all I have to clarify a few things here. I'm trying to explain a concept. If you run into these situations in real live and your customer has walked around with an imbalance in their feet for many years it is unrealistic to think that you can correct the foot to it's “original” or “ideal” position. By correcting the foot you are able to straighten out the foot more than how you found it, slow down the process that could cause future damage to the point where the customer will be in pain. It will in time also make the customers foot more comfortable and the fit of the shoe/boot will be better.
Consider the foot in gait when you envision the processes taking place. Heel strike, mid stance and toe off. When we take a pedograph we only look at a static image of the foot in mid stance. A process such as pronation most frequently starts at heel strike. If the ligaments and joints around the calcanius (heelbone) allow access rotation of that bone the arch will “drop” to much, the foot can not recover it's ideal position before toe off, causing odd pressures through the metatarsal heads and toes. The toes being fairly flexible are the most likely candidates to compensate the imbalance. That's why the toes often will show what's going on in the foot without being the cause.
I won't get into DW's question of what the correction will look like. (just yet at least) There are many different approaches and once you get the concept you'll probably figure out the where and how to easy enough.
Al,
I'll answer your post from One "Last" Question in this tread.
Regarding your observations: 1) Agreed, that is a difficult shape to fit. Consider the toe coming out because of earlier initiated pronation. By taking the cause away you take the stress off the toe and push it in some.
The tripod example is not a bad one, just remember that the toe does not make up one of the legs, it's the 1st metatarsal head. The toe is just and “extension piece” to the tripod. Now if you were to load up the tripod unbalanced one of the legs will be overloaded, not to the point that it would tip over but over time that leg will wear down and if one were to break or buckle it would be that one. Now picture the toe as an extra balance piece attached to the leg of the tripod. In this case shifting the extra balance piece (toe) over would not be a good idea.
If you adjust the load evenly over all the legs and than adjust the extra balance piece you'll be fine. Same with the toe, if it gets overloaded due to imbalanced gait, don't fool around with it. If you re-balance the load you have the flexibility to adjust it without negative effects.
2) No. The callus that forms at the medial base of the big toe is not caused by the pushing against the toe. If you make a shoe that as a full inch between the side and the shoe the callus will still be there. It is caused by the way the foot rolls off over the big toe in gait, access pronation is the root cause. Control the pronation and you will reduce the callus and in theory make the toe more flexible, thus allowing one to push it in some when styling a last.
3) By angling the cone into the direction of the inflair you certainly mitigates the banana look, or Swing King look if you will
. I don't know why that last shape has nearly disappeared for modern day production lasts.
As most of us work off production lasts in one form or another we don't have the option of easily changing the cone orientation. If you can straighten out the foot, even if it's only mildly you will also mitigate the banana look.
We agree that the look of the shoe can be affected by tweaking but just that, tweaks. Mild adjustments to the shape. As is the correction that will cause the toe to require less width in the shoes. Since two teaks are better than one, why not?
I'm not sure I'm understanding you correctly on the “twist” in the last. I'm re-reading your other post but it's not falling into place, please elaborate.
I think we need to take a step back and establish that on a healthy foot a mild clippig of the big toe is not a problem. No, it's not the best thing to do, ideally you leave the toes where they are. It's not by accident that a countour last, as wide in the toe as at the ball has long been a popular style in orthopedic shoes. They are also ugly and many that would benefit from a shoe like that rather suffer.
So in the interest of styling the foot into something it is not meant to be, a sleek, graceful and sensible looking unit we have to compromise. The problem arises when the foot is not in that great a shape to begin with. Adjusting the function will re-align the foot and the compromises requested by the customer bearable.
On the list of limitations of production lasts I want to add a third element, a single last desing needs to be a good fit for as many feet as possible. Not just “normal” feet but pronators, supinators, flat feet and caves feet. Any anatomical features added to those lasts work for some but does eliminate other potential customers.
I do agree that with a set of decent production lasts great shoes can be made that can be made even better with small adjustments for the individual condition beyond just shape.
DW,
Your pedograph is very different in the lateral aspect. Without actually seeing and examining your foot I can't tell you how and why. The heel is certainly pronated but the midfoot seems to correct itself. This distinct lateral pattern is something I see in very flat feet that seem to hinge on the midfoot. If your foot was like that there would be no arch showing. Your Pedograph does not show a pinch callus but the 1st metatarsal joint does not print evenly.
Any other readers have any clues what's going on with this foot type that I'm missing?
No argument with success. Based on the pedograph I see no reason not to pinch the toe.
BTW, the “ideal” foot podograph posted earlier is not my favorite, it's not bad but not great either. It was simply the best I had from a textbook. In my collection of pedographs I don't have anything better as I deal with problem feet, not perfect feet.
The point that I'm not sure you picked up on was that the pronation that's shown I the marked area in the heel is not all that clear unless you know what your looking for. The toe imprint is a much clearer and easier to identify landmark for the same issue. That's what I was trying to say.
Fred,
Thanks for the nice words. Wow, you sure put a lot in a single post. Text based discussions are unfortunately insufficient to clearly show the complex, three plane precesses that go on. Certainly a good topic to consider for the annual HCC meeting.
As much as all this applies to “orthopedic cases” it also applies to nearly every foot that comes through any of our doors, orthopedic, bespoke or western boot maker. With relatively small adjustments a great improvement can be made in the comfort and function of your customers footwear.
You make a very valid point about the flat foot and the externally rotated hip. That is certainly a much more complex situation and it does raise the point that corrections need to be undertaken carefully for those new to this approach.
Any thoughts on the pedograph DW posted?
I'm not going to be around much over the weekend but think this is a great discussion and think it's worth continuing as time permits.
Rob
) First of all I have to clarify a few things here. I'm trying to explain a concept. If you run into these situations in real live and your customer has walked around with an imbalance in their feet for many years it is unrealistic to think that you can correct the foot to it's “original” or “ideal” position. By correcting the foot you are able to straighten out the foot more than how you found it, slow down the process that could cause future damage to the point where the customer will be in pain. It will in time also make the customers foot more comfortable and the fit of the shoe/boot will be better.
Consider the foot in gait when you envision the processes taking place. Heel strike, mid stance and toe off. When we take a pedograph we only look at a static image of the foot in mid stance. A process such as pronation most frequently starts at heel strike. If the ligaments and joints around the calcanius (heelbone) allow access rotation of that bone the arch will “drop” to much, the foot can not recover it's ideal position before toe off, causing odd pressures through the metatarsal heads and toes. The toes being fairly flexible are the most likely candidates to compensate the imbalance. That's why the toes often will show what's going on in the foot without being the cause.
I won't get into DW's question of what the correction will look like. (just yet at least) There are many different approaches and once you get the concept you'll probably figure out the where and how to easy enough.
Al,
I'll answer your post from One "Last" Question in this tread.
Regarding your observations: 1) Agreed, that is a difficult shape to fit. Consider the toe coming out because of earlier initiated pronation. By taking the cause away you take the stress off the toe and push it in some.
The tripod example is not a bad one, just remember that the toe does not make up one of the legs, it's the 1st metatarsal head. The toe is just and “extension piece” to the tripod. Now if you were to load up the tripod unbalanced one of the legs will be overloaded, not to the point that it would tip over but over time that leg will wear down and if one were to break or buckle it would be that one. Now picture the toe as an extra balance piece attached to the leg of the tripod. In this case shifting the extra balance piece (toe) over would not be a good idea.
If you adjust the load evenly over all the legs and than adjust the extra balance piece you'll be fine. Same with the toe, if it gets overloaded due to imbalanced gait, don't fool around with it. If you re-balance the load you have the flexibility to adjust it without negative effects.
2) No. The callus that forms at the medial base of the big toe is not caused by the pushing against the toe. If you make a shoe that as a full inch between the side and the shoe the callus will still be there. It is caused by the way the foot rolls off over the big toe in gait, access pronation is the root cause. Control the pronation and you will reduce the callus and in theory make the toe more flexible, thus allowing one to push it in some when styling a last.
3) By angling the cone into the direction of the inflair you certainly mitigates the banana look, or Swing King look if you will
. I don't know why that last shape has nearly disappeared for modern day production lasts. As most of us work off production lasts in one form or another we don't have the option of easily changing the cone orientation. If you can straighten out the foot, even if it's only mildly you will also mitigate the banana look.
We agree that the look of the shoe can be affected by tweaking but just that, tweaks. Mild adjustments to the shape. As is the correction that will cause the toe to require less width in the shoes. Since two teaks are better than one, why not?
I'm not sure I'm understanding you correctly on the “twist” in the last. I'm re-reading your other post but it's not falling into place, please elaborate.
I think we need to take a step back and establish that on a healthy foot a mild clippig of the big toe is not a problem. No, it's not the best thing to do, ideally you leave the toes where they are. It's not by accident that a countour last, as wide in the toe as at the ball has long been a popular style in orthopedic shoes. They are also ugly and many that would benefit from a shoe like that rather suffer.
So in the interest of styling the foot into something it is not meant to be, a sleek, graceful and sensible looking unit we have to compromise. The problem arises when the foot is not in that great a shape to begin with. Adjusting the function will re-align the foot and the compromises requested by the customer bearable.
On the list of limitations of production lasts I want to add a third element, a single last desing needs to be a good fit for as many feet as possible. Not just “normal” feet but pronators, supinators, flat feet and caves feet. Any anatomical features added to those lasts work for some but does eliminate other potential customers.
I do agree that with a set of decent production lasts great shoes can be made that can be made even better with small adjustments for the individual condition beyond just shape.
DW,
Your pedograph is very different in the lateral aspect. Without actually seeing and examining your foot I can't tell you how and why. The heel is certainly pronated but the midfoot seems to correct itself. This distinct lateral pattern is something I see in very flat feet that seem to hinge on the midfoot. If your foot was like that there would be no arch showing. Your Pedograph does not show a pinch callus but the 1st metatarsal joint does not print evenly.
Any other readers have any clues what's going on with this foot type that I'm missing?
No argument with success. Based on the pedograph I see no reason not to pinch the toe.
BTW, the “ideal” foot podograph posted earlier is not my favorite, it's not bad but not great either. It was simply the best I had from a textbook. In my collection of pedographs I don't have anything better as I deal with problem feet, not perfect feet.
The point that I'm not sure you picked up on was that the pronation that's shown I the marked area in the heel is not all that clear unless you know what your looking for. The toe imprint is a much clearer and easier to identify landmark for the same issue. That's what I was trying to say.
Fred,
Thanks for the nice words. Wow, you sure put a lot in a single post. Text based discussions are unfortunately insufficient to clearly show the complex, three plane precesses that go on. Certainly a good topic to consider for the annual HCC meeting.
As much as all this applies to “orthopedic cases” it also applies to nearly every foot that comes through any of our doors, orthopedic, bespoke or western boot maker. With relatively small adjustments a great improvement can be made in the comfort and function of your customers footwear.
You make a very valid point about the flat foot and the externally rotated hip. That is certainly a much more complex situation and it does raise the point that corrections need to be undertaken carefully for those new to this approach.
Any thoughts on the pedograph DW posted?
I'm not going to be around much over the weekend but think this is a great discussion and think it's worth continuing as time permits.
Rob
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large_shoemaker_at_large
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Re: Correcting common foot problems
Hi All
It's late But got toe cent my 2 cents Canadaian in here. I'll go rooting thru my pedographs and show a pronated foot.
Fred you did an outstanding job of biomechanics! far broader than I dared, to as I try to speak to the lay person,
That said a static print taken on weight bearing is hopefully an image of the foot at full extention. Aka the pronation moment. To translate that to a dynamic model is to understand the gait cycle.
To make it easer to understand, as we walk our feet go thru a lock -unlock-lock cycle. We can alter any phase of the cycle in pedorthic treatment, By design we can augment/ restrcrit the planter surface of the foot from doing these things. medial lateral rear foot and fore foot motions via wedging/posting.
Unless we allow for boney prominance and soft tissue and ulceration you can only really focus on a four corner approach for most foot problems. Altering the medial/ lateral fore foot and rear foot angulation upon heel strike to toe off.
How we determiton this and address this is a whole forum on it's own and won't be nice.
Yes i have pinched the odd toe and a true straight last is something I saw many years ago in a shoe, OLD brain beleive it was an alden shoe who looked like a banana. On old Ortho surgeon ex military always promoted a medial heel wedge for most feet and a straight last shoe. Mostly impossible round these parts.
One must keep in mind that the last 100 years of walking been on flat hard surfaces. The foot hasn't had time to catch up. Pronation to a certian degree is a way of adapting to uneven surfaces. Pronation is a good thing until it is to much and symptomatic.
Balon Law deformety x use = symptomes
If you don't walk, your bunged feet would't be an issue. if you have good feet and run 20 miles a day and have a minor problem it will show up.
Got to go to bed
Any and all replies accepeted
Regards
Brendan
It's late But got toe cent my 2 cents Canadaian in here. I'll go rooting thru my pedographs and show a pronated foot.
Fred you did an outstanding job of biomechanics! far broader than I dared, to as I try to speak to the lay person,
That said a static print taken on weight bearing is hopefully an image of the foot at full extention. Aka the pronation moment. To translate that to a dynamic model is to understand the gait cycle.
To make it easer to understand, as we walk our feet go thru a lock -unlock-lock cycle. We can alter any phase of the cycle in pedorthic treatment, By design we can augment/ restrcrit the planter surface of the foot from doing these things. medial lateral rear foot and fore foot motions via wedging/posting.
Unless we allow for boney prominance and soft tissue and ulceration you can only really focus on a four corner approach for most foot problems. Altering the medial/ lateral fore foot and rear foot angulation upon heel strike to toe off.
How we determiton this and address this is a whole forum on it's own and won't be nice.
Yes i have pinched the odd toe and a true straight last is something I saw many years ago in a shoe, OLD brain beleive it was an alden shoe who looked like a banana. On old Ortho surgeon ex military always promoted a medial heel wedge for most feet and a straight last shoe. Mostly impossible round these parts.
One must keep in mind that the last 100 years of walking been on flat hard surfaces. The foot hasn't had time to catch up. Pronation to a certian degree is a way of adapting to uneven surfaces. Pronation is a good thing until it is to much and symptomatic.
Balon Law deformety x use = symptomes
If you don't walk, your bunged feet would't be an issue. if you have good feet and run 20 miles a day and have a minor problem it will show up.
Got to go to bed
Any and all replies accepeted
Regards
Brendan
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das
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Re: Correcting common foot problems
Fred,
Thanks for taking the time to outline all of that. I certainly got the gist of what you were describing, but man oh man, when you start talking "tech" with orthopedic terms..... Can you refer us to a glossary of those terms? I'm sure I'm not alone here, and not embarrassed to admit, but when you write in such streaming jargon, it is probably a bit daunting for some of the learners (as well as the old hands) out here.
For my (personal) "King of Swing" feet, especially the right one (my left foot seems to tolerate almost anything), I do wedge my heels up medially (the degree of twist is built into my own last) so that when standing I can feel the weight distribution where it ought to be, balanced well from the heel, down the 5th group, and not overloading the 1st head. Maybe when next we meet at the HCC AGM, I'll bare my tootsies and let you have a look to confirm your suspicions.
Rob,
Thank you too, and you are perfectly correct, I misspoke--the 1st met *head* is the leg of the tripod, not the great toe itself. On that medial great toe callous (narrow hard ridge right where it touches the feather-line of the insole) however, I can get it to go away entirely by wearing certain shoes/boots made on inflare lasts, but wearing other more "neutral" shapes it comes back--it seems to be caused by shape/insufficient medial toe-room. That toe of mine just simply does not like to have it's working-room curtailed.
"Twist": how to describe it in words.... Set the last on a level hard surface facing the heel-end. Slowly depress the toe of the last to raise the heel-seat up off the surface, to heel-height. The medial feather-line (if there is a feather-line) ought to be marginally higher off the surface than the lateral side. If the heel-seat is in a perfect horizontal plane (dead level), in my experience, the shoe made on it will be felt to exert upward thrust under the lateral heel, thus tilting or encouraging the foot to pronate at the heel=bad
I suppose we are most keenly aware of our own feet-types and know them perhaps more intimately than we'll ever get to know a customer's feet. It has been said we're our own best guinea pigs in that regards, and I can't argue that. Not a few Forumites here have come to shoemaking in their personal quest to find comfortable shoes for themselves. We cannot rightly project our quirky own feet on the rest of humanity of course, but there's no escaping the experiental learning and wisdom, if you will, that we all derive from observing our own feet, lasts, footwear, etc.
Based on this, I am very reluctant to clip a customer's great toes *very much*--a little for style, sure. And don't get me wrong, I'm not advocating that the big toe *never* feels anything beside it medially inside the footwear--no air space, or empty void certainly. And, "bent bananas" are a bad look any way you cut it. I know what Rob was on about with the "nature form" lasts (we used to call them), that looked like baby's first walking shoes blown up into adult sizes (ramrod straight down the medial side, broad square toes, etc.), however, look at the popularity and professed comfort many people claim for such extreme shapes as Birkenstocks (even with closed toes), and "Crocs", etc. Whether it's just an annoying occasional callous on the toe as in my case, or severe "pinching", bunion, etc.., insufficient swing in a last shape bothers people, so I am very cautions about enforcing style on someone else's foot in this regard. That's all.
My basic "library" of lasts consists of core models, which I modify to suit as needed. But, what has helped me is I have them sorted by degree of inflare based on the bottom papers, which I correlate to customers' shapes before I start checking measurements. I began this experiment with US Military lasts, because they are (were) plentiful, and being "public property" in their R&D, not proprietary. What I found was this: the "bump toed" Munson lasts--which if you read Dr. Munson's book 'The Soldiers Foot & the Military Shoe', he claims were designed by him based on purely anatomical principles, especially his phobia about inducing/exacerbating bunions and toe clipping--he says still were not made as inflared as he would have liked, because most soldiers' feet universally had some degree of valgus from poorly fitting civilian footwear. In all events, here we have a "pure"(?) physician-designed last, ostensibly with few if any bows to fashion, and a good place to start. Then we have the US Navy last (developed in the 1920s for US Marine Corps ankle boots, probably in response to Munson's new last for the Army--you know the rivalry there Army/Navy). This is a far more pleasing-looking last, for a Derby ankle boot, later adapted to an Oxford shoe. When viewed from the top, it looks almost "normal" (neutral), but the swing on the bottom shape is pleasantly hidden in the sculpture, unlike the klugy Munson. In comparing the bottom papers (central longitudinal line toe-to-heel, bisected by a transverse line joint to joint, and the subsequent angles measured and compared), the Navy last has as much inflare as the Munson, and it makes a less inelegant shoe/boot because the inflare is "hidden".
This got me to thinking, and soon all of my existing stocks of lasts were sorted according to this bottom paper analysis. When I went shopping for loads of old factory last runs, I'd often carry a US Navy bottom paper in my pocket, to measure them against, and soon I wound up with a nice variety of inflare category lasts for those who need them.
I was involved a number of years ago, as a consultant, in a very large anthropometric survey study (proprietary-sorry) of current "average" American feet-shapes, which merely reinforced what I already knew, and what the conventional wisdom within the trade has known: 1) most feet are "neutral" shaped (a bit of valgus), 2) the second largest group are outflare (valgus), and the minority were inflare. But, it also proved that shape was a significant "comfort" factory with the test subjects, as much if not moreso than precise measurements alone.
I guess if I'm advocating anything here, it is merely that shape (like everything) is a control-factor not to be ignored in bespoke making, and feet and lasts can easily be quantified and categorized as to their shape, thus resulting in better match-ups between feet and certain styles of stock lasts before the tape measure is ever applied round the last selected for fitting-up. First step for me, again, is to look at the customer's feet touching medially, then their tracings and imprints, and only then which category of last shapes do I go to tape in hand, to pull one for them. That's it in a nutshell.
Thanks for taking the time to outline all of that. I certainly got the gist of what you were describing, but man oh man, when you start talking "tech" with orthopedic terms..... Can you refer us to a glossary of those terms? I'm sure I'm not alone here, and not embarrassed to admit, but when you write in such streaming jargon, it is probably a bit daunting for some of the learners (as well as the old hands) out here.
For my (personal) "King of Swing" feet, especially the right one (my left foot seems to tolerate almost anything), I do wedge my heels up medially (the degree of twist is built into my own last) so that when standing I can feel the weight distribution where it ought to be, balanced well from the heel, down the 5th group, and not overloading the 1st head. Maybe when next we meet at the HCC AGM, I'll bare my tootsies and let you have a look to confirm your suspicions.
Rob,
Thank you too, and you are perfectly correct, I misspoke--the 1st met *head* is the leg of the tripod, not the great toe itself. On that medial great toe callous (narrow hard ridge right where it touches the feather-line of the insole) however, I can get it to go away entirely by wearing certain shoes/boots made on inflare lasts, but wearing other more "neutral" shapes it comes back--it seems to be caused by shape/insufficient medial toe-room. That toe of mine just simply does not like to have it's working-room curtailed.
"Twist": how to describe it in words.... Set the last on a level hard surface facing the heel-end. Slowly depress the toe of the last to raise the heel-seat up off the surface, to heel-height. The medial feather-line (if there is a feather-line) ought to be marginally higher off the surface than the lateral side. If the heel-seat is in a perfect horizontal plane (dead level), in my experience, the shoe made on it will be felt to exert upward thrust under the lateral heel, thus tilting or encouraging the foot to pronate at the heel=bad
I suppose we are most keenly aware of our own feet-types and know them perhaps more intimately than we'll ever get to know a customer's feet. It has been said we're our own best guinea pigs in that regards, and I can't argue that. Not a few Forumites here have come to shoemaking in their personal quest to find comfortable shoes for themselves. We cannot rightly project our quirky own feet on the rest of humanity of course, but there's no escaping the experiental learning and wisdom, if you will, that we all derive from observing our own feet, lasts, footwear, etc.
Based on this, I am very reluctant to clip a customer's great toes *very much*--a little for style, sure. And don't get me wrong, I'm not advocating that the big toe *never* feels anything beside it medially inside the footwear--no air space, or empty void certainly. And, "bent bananas" are a bad look any way you cut it. I know what Rob was on about with the "nature form" lasts (we used to call them), that looked like baby's first walking shoes blown up into adult sizes (ramrod straight down the medial side, broad square toes, etc.), however, look at the popularity and professed comfort many people claim for such extreme shapes as Birkenstocks (even with closed toes), and "Crocs", etc. Whether it's just an annoying occasional callous on the toe as in my case, or severe "pinching", bunion, etc.., insufficient swing in a last shape bothers people, so I am very cautions about enforcing style on someone else's foot in this regard. That's all.
My basic "library" of lasts consists of core models, which I modify to suit as needed. But, what has helped me is I have them sorted by degree of inflare based on the bottom papers, which I correlate to customers' shapes before I start checking measurements. I began this experiment with US Military lasts, because they are (were) plentiful, and being "public property" in their R&D, not proprietary. What I found was this: the "bump toed" Munson lasts--which if you read Dr. Munson's book 'The Soldiers Foot & the Military Shoe', he claims were designed by him based on purely anatomical principles, especially his phobia about inducing/exacerbating bunions and toe clipping--he says still were not made as inflared as he would have liked, because most soldiers' feet universally had some degree of valgus from poorly fitting civilian footwear. In all events, here we have a "pure"(?) physician-designed last, ostensibly with few if any bows to fashion, and a good place to start. Then we have the US Navy last (developed in the 1920s for US Marine Corps ankle boots, probably in response to Munson's new last for the Army--you know the rivalry there Army/Navy). This is a far more pleasing-looking last, for a Derby ankle boot, later adapted to an Oxford shoe. When viewed from the top, it looks almost "normal" (neutral), but the swing on the bottom shape is pleasantly hidden in the sculpture, unlike the klugy Munson. In comparing the bottom papers (central longitudinal line toe-to-heel, bisected by a transverse line joint to joint, and the subsequent angles measured and compared), the Navy last has as much inflare as the Munson, and it makes a less inelegant shoe/boot because the inflare is "hidden".
This got me to thinking, and soon all of my existing stocks of lasts were sorted according to this bottom paper analysis. When I went shopping for loads of old factory last runs, I'd often carry a US Navy bottom paper in my pocket, to measure them against, and soon I wound up with a nice variety of inflare category lasts for those who need them.
I was involved a number of years ago, as a consultant, in a very large anthropometric survey study (proprietary-sorry) of current "average" American feet-shapes, which merely reinforced what I already knew, and what the conventional wisdom within the trade has known: 1) most feet are "neutral" shaped (a bit of valgus), 2) the second largest group are outflare (valgus), and the minority were inflare. But, it also proved that shape was a significant "comfort" factory with the test subjects, as much if not moreso than precise measurements alone.
I guess if I'm advocating anything here, it is merely that shape (like everything) is a control-factor not to be ignored in bespoke making, and feet and lasts can easily be quantified and categorized as to their shape, thus resulting in better match-ups between feet and certain styles of stock lasts before the tape measure is ever applied round the last selected for fitting-up. First step for me, again, is to look at the customer's feet touching medially, then their tracings and imprints, and only then which category of last shapes do I go to tape in hand, to pull one for them. That's it in a nutshell.
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paul
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Re: Correcting common foot problems
Whew! Please excuse me for saying this plain, but you pedorthic guys sure do make my head spin! Between unfamiliar and unexplained words, grammer, spelling and punctuation, I can hardly make it to the end of the posts! But I'm so glad you're here to share what you know with the rest of us. Honestly! (I'll forgive yours, if you'll forgive mine?)
So after reading and re-reading, this is what I've concluded, that I can maybe get away with clipping the big toe some if I wedge the heel medialy? For this inswing type of foot we've been talking about, that is. Is that right? Would about an eigth of an inch be about right, or more?
Is this best done at the heel seat, during construction? Or to the heel base, after assembly?
The old "Thomas Heel" from my shoe repair days comes to my mind. It wasn't straight across the breast or front of the heel, but instead was a kind of lazy S shape that extended forward some on the medial side, into the arch area some, and maybe even a touch thicker or wedged there. It seems this would address this issue of inswing as I'm understanding it. Not that I would do this on a cowboy boot, of course. Am I on the right track?
I like the idea of giving the insole all it's space at the big toe as the pedograph indicates, but compensating above the feather line of the last leaning the toe of the last out laterally some for a more pleasing look. I think it was Al who mentioned this. Did I understand that part correctly?
Paul
So after reading and re-reading, this is what I've concluded, that I can maybe get away with clipping the big toe some if I wedge the heel medialy? For this inswing type of foot we've been talking about, that is. Is that right? Would about an eigth of an inch be about right, or more?
Is this best done at the heel seat, during construction? Or to the heel base, after assembly?
The old "Thomas Heel" from my shoe repair days comes to my mind. It wasn't straight across the breast or front of the heel, but instead was a kind of lazy S shape that extended forward some on the medial side, into the arch area some, and maybe even a touch thicker or wedged there. It seems this would address this issue of inswing as I'm understanding it. Not that I would do this on a cowboy boot, of course. Am I on the right track?
I like the idea of giving the insole all it's space at the big toe as the pedograph indicates, but compensating above the feather line of the last leaning the toe of the last out laterally some for a more pleasing look. I think it was Al who mentioned this. Did I understand that part correctly?
Paul
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fred_coencped
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Re: Correcting common foot problems
CORRECTION!
On my last posting inversion/eversion is the frontal plane.Inversion also means Varus and eversion means valgus.Looking at the foot from the front or back,a varus foot will roll to the outside and a valgus foot will roll to the outside.
DW,In viewing your print which does look as you stated a Pes Cavus or high arched foot.It is a common foot that reveals a varus heel and forefoot valgus therefore mis-aligned.
The heel strike is on the outside and toe off to the inside ,simply put ,but is a little more complicated .The pes cavus foot is a rigid foot structure and does not absorb step shock well[Or jumping out of airplanes].
I agree with Rob as the foot hits the ground and pronates to adapt to the ground surface flat,irregular or on the dance floor{Rumor has you like to dance!},your foot will pronate and not recover at mid stance and supinate.Therefore th heel will lift and through toe off the foot will continue into pronatory motion,exerting the 1st MPJ.
Now as the foot swings through the air the sub talor joint[STJ]and the mid tarsal joints[MTJ]both oblique and longitudinal axes,are like a loose bag of bones relaxed and prepared to receive and adapt to the ground surface.At mid stance it is necessary for the foot to Supinate so the metatarsals mesh and lock against the mid tarsal bones,that is the 3 Cuneiforms and at the base of the 5th metatarsal the Cuboid bone referred to in Podiatry as the cornerstone of the midfoot arch.
If the foot fails to supinate the foot will get stressed.Posting the medial heel or blocking unwanted excessive compensation,or in another perspective bringing the ground up to the medial heel will help the foot to recover from its pronatory motion and supinate the foot sufficiently.Supporting the lateral arch from under the calcaneal/cuboid joint and to the distal neck of the 5th metatarsal bone,or the neck region will keep the lateral arch integrity,as the 5th metatarsal also has to plantarflex from midstance to the toe off phase.
This pes cavus foot is sometimes said to be more difficult foot than a flat foot.It often benefits from metatarsal support and forefoot cushining.I often see the lateral toes contracted from 2 to 5 where you see the tendons being pulled back on the top of the foot,a sure sign of the lessor toe met heads fallen.Your pedograph does not indicate pressure on 2 to 5 ,rather excessive pressure on the 1st methead.
I would like to see Dynamic Pedograph Prints and the results of a bio-mechanical evaluationat to determine criteria such as motion available in the metatarsals.Is the 1st and the 5th either plantarflexed or dorsiflexed,what is the extent of the sub-talor varus,forefoot valgus,hip rotation,knee alinment ,tibial varum[where the lower 1/3rd of the leg curves inward exacerbating the articulation at the ankle where the foot connects to the leg.with Tibial Varum the foot will have to evert further to be flat on the ground just to stand,and you need another approx.4 degrees of eversion motion to roll forward.Hence the medial wedge allows the foot more motion to evert,dorsiflex and ab-duct and recover to supinate locking the mid tarsals against the metatarsals.
Rob,
One more thought regarding the discussion on clipping or pinching the big toe,it is a known fact if the foot fails to supinate at midstance and the 1st mpj fails where the 1st metatarsal dorsiflexes opposed to plantarflexing,the 1st mpj will jam and the medial column will elongate,and the hallux cannot dorsiflex from the overload and jamming will occur.
Now for the normal foot as the 1st metatarsal plantarflexes and glides backwards on the sesamoid bones the medial column will shorten in that supinatory moment as the foot leaves the ground and the medial arch height will consequently increase in height from heel lift to toe off.
If this makes sense theoretically would this help the case of clipping the medial toe and joint?Also the foot is sliding laterally in the shoe as the influence of the hip is externally rotating.
Al,
If all 5 toes are making an impession on the insole,and the foot is following a slight lateral heel strike ,hitting the ground on the 5th met head then,all across the MPJ`s to the 1st met head ,as the foot supinates and forward locomotion is directed laterally,sort of like a Z pattern,all 5 metatarsals plantarflex.
Brendon,
Thanks for your comment on bio mechanics,
And Paul,
I think intrinsic orthopedic modifications in the last is a best approach to custom shoes and boots but it requires a pretty exacting knowledge of foot mechanics and Art-fullness in shoe making and makes me nervous.
My best advice I think with mild medial heel adjustments would be extrinsic heel wedges in the footwear,wedging in the outside heel and forefoot,custom foot orthotics in extra depth boots.
Fred
On my last posting inversion/eversion is the frontal plane.Inversion also means Varus and eversion means valgus.Looking at the foot from the front or back,a varus foot will roll to the outside and a valgus foot will roll to the outside.
DW,In viewing your print which does look as you stated a Pes Cavus or high arched foot.It is a common foot that reveals a varus heel and forefoot valgus therefore mis-aligned.
The heel strike is on the outside and toe off to the inside ,simply put ,but is a little more complicated .The pes cavus foot is a rigid foot structure and does not absorb step shock well[Or jumping out of airplanes].
I agree with Rob as the foot hits the ground and pronates to adapt to the ground surface flat,irregular or on the dance floor{Rumor has you like to dance!},your foot will pronate and not recover at mid stance and supinate.Therefore th heel will lift and through toe off the foot will continue into pronatory motion,exerting the 1st MPJ.
Now as the foot swings through the air the sub talor joint[STJ]and the mid tarsal joints[MTJ]both oblique and longitudinal axes,are like a loose bag of bones relaxed and prepared to receive and adapt to the ground surface.At mid stance it is necessary for the foot to Supinate so the metatarsals mesh and lock against the mid tarsal bones,that is the 3 Cuneiforms and at the base of the 5th metatarsal the Cuboid bone referred to in Podiatry as the cornerstone of the midfoot arch.
If the foot fails to supinate the foot will get stressed.Posting the medial heel or blocking unwanted excessive compensation,or in another perspective bringing the ground up to the medial heel will help the foot to recover from its pronatory motion and supinate the foot sufficiently.Supporting the lateral arch from under the calcaneal/cuboid joint and to the distal neck of the 5th metatarsal bone,or the neck region will keep the lateral arch integrity,as the 5th metatarsal also has to plantarflex from midstance to the toe off phase.
This pes cavus foot is sometimes said to be more difficult foot than a flat foot.It often benefits from metatarsal support and forefoot cushining.I often see the lateral toes contracted from 2 to 5 where you see the tendons being pulled back on the top of the foot,a sure sign of the lessor toe met heads fallen.Your pedograph does not indicate pressure on 2 to 5 ,rather excessive pressure on the 1st methead.
I would like to see Dynamic Pedograph Prints and the results of a bio-mechanical evaluationat to determine criteria such as motion available in the metatarsals.Is the 1st and the 5th either plantarflexed or dorsiflexed,what is the extent of the sub-talor varus,forefoot valgus,hip rotation,knee alinment ,tibial varum[where the lower 1/3rd of the leg curves inward exacerbating the articulation at the ankle where the foot connects to the leg.with Tibial Varum the foot will have to evert further to be flat on the ground just to stand,and you need another approx.4 degrees of eversion motion to roll forward.Hence the medial wedge allows the foot more motion to evert,dorsiflex and ab-duct and recover to supinate locking the mid tarsals against the metatarsals.
Rob,
One more thought regarding the discussion on clipping or pinching the big toe,it is a known fact if the foot fails to supinate at midstance and the 1st mpj fails where the 1st metatarsal dorsiflexes opposed to plantarflexing,the 1st mpj will jam and the medial column will elongate,and the hallux cannot dorsiflex from the overload and jamming will occur.
Now for the normal foot as the 1st metatarsal plantarflexes and glides backwards on the sesamoid bones the medial column will shorten in that supinatory moment as the foot leaves the ground and the medial arch height will consequently increase in height from heel lift to toe off.
If this makes sense theoretically would this help the case of clipping the medial toe and joint?Also the foot is sliding laterally in the shoe as the influence of the hip is externally rotating.
Al,
If all 5 toes are making an impession on the insole,and the foot is following a slight lateral heel strike ,hitting the ground on the 5th met head then,all across the MPJ`s to the 1st met head ,as the foot supinates and forward locomotion is directed laterally,sort of like a Z pattern,all 5 metatarsals plantarflex.
Brendon,
Thanks for your comment on bio mechanics,
And Paul,
I think intrinsic orthopedic modifications in the last is a best approach to custom shoes and boots but it requires a pretty exacting knowledge of foot mechanics and Art-fullness in shoe making and makes me nervous.
My best advice I think with mild medial heel adjustments would be extrinsic heel wedges in the footwear,wedging in the outside heel and forefoot,custom foot orthotics in extra depth boots.
Fred
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gshoes
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Re: Correcting common foot problems
To everyone,
OMG (Thats, Oh My God!)
Somebody throw me a life raft. No really...this stuff is great and I want to know it. I have just started reading my downloaded copy of "The Manufacture of Boots ad shoes" Thanks to this Crispin Site. I received in the mail today my copy of Bespoke Shoes. I realized huge design flaws in my maple lasts and I will refer back to George Koeloff book about last making and start all over again.
I still don't understand what " toe off" is but I think that in a few more pages it will be clear to me.
You guys are great. I want to be a Cordwainera and a Last maker when I grow up. Just watch me! It seems possible now.
Geri
OMG (Thats, Oh My God!)
Somebody throw me a life raft. No really...this stuff is great and I want to know it. I have just started reading my downloaded copy of "The Manufacture of Boots ad shoes" Thanks to this Crispin Site. I received in the mail today my copy of Bespoke Shoes. I realized huge design flaws in my maple lasts and I will refer back to George Koeloff book about last making and start all over again.
I still don't understand what " toe off" is but I think that in a few more pages it will be clear to me.
You guys are great. I want to be a Cordwainera and a Last maker when I grow up. Just watch me! It seems possible now.
Geri
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gshoes
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Re: Correcting common foot problems
So what if you are making a shoe for someone with a deformaty of the foot and the bones are larger than a normal foot and not proportionate to a normal foot? Shouldn't there be a certain point on an individual foot that the top of the back of heel should touch. Just like people have short toes or very long toes some people might have a very tall or short ankle. I hate using charts of standardized numbers for non standard feet. It doesn't make sense.
Geri
Geri
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fred_coencped
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Re: Correcting common foot problems
I was wondering where art and science in shoemaking take a back seat to experience and intuition.The foot is as unique as an individual and complex as ourselves and the whole universe.Standards to me are like categorizing our natural intelligence into shear conformity.
My contention is ,enough with the book and just follow the foot.because the foot tells us all of its landmarks in its dynamic nature.
So teaching and learning becomes a totally self taught entity unto itself We copy older established ideas and techniques that are tried and true,then we run ,fall on our knees and face,heal ,scrape off the muck and reach the tried and true age old empirical method of trial and error only to recognize beyond all boundarys the importance of stepping out of the box.
Formulas are for science and the magic of the line or curve is for art and creativity.If form follows function then following leaves us all to foot function and the entire lower extremity,and the torso,in short Anatomy of the entire kinetic chain.
Geri,You asked a really interesting question today and another good question the other day from what appears to be left unaddressed.
Your question was in regard to the standard last.The waist and lower instep measurement is the girth measure around the semi-weight bearing foot and that measure corresponds to the last measurement,at least theoretically.When the shoe is made around that last the space between the shoe insole and the height of the arch leaves a void from the medial feather line to the arch.I think you referred to that space as a gap.
I wish I could give a definitive answer to that question.The last arch could be undercut more .In a cast of the foot where a "innersole/foot orthotic"is fabricated to the arch and becomes the last bottom before the insole is attached.Then the girth measurements are on the mark and there is no gap.
In the standard last where the "gap"appears in the medial arch area it makes sense to me to pull the waist area tighter on the last because of the fleshier area on the foot in the waist,and the ball measurement should not be altered.We were discussing clipping the 1st metatarsal area and big toe area of the last/insole pattern but the girth of the last still matches the foot.For reasons of the foot spreading on full weight bearing it would be prudent on your daughters to compare such ball measurements.
One other thought on the gap,when creating a custom or semi-custom foot orthotic for a standard last shoe the entire void from heel to ball is filled for total contact for the rearfoot and midfoot.Worth mentioning for Al[My favorite King of Swing in the whole wide world} is arch fill is often added to a plaster orthotic foot mold not to overcorrect ,especially more arch fill for the higher arched foot as that foot usually needs more support under the medial heel to block excessive pronatory motion allowing the foot room to pronate and recover to supinate at midstance.
Your daughters foot needs careful bio mechanical considerations to build an effective last,foot orthotic and shoe.How did you cast her slipper cast and do you know how to capture her forefoot to rearfoot anatomy,by locking the mid-tarsal joint,and so called sub talor neutral.Also an adequate knowledge of bio mechanics is critical.I wold like to reccomendworking with plaster of paris,there are ways to make multiple pairs and pull the last in one piece from the shoe and its easy to make and modify orthotic cast.
Admin,Maybe this discussion should be somewhere in lastmaking,or over there in correcting common foot problems,just following the flow of the discussion and didn`t know how to move it elsewhere and hope that here is OK,Fred
My contention is ,enough with the book and just follow the foot.because the foot tells us all of its landmarks in its dynamic nature.
So teaching and learning becomes a totally self taught entity unto itself We copy older established ideas and techniques that are tried and true,then we run ,fall on our knees and face,heal ,scrape off the muck and reach the tried and true age old empirical method of trial and error only to recognize beyond all boundarys the importance of stepping out of the box.
Formulas are for science and the magic of the line or curve is for art and creativity.If form follows function then following leaves us all to foot function and the entire lower extremity,and the torso,in short Anatomy of the entire kinetic chain.
Geri,You asked a really interesting question today and another good question the other day from what appears to be left unaddressed.
Your question was in regard to the standard last.The waist and lower instep measurement is the girth measure around the semi-weight bearing foot and that measure corresponds to the last measurement,at least theoretically.When the shoe is made around that last the space between the shoe insole and the height of the arch leaves a void from the medial feather line to the arch.I think you referred to that space as a gap.
I wish I could give a definitive answer to that question.The last arch could be undercut more .In a cast of the foot where a "innersole/foot orthotic"is fabricated to the arch and becomes the last bottom before the insole is attached.Then the girth measurements are on the mark and there is no gap.
In the standard last where the "gap"appears in the medial arch area it makes sense to me to pull the waist area tighter on the last because of the fleshier area on the foot in the waist,and the ball measurement should not be altered.We were discussing clipping the 1st metatarsal area and big toe area of the last/insole pattern but the girth of the last still matches the foot.For reasons of the foot spreading on full weight bearing it would be prudent on your daughters to compare such ball measurements.
One other thought on the gap,when creating a custom or semi-custom foot orthotic for a standard last shoe the entire void from heel to ball is filled for total contact for the rearfoot and midfoot.Worth mentioning for Al[My favorite King of Swing in the whole wide world} is arch fill is often added to a plaster orthotic foot mold not to overcorrect ,especially more arch fill for the higher arched foot as that foot usually needs more support under the medial heel to block excessive pronatory motion allowing the foot room to pronate and recover to supinate at midstance.
Your daughters foot needs careful bio mechanical considerations to build an effective last,foot orthotic and shoe.How did you cast her slipper cast and do you know how to capture her forefoot to rearfoot anatomy,by locking the mid-tarsal joint,and so called sub talor neutral.Also an adequate knowledge of bio mechanics is critical.I wold like to reccomendworking with plaster of paris,there are ways to make multiple pairs and pull the last in one piece from the shoe and its easy to make and modify orthotic cast.
Admin,Maybe this discussion should be somewhere in lastmaking,or over there in correcting common foot problems,just following the flow of the discussion and didn`t know how to move it elsewhere and hope that here is OK,Fred
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gshoes
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Re: Correcting common foot problems
Fred,
I am sure that I was the person responsible for asking my questions in the wrong forum. Sorry.
As far as the way that I casted my daughters foot, I do admit that I had help with that task. A person that was very knowledgable in foot orthoics prepared them for me. I am aware that I could cause further foot problems if I misalign things.
My problem is that I can not find a shoe that fits and therefore I can not create a plaster cast from the shoe if thats what you meant.
Geri
I am sure that I was the person responsible for asking my questions in the wrong forum. Sorry.
As far as the way that I casted my daughters foot, I do admit that I had help with that task. A person that was very knowledgable in foot orthoics prepared them for me. I am aware that I could cause further foot problems if I misalign things.
My problem is that I can not find a shoe that fits and therefore I can not create a plaster cast from the shoe if thats what you meant.
Geri
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fred_coencped
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Re: Correcting common foot problems
Geri,
I was wondering how you arrived at that slipper cast and proceeded with that nasty bondo stuff.How about getting your knowledgeable associate to cast your daughters foot for an orthopedic shoe last?Is that possible?Let me know and I will be happy to coach you through all of the processes.. developing the last and innersole/orthotic.Moulding plaster is inexpensive,easy to shape ,multiple pairs can be made and cloning is easy.Clones can be made in rigid urethane foam and the last can be pulled out of the shoe in one piece with a last hook,without breaking the last .
So no I did not mean producing an in-shoe mold of an existing shoe at all.Get a model of the foot,pedograph prints static and dynamic with measurements,etc....and go for it!
This way the innersole/footorthotic is built on the last to facitate the last bottom,also the shoe should have a long medial heel counter,about 1" behind the 1st MPJ.
Caution,The casting must be right for the last to be good.OK,Fred
I was wondering how you arrived at that slipper cast and proceeded with that nasty bondo stuff.How about getting your knowledgeable associate to cast your daughters foot for an orthopedic shoe last?Is that possible?Let me know and I will be happy to coach you through all of the processes.. developing the last and innersole/orthotic.Moulding plaster is inexpensive,easy to shape ,multiple pairs can be made and cloning is easy.Clones can be made in rigid urethane foam and the last can be pulled out of the shoe in one piece with a last hook,without breaking the last .
So no I did not mean producing an in-shoe mold of an existing shoe at all.Get a model of the foot,pedograph prints static and dynamic with measurements,etc....and go for it!
This way the innersole/footorthotic is built on the last to facitate the last bottom,also the shoe should have a long medial heel counter,about 1" behind the 1st MPJ.
Caution,The casting must be right for the last to be good.OK,Fred
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gshoes
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Re: Correcting common foot problems
Fred,
I arrived at the slipper cast in preperation for an orthtic insert. I used the bondo cast to compare to my wooden last with a wire contour tool.
I also had the same friend help me to do a two part cast of the foot and then I poured more of the same bondo stuff into in with bent conduit into it. Is this the kind of casting that you are asking for.
Your help would be greatly appreciated.
Geri
I arrived at the slipper cast in preperation for an orthtic insert. I used the bondo cast to compare to my wooden last with a wire contour tool.
I also had the same friend help me to do a two part cast of the foot and then I poured more of the same bondo stuff into in with bent conduit into it. Is this the kind of casting that you are asking for.
Your help would be greatly appreciated.
Geri
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gshoes
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Re: Correcting common foot problems
I found a supplier for EVA and got samples and a price list mailed out to me today.JMS Plastics in NJ. It sure is nice to be able to hold the product in your hand a feel what is meant by 35 and 45 Durometers.
Geri
Geri
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fred_coencped
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Re: Correcting common foot problems
Geri,That foot mold looks like it is flat .For a shoe with a 1/2" heel height,you must start with the casting made with the same heel height on a casting block corresponding with the heel pitch as the intended footwear,and also a wedge under the toe for tot spring.As I stated previouswill be shaped like the last.
I would again strongly recomend working in plaster.It is easier to add and shape the last.
What does the side profile of the foot mold look like and is that your daughters foot?Is the pipe to create a thimble or is it reinforcement,or for another reason?
Are you able to vacuum press custom insoles and grind to balance.And do you have a convection oven?
Fred
I would again strongly recomend working in plaster.It is easier to add and shape the last.
What does the side profile of the foot mold look like and is that your daughters foot?Is the pipe to create a thimble or is it reinforcement,or for another reason?
Are you able to vacuum press custom insoles and grind to balance.And do you have a convection oven?
Fred
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gshoes
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Re: Correcting common foot problems
Fred,
The cast is of my daughters foot and here are some pics. She was casted with her foot flat on the ground. I later grinded a bit of her arch away. That was done previously to recasting the little slipper cast in which her arch was maniputed into a well formed arch.
My daughter stands 6'4" tall and I did not want her up in a heel and I had no reason at the time to want to put in heels especially with her very loose jointed ankle. I saw no reason to do that. Now I am being told that for mechanical issues with her gait and better toe off that I should create a last with more of a heel, like maybe 7/8". So that is my new plan.
I will be going to visit my friend this weekend and see if we can get her casted again.
The casts that I made, were meant to use the conduit as a thimble on my lasting jack, but they also serve as reinforcement, however this material has proven to be quite durable even wthout the metal.
I do have a convection oven. And I am making a small vacumn table that is able to fit the slipper casts that I made. I will be hooking it up to a shop vac. I guess that that means that I can make custom insoles? I have used sheets of polypropelene on the little casts and then covered them with leather.
I own a Landis 400 finishing machine and a belt sander but I am not sure what you mean by "grind to balance".
When you say that plaster is better than the wood for a last, are you talking about regular plaster or dental grade plaster?
Geri
The cast is of my daughters foot and here are some pics. She was casted with her foot flat on the ground. I later grinded a bit of her arch away. That was done previously to recasting the little slipper cast in which her arch was maniputed into a well formed arch.
My daughter stands 6'4" tall and I did not want her up in a heel and I had no reason at the time to want to put in heels especially with her very loose jointed ankle. I saw no reason to do that. Now I am being told that for mechanical issues with her gait and better toe off that I should create a last with more of a heel, like maybe 7/8". So that is my new plan.
I will be going to visit my friend this weekend and see if we can get her casted again.
The casts that I made, were meant to use the conduit as a thimble on my lasting jack, but they also serve as reinforcement, however this material has proven to be quite durable even wthout the metal.
I do have a convection oven. And I am making a small vacumn table that is able to fit the slipper casts that I made. I will be hooking it up to a shop vac. I guess that that means that I can make custom insoles? I have used sheets of polypropelene on the little casts and then covered them with leather.
I own a Landis 400 finishing machine and a belt sander but I am not sure what you mean by "grind to balance".
When you say that plaster is better than the wood for a last, are you talking about regular plaster or dental grade plaster?
Geri
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fred_coencped
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Re: Correcting common foot problems
Geri,I see the foot mold is as flat as the surface it was cast upon and it is good as a paper weight period.Casting with the mid-tarsal joint and sub talor joints with a casting platform of 1/2" as stated previous with foam under the foot semi weight bearing and seated should be enough heel height unless her ankle joint is plantar flexed or limited dorsiflexion,otherwise known as ankle equinus.
When you are speak with your ally pass on this info and passed info from prior post to get some clarification in the casting.
Moulding plaster is the way to go.There is nothing wrong with wood compared to plaster.If you can fabricate a pair of good last with a spacer for extra depth to accomodate a custom insole ,that method is very good.However plaster of paris is good to make the orthopedic last and is easy to grind and sand.
Also I did not suggest wood is better then plaster.I did suggest cloning a plaster last and you could reproduce your last in rigid Urethane.IMO it is not practical or economical to work with bondo or wood for the orthopedic last.Of course it is possible to these things in a variety of ways and only you can decide which way is effective and efficient.Foresight and planning is clearly going to give you the desired results.
I suspect your friend helping you is an orthotist.The thimble in the casting is not neccasary for the construction or reinforcement,I think it is overkill.The lasting and bottom work is done on your lap,cement construction with mock welting is very common,sufficient and durable.All of the handwelting and pegging isn`t neccasary either.You could consider having your insole/midsole Mckay stitched in a shoe repair shop if you want a mid sole.First things first,you need the last and you need the plantar surface of the foot to support and align this foot.
You are dealing with a medical condition that requires a thorough knowledge of bio- mechanics.Most shoemakers would recognize their limitations and refer a reputable orthopedic shoe specialist,so I have to ask you for a complete assesment and/or a medical referral,I am afraid your desire to help your daughter although admirable requires a thorough knowledge of bio mechanics.
Have you checked with the Pedorthic Footwear Association regarding certification and a listing of publications ,courses and testing?
,Fred
When you are speak with your ally pass on this info and passed info from prior post to get some clarification in the casting.
Moulding plaster is the way to go.There is nothing wrong with wood compared to plaster.If you can fabricate a pair of good last with a spacer for extra depth to accomodate a custom insole ,that method is very good.However plaster of paris is good to make the orthopedic last and is easy to grind and sand.
Also I did not suggest wood is better then plaster.I did suggest cloning a plaster last and you could reproduce your last in rigid Urethane.IMO it is not practical or economical to work with bondo or wood for the orthopedic last.Of course it is possible to these things in a variety of ways and only you can decide which way is effective and efficient.Foresight and planning is clearly going to give you the desired results.
I suspect your friend helping you is an orthotist.The thimble in the casting is not neccasary for the construction or reinforcement,I think it is overkill.The lasting and bottom work is done on your lap,cement construction with mock welting is very common,sufficient and durable.All of the handwelting and pegging isn`t neccasary either.You could consider having your insole/midsole Mckay stitched in a shoe repair shop if you want a mid sole.First things first,you need the last and you need the plantar surface of the foot to support and align this foot.
You are dealing with a medical condition that requires a thorough knowledge of bio- mechanics.Most shoemakers would recognize their limitations and refer a reputable orthopedic shoe specialist,so I have to ask you for a complete assesment and/or a medical referral,I am afraid your desire to help your daughter although admirable requires a thorough knowledge of bio mechanics.
Have you checked with the Pedorthic Footwear Association regarding certification and a listing of publications ,courses and testing?
,Fred
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gshoes
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Re: Correcting common foot problems
Fred,
I will pass all of this information on to my friend and helper. I appreciate your thoroughness and I will look into what courses are available for this interest of mine. I did not know where to turn to.
Again, I will see my friend later this week and I will let you know what they can do for me. Thanks Fred.
Geri
I will pass all of this information on to my friend and helper. I appreciate your thoroughness and I will look into what courses are available for this interest of mine. I did not know where to turn to.
Again, I will see my friend later this week and I will let you know what they can do for me. Thanks Fred.
Geri
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gshoes
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Re: Correcting common foot problems
Fred, Robert and all following this thread,
A teenager changes everything and everyday is a big surprise. So I have been on a long detour that I really don't like to even think about.
And then there are insurance companies. I have decided that I will get a last made for my daughter through the insurance company since I do not wish to cause further foot problems. I have been told through the orthotic supplier that they are a covered benefit. And now I am told by the doctor that they are not.
HMO's?
So the fight and the wait begins. The Pederthist tells me that because we are going with a custom orthotic shoe we can actually go with a higher heel than before when we were just adding the orthotic to a store bought shoe. She said that now we can increase the depth of the padding and the ball of the foot can take more weight.
I was told that I will actually take possesion of the last after the shoe is made. We will see.
I plan on taking a video of her feet being casted for the shoe,
Geri
A teenager changes everything and everyday is a big surprise. So I have been on a long detour that I really don't like to even think about.
And then there are insurance companies. I have decided that I will get a last made for my daughter through the insurance company since I do not wish to cause further foot problems. I have been told through the orthotic supplier that they are a covered benefit. And now I am told by the doctor that they are not.
HMO's?
So the fight and the wait begins. The Pederthist tells me that because we are going with a custom orthotic shoe we can actually go with a higher heel than before when we were just adding the orthotic to a store bought shoe. She said that now we can increase the depth of the padding and the ball of the foot can take more weight.
I was told that I will actually take possesion of the last after the shoe is made. We will see.
I plan on taking a video of her feet being casted for the shoe,
Geri