Correcting common foot problems

[mac]

DW,
Sorry I'm slow on the draw answering on this one! I don't have too much to add to Robert's expertise but I'll throw in my 2 cents worth anyway. I think you have it right with the heel to ball length being too long that would increase pressure at the distal end of the toe and 1st mtp joint pressure (problem with toe spring). Other causes of discomfort could be fixed with no changes... if your client is overpronating then your stiffer leather sole and stitched in heel counter in the production boot would reduce the problem. I agree with Robert about carving abit out of the arch... but as you already have a good fit and I know you hate cutting into the last you could always put a 1/8 buildup under the lateral calcaneus to slightly invert the heel and reduce pronation. This is similar to a Kirby skive technique used in orthotics used to reduce pronation at heel contact. Come t0 think of it... did you change the length of the heel? If your fitter model has a shorter heel (I don't mean short heel measurement... remember how the heel on my boots were cut a little short) it may very well change toe-off especially if he walks with his feet externally rotated.
Hope this helps a bit
Sean

[jenny_fleishman]

DW, I have no expertise on this, however, I have disproportionally long toes--on a Brannock devise my feet measure size 5-5.5, and my arch length is 3.5-4.

This is one of the many factors that has resulted in my quest to make my own shoes--the widest part of most factory-made shoes is too far forward. The shoe upper then puts some pressure on the side of my big toe joint, causing discomfort and probably contributing to my mild bunions.

While my symptoms are different than your customer's, I am surprised that having the heel to ball length a little longer than on the footprint would be comfortable for anyone! It's always been trouble for me!

Jenny

[dw]

Sean,

Thanks...that's what I'm leaning to--nothing for it but to shorten the heel to ball, relast the fitter's model and see if that helps. Funny you should mention it, though, I was considering a lateral heel wedge on the last to shift the weight laterally. Looking at the footprint again, I think that might be overthinking and overcorrecting. When confronted by these kinds of "mysteries" my policy is always to make small corrections and document everything.

Jenny,

I know...I agree...that's why I'm (ordinarily) such a stickler for accurate heel to ball lengths. That said, Luchesse always admonished "if you're gonna fit 'em wrong, fit 'em long. A sentiment I've always thought was good advice--as far as it went.

thanks both...

Tight Stitches
DWFII--Member HCC

[relferink]

Hmm... I guess a slightly to long heel to ball could make the foot slide forward some when walking and have the toe hit the side of the boot. The first thing I would expect to hear is heel slippage. Today the thought of asking you if the foot could be sliding forward came to mind, dismissed that because you mentioned heel slippage was not a problem.
I just re-read your description and it does sound like MPJ 1 is the problem. Other then a re-alignment attempt I would say stiffening the sole and taking the motion out of the joint is all you can do. You probably already do that in the boots since they are nice and firm compared to the fitter. Somehow the different way the new last holds the foot causes pressure on the joint.
I assume you are going to correct the heel to ball measurement in the last and send him a new fitter if you can not convince him to drive down and see you. If you can take a look at his old boots, see if the wear is uneven that may yield some more clues even if he does not have the symptoms with those. Specifically look for wear under the big toe.

Sean, I'm not sure I'm understanding your reference to a shorter heel. Do you mean the height of the heel stack? As for a heel skive I would want to put that medial of the heel as I know a Kirby skive to be. That is still a good option if the problem persists once the boot is ready but I would prefer to find a way to incorporate a solution into the last.

I have my doubts that just fixing the heel to ball size would fit the problem but if that's something different from what you normally do it is a very valid place to start.

Good luck with this one and keep us posted,

Rob

[dw]

Robert,

Well, your point is agood one. The missing info is that he is held pretty closely into the back of the heel on the left foot. No heel slippage to speak of, in other words. So that might make a difference.

anyway...this will take a while to play out...


Tight Stitches
DWFII--member HCC

[mac]

Robert,
Sorry, It is sometimes difficult to explain things in the written form... I'm a very visual person. I don't mean the height of the heel stack. DW often makes the breast of the heel impinge further (more distal)into the shank to make it easier to get out of the stirrups. When walking/ standing this would increase the support under the proximal arch and may decrease pronation. ( a similar effect to putting a Thomas heel on a shoe) My thought was that his client may pronate more in the boot if the fitter has a "short Heel" (breast of the heel further from the toes). Hope that makes sense.
On a Kirby skive you definately skive Medial to the center of the calcaneus on the cast/ last. Rather than cutting into the last you can add 1/8 to the lateral border of the last to give the heel the same shape. Not my preferrred way of doing things but if you want to save the last for another customer it works great! (Rob, grab an old positive plaster cast and skive the right Kirby style and then add plaster on the lateral aspect of the left and you 'll see that the result is very similar)
Good luck DW,
Let me know how it works out!

[relferink]

Sean,

Thanks for the explanation on the length of the heel. In shoes the proportions of a stack heel are very straight forward, width equals length, what are the proportions on a western boot? Considering the angle of the heel stack I assume it's different. Since I don't (yet) make boots you peaked my curiosity.

I get your explanation now on the heel skive. The thing that confused me was me mistakingly thinking that you were referring to adding a skive on the insole of the boot, you were talking about a modification to the last and your right; Building up on the lateral side has a similar effect to taking off on the medial side. For fitting purposes I would rather cut the last and take off medially since one would run the risk of the foot “falling” into the lateral added skive and the ankle bone hitting the top line. Of course that's only the case in a shoe.

Once you make a modification like this to the last (and it does not matter if you cut or add) you will have to build up the insole with some extra material in the heel to level it off with the ball area or the heel stack will show higher medially compared to the lateral side. At that rate it may even be easier to just add a medial heel skive in top of the insole once the boot is ready. It will be harder to duplicate for future pairs if it's not part of the last but that would be the same if you take if off the last to use that last for other customers till this one comes back.

Again I appreciate the clarification. It's easy to explain with a last in hand but with just words it gets a lot harder. We're simply not all as gifted in word smithing (is that even a word) as DW.

Rob

[dw]

Robert,

Not to kibbitz here but yes, I think "wordsmithing" may be a valid word although I am not certain of its origins or provenance.

As for length of heel on a boot...it can be what ever you want, of course. And with lower, say 7/8" heels, length and width might be similar if not identical...just as on a shoe. That said, one third the length of the last is considered about right for western (cowboy) boots although in some traditions a heel that runs further under the shank is nearly mandatory to prevent the boot from sliding too far into the stirrup--thus running the risk of a hung leg should the rider be unseated.


Tight Stitches
DWFII--Member HCC

[relferink]

Paul,

Good idea to move the cofferdam thing here. It is a nice topic worthy of the new status “correction common foot problems” now has.
A cofferdam is a shoe modification on the outside of the shoe to increase stability or to control access proration or supination. It's mostly done to factory made shoes, not custom or bespoke work. If you need to do it in custom work you can hide most of the bulk in between the lining and the upper so from the outside it is not noticeable, yet gives extra stability.
The pictures are a very extreme example, this one was made for Boston Red Sox pitcher Curt Shilling after he had ankle surgery. The goal was to increase stability and help with his rehab. More commonly you will find the cofferdam only lateral or medial. What the pictures do demonstrate is how you increase the width on the base of the shoe.
Before:

5027.jpg

After:

5028.jpg

5029.jpg

The way I attach this to the shoe is first rough the grain to get a good adhesion. Next you heat mold a rubber or EVA to the shoe. The key is to heat it up so it forms to the contours but when it cools down it will hold it's shape. Next you grind off any access and bevel the edges. If needed yo put a new, wider outsole on the shoe. Depending on the weight of the person and the correction needed you can choose from light but soft Cloud or very firm high density SBR rubber (not sure what the SBR stands for). The cleat in the picture has 4 layers, the first layer Soleflex EVA, the second SBR rubber, the 3rd Soleflex and the final outer layer SBR rubber again, this to get a good combination between rigidity and weight. The SBR rubber and lamination process makes it stiff, the Soleflex keeps the weight reasonable. I did not put this shoe on the scale before and after so I can't tell you how much weight was added but it seemed very reasonable. The reason this one is o much firmer than average is the use, the way a pitcher rotates on the foot before the actually throws the ball is quite amazing if you look at it closely and it was a challenge to figure out how to control the foot and ankle.
The player is currently pitching without any brace or shoe modification and does well. Never mind that he lost last night, we'll blame that on old age and not the ankle.

Rob

(Message edited by relferink on May 24, 2007)

[paul]

Rob,

Thank you for the explaination. I have seen build ups like this on shoes before, but usually just on lateral or medial sides as you describe. And now I'll know what it's called.

Really nice looking job too! I like the way you rolled your edge rather than the long taper of a skive.

Thanks again,
PK

[relferink]

Paul,

This may not have been the most perfect example, normal you end the cofferdam at the sole level. Since this is a cleat and the spikes only dig in partially I had to go longer.
If I had stopped at the sole level it would not have given any stability cause it would not have reached the ground, if I had gone to the bottom of the spikes the cleat would not have had any grip. Therefore the cofferdam extends beyond the sole and I had indeed rolled the edges to keep them from catching and slowly causing everything to be ripped off. The original idea was to ad soling to the bottom of this to keep dirt and sand from getting in between the lamination layers but could not do that till I was sure I was on the correct level as far as grip yet stability. The player however refused to give up the shoe to have the soling put on once he got it. Maybe I did to good a job?
Originally I was planning on re-soling the whole cleat but could not find anyone who made a plate with the regulation spikes wide enough to cover the cofferdams. It was the medical team's intention to have him play regular games with this. To the best of my knowledge he never did. This was plan B.

Rob

[mac]

Robert,
I've never seen a modification like this done to a cleat! Beautiful work. I've never used SBR Rubber before. Where do you get it? What other uses do you have for it. I only do mods like this a couple of times a year so other uses would be good. Also never heard the term "cofferdam"... I always called it an external flare or buttress. VERY COOL
Sean

[relferink]

Thanks Sean,

The cleat was a bit of a curve ball at first (no pun intended) but it worked out well. As I mentioned the original plan was to take the sole off, ad the cofferdam and replace the spiked sole with a wider model. To bad the team's therapist took all the credit for it in the media but their check cleared the bank just fine so I shouldn't complaint. (how come there is no clipart icon of a little guy jumping in a pile of cash?)
The SBR Rubber is a heavy duty, high density, heavy weight synthetic sheet material. I get it from my local finder as midsoling sheet. It's one of the best midsoling materials I've come across and I would not hesitate using it on a heavy work boot. Since most of their sheet materials come from Soletech I would assume this one does as well, in fact it does, just checked the Soletech website. I get the 6 Iron, it's heat moldable but because it's so dense by the time it's playable enough it will burn the skin of your fingertips as I found out the hard way. If I had made the entire cofferdam from this rubber it would have added 5 to 10 pounds to the shoe, that's why I laminated with Soleflex. I very rarely need to use materials this stiff for a cofferdam reinforcement, usually soleflex will do just fine and also has a nice strength / weight balance. What's the point in supporting the foot if the customer can't lift up the shoe.
I never heard the term Buttress used for this but it does make sense and is probably more descriptive than cofferdam. A flare I define just widening the heel / sole, not going up the quarter.
I use the midsoling also in my custom shoes when the footbed need stabilisation around the heel, I cut a strip and heat mold it around the heal seat, than build the orthotic to the last and the shoe over that. Can't find a picture of that now and don't have one I'm working on at the moment.

Rob

[hidesmith]

OK, this is not necessarily a foor question, but I believe it's related to footwear. What do the collective "we" know about restless leg syndrome? As I said, I suspect it's related to the shoes we wear. This conclusion comes from my experience with my own feet (if THAT isn't a blow to my ego, I don't know what is!).

I have designed my shoes to sort of recreate walking barefoot - there is a low heel, leather inner sole and soft counters. I have taken to wearing Birkenstock inner soles inside my shoes, and it seems to help. I'm stymied, though, as to why I can walk barefoot and not get symptoms, but when I wear shoes, I seem to get restless leg symptoms.

My father has RLS also, so I suppose it may be strictly genetic, and have nothing to do with footwear. It may also be coincidental that I know another shoemaker here in NH who has RLS and makes shoes that also mimic walking barefoot.
Anyone have any ideas?
Thanks,

Bruce

[hidesmith]

If anyone has any questions about what a "foor" is, contact me and I'll educate you. After that, you can educate me as to how to use a spell check on this web site. I'm embarassed.

Bruce

[relferink]

Bruce,

I can't wait to be educated on foor. As for the spell check, try using an Internet browser such as Firefox it comes with a build in spell check for forms or areas on websites (such as the colloquy) you fill out. It's somewhat limited but better than having to come up with an explanation for foor.

Restless leg syndrome: I'm not sure if I'm qualified to say much about that since it's a neurological disease and I'm definitely not a doctor but I have some strong feelings about the “walking as if barefoot”. Your shoes may mimic waling barefoot more so than the average by going with a low heel and minimal structural support but I don't think there is much comparison to truly going barefoot.
The fact that you mention the Birkenstock innersole makes it anything but barefoot since it's a specifically shaped insole supporting and offloading different parts of the foot.

I may seem to jump at your throat and I'm not trying to do that but I feel strongly that “walking as if barefoot” is a term thought up by some marketing executive without any really sensible science behind it. The reason lays in the the design and function of the foot. It is true that there is a lot of positive to be said for going barefoot and when examining different cultures some of the strongest feet are found on people that walk mostly barefoot.
HOWEVER these people do not spend their entire life walking on concrete sidewalks and having their feet restricted into shoes before they ever take their first step. So “modern” feet are simply not mend to go truly barefoot. Consider the popularity of flip flops (about as close as you can get to going barefoot) and the increase they cause in foot problems and number of visits to podiatrists.
Using footwear that is not restrictive and gives the foot a degree of freedom is fine but it is truly not like going barefoot.

That said I do agree that the foot function and position can have an effect on RLS. It's my instinct that it has to do with the pressure and tension on the nerves and muscles in the leg, in part caused by what happens inside the foot while walking and standing. That is as far as I can justify my reasoning. I have no answer to offer what it is that makes someone feel better with shoe and insole X vs. Y. Conventional wisdom would suggest that with structural support the muscles in the legs are stressed less so there goes that theory.

Suffering from the symptoms yourself gives you a unique opportunity to experiment with different footwear options and have the best feedback you can get; your own body aches. Maybe not particular pleasant but if there truly is a link between RLS and footwear you may be the one to figure it out.

Sorry I don't have much more to offer than my not so humble opinion.

Rob

[hidesmith]

Rob,
I don't believe the foor was invented to walk on asphalt and cement. The fact that we ask it to means we need tend to need something more than just bare feet. However, anything we put on our feet changes the way our foor reacts to the impact necessary to walking. Would this be a definition of the word "conundrum"?

I was kind of hoping this is a subject that one of the more expert makers had dealt with. Quite a while ago, when I described my heel pain, DW suggested a solution that helped a good deal. I was hoping an ortho or pedo something-or-other had seen a lot of this, and knew the answer. Has anyone on the forum dealt with RLS before?
Thanks for the input, Rob. Did you notice that I figured out how to use my splle shecker?

[danfreeman]

I think walking barefoot is best; but only if you've been doing it all your life, and never walk on anything except the grassy savannah or the forest floor, and live in a warm climate. In other words, we have to wear shoes! I have long believed that shoes or boots are never GOOD for your feet--they are either bad for your feet, or not bad for them. I try to make footwear that does what's needed in terms of support, protection--yes, and appearance, too--and does not hurt your feet.

[paul]

Dan,

Hey! I like that! I'm always on the lookout for good lines to add to my schpeel. Can I use itr?

Thanks, PK

[danfreeman]

Please do. Of course, it oversimplifies matters somewhat. But then, that's what a spiel (where's my shpell checker?) is for.

[fred_coencped]

DW,I have made some cowboy boot custom insoles in various materials for my clients.the last bottom is not difficult to match with the inferior portion of the footbed. Of course the forefoot generally does not allow much height for metatarsal heads or the toes.therefore spacers can resolve those situations.With that said,I would like to bring to this forum my concerns regarding intrinsic last modifications that I make in last making for custom orthopedic shoes ,boots, sandals and foot orthotics into the cowboy boot last. Could you address the mention of your inquiry of April 5th regarding your customer.Just as an assumtion or hypothetical case study so to speak and just being theoretical,lets say we wanted to lower the 1st MPJ [metatarsal phalangeal joint],incorporate a metatarsl raise for the 2nd,3rd,&4th metatarsals and utilize the medial skive as mentioned by Robert,with the lateral heel wedge.My question is what woud be different in the bottoming applications after the insole is filled and rebalanced to the original last bottom?I am getting ready to build my very first pair of cowboy boots for a client and I guess I am a bit nervous.The sizes are mismatched and I have a run of Jones and Vining lasts in M`s D widths with full steel bottoms to be removed.Your thoughts and relections are greatly appreciated.Robert ,Sean ,Jenny or anyone else I welcome your resonses and consideration.I think Jenny`s insight to a dynamic pedograph really reflects the gait pattern and pressure as a very valuable tool in gait analysis.Thanks,Fred

[relferink]

Fred,
I'm trying to wrap my head around your specific question and it's just not falling in place. Do you think you could rephrase the question?
You ask about the difference in bottom applications after the insole is fitted and rebalanced to the original last bottom. The point is not to balance to the original last bottom, by wedging you change the last bottom and the balance, you do not re-balance as that would take away that effect. Once re-balanced with wedges you add the insole and go around your normal bottoming procedures. I don't think that's what you meant but if you can rephrase I may be able to come up with a better answer.
Rob

[mac]

Huh? What... did I I just hear my name? Yawn... just coming out of hibernation. I've been lurking in the background for so long. I think I know what you are trying to get at but, like Robert, I could interpret your words in several different ways. Are you making a custom removable insole/orthotic to put inside the boot? or are you modifying the plantar surface of the last much like you would do a buildup? Please be specific on the motion you are trying to control or the bony prominence your are accommodating. We need the WHY to help with the what to do about it. Generally, I would bow to Robert's experience here but maybe I can throw in my 2 cents worth.

[fred_coencped]

Hey Robert Et tu Sean,The other day I finally ordered DSL/broadband from my provider.And I just tried to further explain my question to Robert but I lost the dial up connect. So here goes again .The intrinsic last modifications are to create an intrinsic orthopedic insole that is permanent,firm insole leather to survive the lifetime of the finished boot versus a removable footbed. To address Roberts question or concern regarding rebalancing the corrections back to vertical is to bring the 'innersole' back to vertical,remembering that the corrections are already applied into the orthopedic last.AT that point lies my question ,after balancing the 'innersole'then the Insole is added ,Lasting the upper and continuing tradional bottoming processes.This is totally supporting the medial heel correction ,supporting the metatarsals and as an example of dropping the 1st mpj allowing plantarflexion of the 1st metartarsal at midstance balancing forefoot valgus with rearfoot varus or valgus.the completed insole/'innersole'would be thicker under the medial calcaneal tuberosity,and thicker uner the lesser lateral metatarsal heads and 10 to 11 iron thick under the 1st met.head. Also support in the metatarsal arch would be filled.This is rebalancing the last,I hope these thoughts shed some light on this subject of an orthopedic shoe last.I understand a removable footbed very well,I would like to know very specifically the consequences of inseaming,heel wiping prior to the finishing of the heel and sole being the same as any boot devoid of external wedging. This issue involves no removable footbeads or orthotics,because of the lack of permancy in eva materials vs rigid shank independent orthotics.I sure hope this response helps to clarify my concerns,if not please advise.This is more a theoretical then specific question regarding my experiences.And this has been on my mind for a long time.By the way Jennys response to DW`s inquiry of 4/05/07 regarding a dynamic pedograph print was great.I use it a lot in my practice in gait analysis to confirm findings in a bio-mechanical assessment.Thanks,Fred

[relferink]

Fred,

That clears it up for me. You actually manged to get Sean out of hibernation, no small achievement.
All kidding aside, good to “see” you back Sean. I don't buy the bowing to my experience. We all have specific experiences that can be helpful when shared to get our customer better shoes. I get stumped as most other do from time to time. Besides, next thing you'll start saying things like “age before beauty” and that would really tick me off

Personally I would go with a removable footbed but you could cement it in place. Cork would be my material of choice. Take the last that has the modifications incorporated, mold a thin insole against the last, wetting it in rubbing alcohol and putting it under a press to dry works well and dries faster than water. It will also allow you to “fill in” cavities like negative metatarsal pads in the last shape.
Next even out the bottom with cork, cover with a regular insole and inseam as usual. You can cement the insole to the cork or leave it loose so you can take out the footbed to make adjustments as needed.
When tacking the insole to the last over the cork nail it to the last in at least 3 spots, heel, just behind the ball and at the toe as the insole could move around a little more because of the extra layer underneath. Don't take these nails out till your done inseaming.
Alternatively you could build up the differences with leather, you still want a full insole to the foot to prevent the edges from the leather buildup pieces to come loose over time. Leather will also be heavier and stiffer. How would you address modifications if needed with a non removable liner?

Just my . Sean, I'm curious how you would tackle this.

HEY SEAN, ARE YOU STILL AWAKE???

Rob