Troubleshooting orthotics and footwear for a Rigid forefoot varus – The E Quad


By Kylie Pearce, B.Sc (Podiatry), C.Ped, Education Coordinator

In this blog, I’d like to comment on the best type of orthotic design, and I’ll also give you some footwear recommendations, for someone with a rigid forefoot varus. Looking back at my 20 plus years of experience as Podiatrist one thing I have observed is that people who have a rigid forefoot varus often have difficulty getting the right type of shoes and they often have shoe fit problems in general. Also it’s not uncommon for people with this foot type to have had difficulty getting the right type orthotic design or an orthotic that they feel really comfortable with. I have had my fair share of patients come in to see me over the years who bring in a shopping bag of various orthotics that they have tried and not had good results with and they may have even come to the conclusion that orthotics don’t work for them. This is probably because the main area that needs to be addressed with this foot type is the fact that they have a rigid forefoot varus and no one has ever given them orthotics with extrinsic forefoot posting, the majority of orthotic designs address the rearfoot only.

quadevideostillThe reason why people with this foot type often have shoe fit problems is the forefoot is abducted on the rearfoot because of the forefoot varus and this can result in what is known as a reverse lasted foot shape. Modern shoes are shaped so that there is more space on the medial side of each foot, this is how we can tell Left and Right shoes apart. Historically, this wasn’t always the case with shoes and both shoes were made with the same shaped last – no difference between Left and Right. So with someone who has a reverse lasted foot shape they tend to have a curved lateral border to the foot (rather than straight) and the forefoot has moved laterally (is abducted) because of the varus forefoot, this is because of triplanar motion. It is almost as if these people would be more comfortable wearing their modern shoes on the wrong feet. Generally what works best is if they look for straight lasted shoes, rather than curved lasted shoes that curve a lot medially and are more banana-shaped. Modern Straight-lasted shoes do have a Left and a Right and they do have more room in the shoe medially but they tend to look more like the traditional straight lasted shoe which was where there was no difference between left and right. So you can see how someone with this foot type is going to feel very uncomfortable in curve lasted shoes and they may have difficulty getting their orthotics to fit in their shoes. It may even appear that their orthotics are too wide, when it could be just the fact that the shape of the shoe is curving in the wrong direction.

Unfortunately many women’s shoe designs tend to be curve lasted and this can make orthotic fitting more challenging. Some examples of manufacturers that have many curve lasted shoe designs are: Adidas, Nike, Reebok and in particular, Pearl Izumi.

So how do you tell if your E Quad orthotics are too wide or if it is possibly the wrong shoe shape that is exacerbating shoe fit problems? The simplest way is to stand on your orthotics with no shoes on and look down at your feet. If you don’t see any or much red orthotic then the device is correct and the shoe may be the issue. If you stand on the orthotic and your foot is inside with extra red shell all around your foot, then it could be that the device is too wide for you and you may do better with our narrow grind. If you are uncertain, we are happy to assist and we can easily help you by having a look at some photos of you standing in your orthotics without shoes.

Ideally it is best to have a fit kit and try on your orthotics in the right shoes before you buy them, but we understand that this isn’t always possible.

If you are interested about finding out more about recommended shoe styles by foot type you can download our information sheet here, which will give you some good alternatives based on each foot type.

People who have F Quad feet can also have similar shoe fit issues because of forefoot abduction ,this can been seen clinically as too many toes laterally, so F Quads  also need to avoid curve lasted shoes and in general they Fs may need a more corrective orthotic design that tends to be bulkier and there will be certain shoes styles that just won’t work or be able to accommodate the type of orthotic that is really needed to get the best results. After all, orthotics are only as effective as the shoes you put them in and if you have inadequate shoes, you’ll get inadequate results.


by Louis J. DeCaro, DPM

Louis J DeCaro DPMRecently Dr. Louis J DeCaro, President of the American College of Foot & Ankle Pediatrics conducted a webinar broadcast nationally for the National Down Syndrome Society. Titled “How Early Intervention in Pediatric Foot Care Can Improve Quality of Life in Children with Down Syndrome,” Dr. DeCaro discussed how the growing foot structure/shape in children with Down syndrome influences balance, gait, and a variety of foot conditions that can be treated during early development. Common symptoms include flat feet, pronation, foot/leg pain, toe-walking, in toeing, and others. Check out the full Webinar on You Tube!