Troubleshooting: Getting Foot Orthoses to Fit Correctly in Shoes.

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

There’s an old maxim in the Podiatry and Pedorthic world that, an orthotic is only as good as the shoe you put it in. This has proven to be very true and it is worth discussing this in detail when going over orthotic therapy as an option. This is commonly referred to ashaving the ‘shoe talk’. It doesn’t matter how expensive and customized your patient’s foot orthotics may be, they could end up having little functionality and benefit if they decide to wear them in shoes that are worn, fit incorrectly or aren’t well designed to accommodate foot orthotics.

It’s important to educate anyone who is considering foot orthotics that they need to look at what shoes they will wear with them and make sure that the shoes aren’t too small to accommodate the orthotic devices because orthotics do take up some room in shoes and there needs to be adequate, length, width and depth to ensure that your patient’s feet will fit correctly in shoes with foot orthotics.

It’s really important that the orthotics sit correctly at the back of the shoe, the heel cup should cup around their heel and there shouldn’t be any gap between the orthotic and the back of the shoe (heel counter). If they have shoes that are long enough, wide enough and deep enough, there are a few other factors to consider. Many shoes have a build in foot bed, if you remove this and replace it with the orthotics then usually fit problems are lessened. But in certain shoe styles, like elastic sided boots, the orthotics have a tendency to slip forward, especially if the heel height is greater than an inch. If your patient wants to wear your orthotics in shoes that have heels higher than an inch, you should discuss this with them because the orthotics may need to be customized for this.

Unfortunately these days, many athletic shoe models aren’t orthotic friendly. Shoe brands that are notoriously bad for accommodating orthotics are Nike, Adidas and Reebok. Please refer to our shoe recommendations by foot type list that you can download here.

Here’s some tips on troubleshooting these problems:

If the orthotic isn’t seating itself back far enough in the shoe, or it has a tendency to slide forward when you put your foot in the shoe. This is commonly because of shoe fit or shoe style problems as discussed above but if your patient has shoes that fit correctly and are a suitable style then a simple way to prevent this is to use a little bit of double-sided tape or Velcro to ensure that the orthotic doesn’t slip forward. If the orthotics do slide forward when they are putting on their shoes, usually if they tap the back of their heels the orthotics will slide back into place and often their weight is enough to keep them there. If not, try the Velcro or tape trick. Just place double-sided tape under the heel of the orthotic and in the center of the heel area in the shoe if you are using Velcro.

The other possible problem is that the orthotic is too wide.  To test this, have your patient stand on the orthotic without their shoes and look down at their feet. If the orthotic is not wider than the circumference of their foot ie, you can’t see any of the orthotic when you are looking down then the orthotic is not too wide! If the orthotic is wider than their foot, you can adjust this for them.

So it basically comes down to:
The orthotic is too wide  – this is rare because your orthotics should have been fitted correctly when dispensed.
Or, the shoe is too small (not wide enough, deep enough or long enough).
Or the shoe style isn’t really suitable for orthotics.

If the orthotics feel good and look like they fit correctly when standing on the orthotics when they’re not in the shoe, then it’s most likely a poor fit between the orthotic and the shoe. Have a look to see if the orthotic sits all the way back into the shoe.  Some shoe styles, like dress shoes or even Nikes and Adidas – really cut out the midfoot and the orthotic doesn’t sit properly in the heel counter.  This can be an issue. The answer is to look for a better shoe style, or cut the orthotic down, which reduces correction, so this is only indicated when the orthotic is too wide or if there are restrictions on what styles of shoes can be worn. Sometimes there is a balance between getting the right amount of correction and getting orthotics that fit well in their shoes. But in my experience starting off with the right shoe style that accommodates foot orthotics well and fits your patient’s foot correctly will get them off on the right foot in regard to getting you the maximum benefit from wearing foot orthotics.

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Using Heel Lifts for Leg Length Inequality

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

When someone has a leg length inequality often it is indicated to use a heel lift. Commonly this is attached to the heel post of a functional foot orthosis (for the shorter limb) as part of a customized orthotic prescription. There are limitations on the amount of lift or correction that can be achieved using heel lifts, the biggest factor is to do with shoe fit, particularly shoe depth, and if you add too much of a heel lift the person will tend to walk out of their shoe or you’ll get excessive heel slippage.

The maximum amount of heel lift attached to the heel post of an orthotic device is about 1/4”, more than that can cause a pelvic iniquity. This amount of lift will also fit in most standard shoes, but not smaller dress shoes.

An alternative to attaching a lift to the heel post of foot orthoses is to make a 3/8” detached tapered lift that extends from the heel to the ball of the foot. This is placed in the shoe of the shorter limb and the orthotic is placed on top of it. These lifts are customized for right or left. This amount of a lift will only fit in deep shoes like Athletic footwear or boots.

More than 3/8” needs to go on the outside of the shoe, and should extend the full length of the shoe, tapering at the toes, think of a platform shoe but just on the shorter side.

Another factor to consider is if the leg length inequality is functional or structural. Functional leg length inequality is where the limbs are actually the same length but one appears to ‘function’ as a shorter limb because of the position of the back and pelvis.

Functional Leg Length Inequality caused by Hip Tilting

A true structural leg length inequality is where there is an actual difference in the length of the limbs, this has a number of causes and it can be congenital but a common cause is after trauma, like an accident causing a fracture of one limb or damage to a growth plate on one side. Surgery can also be a cause. Especially in older patients, leg length inequality can be an unintended consequence of having a hip replaced.

Structural Leg Length Inequality caused by different sized limbs

So you have done an evaluation on your patient and have determined that there is a structural leg length inequality and you feel that your patient would benefit from having a heel lift but you want to know how much of a lift you should use? How much to add depends on the severity, the shoe it needs to go into and the age of the patient. The general rule is to start with no more than half the difference. For example if you have a patient that is 1” shorter on the right, you could recommend the 3/8” lift but you need to explain to the patient that it will require very deep shoes. Or go with a 1/4” lift on the orthotic and have the sole of the shoe modified to add another ¼” to 1/2”. Remember, many patients – particularly women because of cosmetic considerations, are reluctant to have shoes modified unless there is a significant difference in their limb length.

Another factor to consider is if someone has had a limb length inequality for a long time they may have ‘compensated’ for it and a large amount of change in a heel lift may not be tolerated well. In this case you can ramp up the amount of lift gradually to help improve their function and improve any symptoms associated with the leg length inequality.

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Visit with Rob Young from Grand Haven Foot & Ankle

from left to right: Scott LaBianco, Roberta Nole and Rob Young


Nolaro24, LLC was proud to host Rob Young from Grand Haven Foot & Ankle in Grand Haven MI for a few days after attending our Biomechanics & Orthotics Master Class on April 20-21. Rob spent a few days with Roberta Nole and Scott LaBianco of Stride Pedorthic Center learning about foot typing, observing, and learning about custom and prefabricated orthotics. Rob is working towards his C.Ped certification, and was eager to learn anything he could about biomechanics and foot pathologies. We had a great visit with him and we are sure he is going to be even more of an asset to Grand Haven Foot & Ankle once he gets his certification!

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