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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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