Foot of the Week – Episode 20 – Fitting AFO in Shoe

In this week’s video blog, we have a guest appearance by Diana Bean, granddaughter of LL Bean, who wears Insightful’s Blaze MI brace for post tib (posterior tibial tendonitis). She had some pain in her toe caused by a condition called hammertoes. This condition is not addressed by the Blaze brace, but provided us an opportunity to show how shoes often need adjustment in order to relieve pain and discomfort. In this particular situation, the shoe needed to be marked in the area creating the pressure so that the orthotist could remove some material from the shoe thereby creating more space for the problematic toe. Often times when pressure or irritation is a problem, people incorrectly think that adding padding is the answer. The solution is actually the reverse of what most people might think. Rather than adding more padding or cushioning to the area of the foot and ankle, the answer is to remove material from the shoe or ankle brace, creating the required space. This is called a “relief” for the prominent area of the foot and ankle. This is a practice commonly used in AFO’s or ankle foot orthoses but also is commonly needed in shoe fitting.

Video Transcript:

Hi, Ian here from Insightful Products. We’ve got Diana Bean here. Diana, I guess your grandfather was L.L Bean? 

Yes. 

So, we’re feeling kind of honored to be working with her. And she’s got a Blaze MI design which is working pretty well except for the fact that you have some toe problems, right?

Right, hammer toes. 

She has hammer toes on the left side and that hammer toe is creating a problem. What we did here is we relieved the top part by cutting a little bit into the shoe and that solved the problem on the dorsum of the toe, but she still has a hammer toe problem at the very end of the toe where the toe drives down into the shoe.  So we’re going to take care of that problem today.

The shoe didn’t have an insert, so we’ve created an insert out of very low coefficient of friction leather and with plastazote. And after a while the pressure packed down the plastazote and we can see exactly the area of high pressure that is causing the problem. So, we have to relieve the shoe in order to solve the problem. So, inside the shoe here we’ll have to make a relief. 

In order to find exactly the right spot, we use lipstick or in this case eye liner pencil. The lipstick is really good because it’s red and gloppy. Color the spot that’s right underneath the high-pressure spot right there. And then insert this into the shoe press down a little bit and then we have a mark from which we can make our relief.

So now I’m going to take a tool and go down there and create a relief. So, this is the spot right here of concern, it’s the very distal end of her third toe and that’s really pushing hard down on the bottom of the shoe. So, what we did is we’ve created a relief in the plantar surface of the shoe. 

That sock’s good. 

It’s supposed to be higher than the brace. 

Yeah, that’s right.  Who told you that? 

Oh, it said so in the literature. 

Oh good, you’ve read our instructions, way to go. How does that feel? 

Good, really good.

Yeah, feel better?

Yeah. It feels pretty good.

Come right back to me like that. 

It’s good. I’m pleased.

Well, that’s it for Foot of the Week. We’ll see you next week.