Summertime Orthotic Strategies

Q: For patients who wear custom orthotics, what footwear advice do you give going into the warm weather months? Are there any specific modifications or suggestions regarding their orthotics that you make, as well during this time of year?

A:

Most of the panelists advocate for smart choices in summer footwear. Alicia Canzanese, DPM says that this flexibility of recommendations in her practice applies to patients with custom orthotics, more stable deformities, those who are not a fall risk, and perhaps more active individuals and athletes.

“If they are going to be doing an activity with a lot of standing or walking, then I recommend they wear shoes that accommodate their orthotics,” she explains. “However, for shorter or less active outdoor activities, flip-flops or sandals may be okay. I reinforce the need to stay away from flat, thin, thong-type flip-flops and instead look for something more substantial, supportive and cushioned.”

Jay Spector, DPM shares that in the warmer months he typically recommends supportive sandals, similar to Birkenstocks, with a supportive sandal foot bed.

Taking the opportunity to educate patients on the best use of custom orthotics, Michael Donato, DPM shares with patients that putting the orthotic in an unstable shoe compromises the effectiveness of the devices.

“If the patient is going to the beach or somewhere that they want to wear a sandal, I recommend specific brands that have arch support built into them,” he adds.

Joseph Agostinelli, DPM advocates staying with a similar approach to the rest of the year, including advising use of cotton/acrylic socks, making sure not to wear the orthotics without a proper sock interface. He also states he does not make any specific alterations to orthotics for summer use.

Q: What experience do you have with the companies that make custom molded orthotic sandals/flip flops?   

A:

Dr. Spector shares his positive experience with some companies who make custom foot beds for sandals.

“We just started making 3D-scanned and printed orthotics in the office where we can send in the scan and have the company make custom sandals that we will roll out in the next few weeks,” he says.

Over the years, Dr. Donato relates prescribing custom orthotics that fit into specific sandals, and more recently sandals with a custom-molded orthotic built into the sandal footbed.

“In both instances patients seem to enjoy the freedom from heavier shoes during the warm weather months while still maintaining the stability and control that their feet require,” he elaborates.

Customization is also a part of Dr. Agostinelli’s practice, as he shares that military brace shops he works with can accommodate a wide variety of orders. He adds that an orthotics and prosthetics lab he worked with in private practice had similar capabilities.

“I find the diabetic custom sandals excellent as a general orthotic sandal, whether the patient has diabetes or not,” he says.

Dr. Canzanese does not currently have experience with such companies, but says she has spoken to patients about their services. She shares that cost was a limiting factor in patients pursuing this option.

Q: What qualities do you have patients look for when shopping for summer shoe gear? Are there any specific brands or styles you recommend?

A:

Geographic climate influences Dr. Agostinelli’s recommendations, specifically focusing on running shoes with breathable materials due to Florida weather near his practice. He says he doesn’t recommend specific brands, and instead stresses the importance of proper fit among all of the quality running shoe options.

Dr. Donato says he is comfortable with flip-flops or sandals for patients with healthy, strong feet. On the other hand, he adds that patients with foot pathology such as posterior tibialis tendinitis or plantar fasciitis need support to maintain an active healthy lifestyle. These individuals should continue to wear supportive shoes and orthotics as deemed medically necessary, possibly considering sandals with custom orthotics.

“My favorite sandal brands to recommend are Vionic and Naot since they seem to bridge the need for arch support and the desire for style,” he says. “Specifically, Naot, Finn Comfort, Ariat, Birkenstock, Theresia, Aetrex Sandalistas, Cambrian and Dansko are great sandal brands that have models that can accommodate orthotics. Xero has minimalist sandals and lightweight shoes for those who don’t require as much support or for those looking to build foot strength. Oofos and Olukai also make quality flip-flops.”

Dr. Canzanese advises patients to seek out summer footwear with a more substantial sole, without excess flexibility, but with support and cushioning similar to the sole of the sneaker. She recommends models with more of an orthotic foot bed such as Powerstep, Vionic or Spenco, especially for those with pes planus or hyperpronatory concerns. Lastly, she encourages selection of a sandal with a strap around the back for extra security at the heel.

“Over the years I have gradually put together a list of sandals and flip-flop brands that tend to fit my criteria as a guide that I share with patients,” she says. “As a long-term orthotic-wearer myself, my current go-to brands are Oofos, Keen and Revitalign.”

Dr. Spector agrees that more supportive flip-flops and slides are preferrable to less stable traditional summer footwear. He also shares that some shoe companies make merino wool uppers that are surprisingly cool in the summer.

“Even though you can wear open toe shoes, make sure they are not too tight in the forefoot, as this can lead to issues,” he continues. “I recommend AllBirds for closed shoes and Chaco or Birkenstock sandals.”

Q: Do you dispense any “medical grade” flip-flops or sandals in the office? If so, how has this impacted patient outcomes and/or your practice?

A:

The panelists have not personally dispensed such footwear as part of their practice, but have opinions on how patients might be able to obtain appropriate choices. Dr. Canzanese has considered in-office dispensing, but inventory and cost concerns are an issue. Instead, she relies on her list of  “approved” flip-flop and sandal brands, which she relates has satisfied many patients, as most prefer to browse and shop online.

Dr. Spector’s practice is located next door to a running shoe store, relating that he often recommends Oofos flip-flops or slides to either wear outside or as house shoes.

Q: Are there any patient populations you discourage from wearing sandals or flip-flops?

A:

Dr. Agostinelli advises against flip-flops for all of his patients, but recommends diabetic sandals as an option for some without proprioceptive issues or peripheral neuropathy.

The panelists overall share a significant list of conditions not conducive to sandal or flip-flop use including: peripheral arterial disease, neuropathy, history of amputation, uncontrolled diabetes, history of diabetic foot complications, significant fall risk, chronic or unstable posterior tibial tendon dysfunction, acute or subacute injury, unsteady gate, such as post-stroke or those with drop foot.

Dr. Canzanese is an Associate of the American College of Foot and Ankle Surgeons, a Diplomate of the American Board of Podiatric Medicine, and a Fellow of the American Academy of Podiatric Sports Medicine. She is a certified athletic trainer, a member of the American Association for Women Podiatrists and is in private practice in Glenside, Pa. 

Dr. Spector is a Fellow and current Vice President of the American Academy of Podiatric Sports Medicine. He is an RRCA  and USATF Certified Running Coach and in practice in Johns Creek, Ga. Dr. Spector can be found at www.atlantasportspodiatry.com.

Dr. Donato is a Fellow and current Secretary/Treasurer of the American Academy of Podiatric Sports Medicine, a Fellow of the American College of Foot and Ankle Surgeons, a Diplomate of the American Board of Foot and Ankle Surgery and is board-certified in Foot and Rearfoot Reconstructive/Ankle Surgery. He is in practice in Fredericksburg, Va.

Dr. Agostinelli is a Fellow and current President of the American Academy of Podiatric Sports Medicine. He is a retired Colonel in the U.S. Air Force. He currently practices in Fort Walton Beach, Fla.