Orthotic Approaches for Summer Footwear

Created in partnership with the American Association for Women Podiatrists. 

Welcome back again, everybody to Podiatry Today Podcast where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the assistant editorial director for Podiatry Today. This episode today is created in partnership with the American Association for Women Podiatrists, and our guest with us today is the co-vice president of that organization. Alyssa Carroll, DPM is also an associate of the American College of Foot and Ankle Surgeons and practices in Raleigh, North Carolina. This orthotics Q&A podcast is going to focus on orthotics in summer shoes. Thank you so much, Dr. Carroll for being with us today and helping us understand a little bit more about some pearls on this topic.

Dr. Alyssa Carroll:

Thank you so much for having me.

Dr. Jennifer Spector:

So every season has different shoe styles associated with it, and I'm sure that everybody's had the experience of patients asking these questions about, "How do I make my orthotics work in," fill in the blank, "type of shoe?" So what challenges have you noted when it comes to custom orthotics and summer style shoes?

Dr. Alyssa Carroll:

Yes, the summer shoes. So I think the most obvious challenge that we probably think about first is those open toed shoes and how that's going to work, but also those lighter slide on shoes that people want to be able to just throw on, especially a lighter shoe that's not going to be as hot in the summer. So I think those are probably the three big challenges that I typically see this time of year.

Dr. Jennifer Spector:

So in your experience, how have you gone about trying to address some of these challenges?

Dr. Alyssa Carroll:

So this is really where I take an extra few minutes with the patient to really get an idea of what they're wanting to wear, and I think that can clear up a lot of questions. We're lucky enough that we are living in a time where there's a lot of options and there are a lot of really great brands that have removable insoles, even in a super lightweight shoe that you wouldn't necessarily think of or we even had five, 10 years ago. So I think if you can get a better sense of what they're hoping to wear, sometimes you don't have to make a huge adjustment to the orthotic itself.

And then I think the other component to this is just understanding that some of these shoes will not be accommodative to an orthotic, and that might be okay. I think if they're really wanting to wear a sandal or some kind of open toed shoe, what is their orthotic for? Is it for arch support? Okay, let's try to find a sandal with built-in arch support. Do you have hallux limitus or rigidus? Okay, let's find a super rigid, maybe even rocker bottom style shoe that might get you through the few times that you're not able to wear your orthotics. So I think just kind of knowing what they're wanting to wear and knowing what their orthotic is supposed to be doing, we might be able to navigate that pretty well.

Dr. Jennifer Spector:

So you've touched on this already, but are there any particular features or approaches to a custom orthotic or to that summer shoe that have been particularly successful for you?

Dr. Alyssa Carroll:

Yeah. So I'll probably focus more on the orthotic itself for this because I think we talked a little bit about some of those other options. So this might be something where maybe we make a thinner orthotic, just acknowledging to the patient it's not going to have as much cushion, it's not going to do X, Y, and Z that you might be used to with another orthotic that's going to fit in a more accommodating shoe. But there's some options here. I think another possibility, especially if a patient wants to wear a sandal or something like that, another popular thing I like to do is maybe add a met pad, adhesive met pad, but really sticks in there and then that's something that they can keep in their sandals. So that's another accommodation that you can make as well.

Dr. Jennifer Spector:

Yeah, sometimes it's just about finding out what the goals are and seeing if there's ways that we can get them as close to it as humanly possible.

Dr. Alyssa Carroll:

Exactly. It's amazing, I constantly have patients come in and you're the second or third podiatrist that they've seen and they come in with a really great orthotic and I'm like, "If you just spend a few extra minutes," it's like the whole time the orthotic was not made with any consideration about what the shoe was going to be. So the patient's like, "The orthotic might be fine, but I can't put it in any of my shoes." So just really making those really big clarifications go such a long way.

Dr. Jennifer Spector:

How do you go about managing expectations on the part of the patient as far as what type of shoe gear is going to be reasonable for them and also reasonable for their orthotic?

Dr. Alyssa Carroll:

I think getting to know your patient and I truly try to tailor it to them. And I think understanding if it's someone with a severe pes planus that we've just finally, after years gotten their PT tendonitis or their PT dysfunction under control, okay, we're not going to be able to go too far out of the realm of you need to be in the orthotic 99.9% of the time. But if it's someone that's coming in with something a little bit more manageable and they have a little bit more flexibility, I think the expectations there can be reasonable. Maybe you wear it 80% of the time, or again, you can maybe get away with some of these shoes that have better built-in support. But you're exactly right, managing expectations based on what the pathology is and what we're really doing here. I think that really goes a long way. And again, I think a lot of people just need the resources about the different shoe options out there. I think most of my patients are really surprised with how many options there are.

Dr. Jennifer Spector:

Absolutely. And you mentioned that you might make a thinner shelled orthotic for a summer style shoe. Are there any other accommodations that you make sometimes? Do you change your posting at all or your padding or your length? Are there any things that come up on a regular basis for you?

Dr. Alyssa Carroll:

Yeah, all of the above to be honest. And again, I think it depends on what we're doing. I mean, really when possible, obviously trying to not do any external posting, if that's feasible, maybe utilizing some internal padding or skiving or different ways to manipulate that rear foot that maybe isn't going to have that bulk that a posting would, for instance. And then again, I think I mentioned before, but this is a big one, just telling patients, "It's okay to give up some of that padding and cushion. I don't think you're going to miss it as much as you think you will, and you'll be surprised with how many shoes you can fit that into. And you don't even necessarily have to have a shoe with a removable insole depending on the dimensions of the device."

And I think going into that thinner orthotic, definitely doing more of a shell or sulcus length, I always tell my patients who like lots of different styles, "It's going to give you a lot more flexibility with what the toe box of the shoe is looking like without you having to do trims and things like that." So all of those things, they happen daily at this time of year.

Dr. Jennifer Spector:

Absolutely. I think the listeners will definitely identify with that experience. And so going along with that, to conclude today, is there one particular thing that you hope that listeners take away from this discussion today that you feel has made a difference for you in managing and maximizing the use of orthotics in summer style shoes?

Dr. Alyssa Carroll:

Yes. So really two things. One is educate yourself about what options are out there. I basically got to a point where I have come up with a list of brands that not only are APMA, they have the seal, but they are shoes I've worn and I've tested and I've felt myself repeating the same things. And I just keep a list. And at the very top of the list for the patients, I also list out some principles to look for because I don't like to pigeonhole them into one shoe or one brand. Everyone likes different things, but at least they have the principles to look for. So that empowers the patient to find the shoe that will work for them in their orthotic. Or like we mentioned previously, maybe a shoe that is a house shoe or a sandal that orthotic does not go in, but it's still giving them some of those benefits.

The second thing would be, again, just taking those few extra minutes with the patient and really setting expectations, but also understanding what they're wearing and what they're hoping to wear, because I think you can save yourself a lot of time down the road, specifically your staff's time with questions on the phone and a lot of troubleshooting, and it just goes so much smoother.

Dr. Jennifer Spector:

Well, I think it's very clear that communication and education provided by the podiatrist is just vital to success in these situations. And we thank you so much for sharing your experience with us today. And thank you to the listeners for joining us as well. Don't forget that you can check out other episodes of Podiatry Today Podcast on podiatrytoday.com, SoundCloud, Apple Podcasts, and your favorite podcast platforms.