Dec 3

Written by: Larry Huppin, DPM
12/3/2009 3:46 PM

A 23 year old woman who recently took up Salsa dancing presented to my office today complaining of generalized numbness and tingling in the balls of both feet after dancing for an hour.  Pain continued into the morning following dancing. No other foot complaints. Her exam was essentially normal – I couldn’t elicit any pain or symptoms. She is just dancing upwards of 20 hours per week and is overloading her met heads causing inflammation and neuritic symptoms.   She is wearing a shoe like the one on the right.

Our treatment goal is simply to transfer as much force as possible off of the metatarsal heads. A 2005 study by Yung-Hui in Applied Ergonomics demonstrated that “the use of total contact orthosis in high heel shoes reduced heel pressure by 25% and medial forefoot pressure by 24%, attenuate the impact force by 33.2%, and offered higher perceived comfort when compared to the non-insert condition”.

Note that this study recommended a “total contact insert”. We thus want to ensure that the orthotic conforms closely to the arch of the foot. We accomplish that by using a minimum cast fill. Obviously, the orthosis must also be small enough to fit into this dance shoe.

So here is the prescription for our patient’s high-heeled salsa shoes:

• Graphite
• 6mm heel cup
• Narrow width
• Minimum fill
• Vinyl cover to the sulcus  (We use black vinyl and dark colored graphite so that the device doesn't show in her black dance shoes)

We also recommend sending the shoe to the lab to ensure a perfect fit in the shoe. Warn the patient that they may have to get a new shoe after receiving the orthosis. Although we can pretty much guarantee that the orthosis will fit in the shoe, we cannot guarantee that there will still be room for the patient’s foot.

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