Written by: Larry Huppin, DPM
12/21/2009 9:18 AM

For the most part we recommend prescribing orthoses based on your patient’s pathology rather than for a particular activity. Sometimes, however, your patients’ shoes will play a role in dictating the type of orthosis that can be used. A prime example is the soccer cleat.

Soccer cleats tend to run small. They have a narrow waist, usually a very thin sock liner if they have one at all and on top of this, soccer players often prefer to wear them somewhat tight. This all makes for a challenging task fitting a foot orthotic into a soccer cleat.

It is doable, however, and I prescribe orthoses for soccer cleats almost every week. These are usually an additional pair of orthoses that are used only in the soccer cleats. To ensure proper fit the cleats should be sent with the prescription to the lab. 

Although the prescription will change based on the pathology, here is my standard prescription for the soccer cleat:

• Material: I want a relatively thin shell. Although graphite is an acceptable choice for soccer shoes, over time polypropylene is less likely to fracture under the pounding of soccer. I like to use the ProLab direct milled poly. If the patient weighs less than 130 lbs, I prescribe 2mm thickness and above 130 lbs I prescribe 3mm.
• Heel cup: Shallow. Since you will send the shoe to the lab and ask for “fit to shoe”. We’ll make the heel cup as deep as possible while still fitting into the shoe.
• Width: Standard. Even better, send the shoe to the lab and ask for “fit to shoe”. We’ll make the orthosis as wide as possible while still fitting into the shoe.
• Cast fill: medial skive, inversion: Depends on pathology. Discussed in Orthoses for Soccer Cleats Part 2.
• Post: No rearfoot post, instead I ask for a spot grind
• Cover: Depending on the pathology, a cover is not always necessary. If a cover is necessary (this will be discussed in part 2 of this series) I prescribe EVA soft to the sulcus. Given the limited room in the toebox of a soccer cleat, full length covers should be avoided.

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