Can a patient be "over" or "under" controlled just based on their shoe/orthotic relationship? In my opinion, the answer is yes. I recently attended a shoe update discussion and I was reminded of how complex the shoe industry has become. Materials, technologies, attitudes and consumer opinions have changed dramatically over the past few decades. A practitioner must be senstive and aware of the options available on the market. I have seen a fair number of patients who have been "over" controlled by using a semi-rigid/rigid orthotic in an aggressive motion-control shoe.
We may need to readjust our habits in both areas of orthotic fabrication and shoe recommendation. It seems that many patients, and a few physicians, do not take this relationship seriously enough. It is prudent for all of us to keep abreast of the changes and options within the shoe industry and realize that consumers often drive the market. As trends such as "postural" shoes and "barefoot" shoes reach the public, we have an obligation to understand them and inform our patients of the pros and cons of their use. Unlike orthotics, shoes are both a non-prescription treatment option as well as part of fashion and function. Acknowleding the importance and permenance of this relationship will be important as we give advice and recommendations to both our patients and ourselves. Just as the shoe/orthotic relationship balance is important, so too is our relationship with the shoe industry. Stay abreast of changes, you can bet your patients do.