10/14/2010 6:14 AM
A patient presented yesterday with painful 4th and 5th toes on the right foot in the steel toe boots he must wear for work. He had tried a number of brands and always developed rather severe pain by the end of the day. The left foot was fine
He had an interesting foot with considerable splay of the toes. He had a hallux varus right along with adductovarus 4 and 5 with lateral splay of the 5th. The pain was coming from pressure on 4 and 5 both dorsally and laterally.
His boots were a size 14C. We keep a Brannock device in the office and his feet measured as a 14C. If the Brannock could measure width at the toes, however, he probably would be a 14EEE. To relieve his pain he would need more room in the toebox both in depth and width. To get a boot that would not put undue pressure on the toes of his right foot, however, could result in a boot that was too large for the left foot.
Our solution was to recommend the use of the PW Minor Super Depth Steel Toe Work Boots. The P.W. Minor Hercules ST has added depth and extra space added to the forefoot area to accommodate custom orthotics. It comes in widths up to 14 3E. We referred him to a local pedorthic shoe store that carries PW Minor. They will likely have to order the boots after sizing him and then add some fillers to the left boot as it doesn’t feel too large.
If you don’t have a local shoe store that can get the boots, they can also be ordered from HealthyFeetStore.com. This podiatrist owned site offers mismatched sizes as part of their Different Sized Feet Program.