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Aug 4

Written by: Cherri Choate, DPM
8/4/2010

For most patients, a pair of dress orthotics is usually a secondary order following successful use of functional orthotics.  Although the dress orthotics are functional, they often offer less aggressive correction due to the limitations of the dress shoes.  The modifications to consider in these re-order situations are the following:
     ** Heel cup-  A standard heel cup of 14 mm is usually too deep in dress shoes.  In order to avoid lifting of the heel during gait, it is recommended to order a heel cup depth of 8-12 mm.
     ** Rearfoot post-  A standard rearfoot post often will not fit well in the heel counter of dress shoes.  If a rearfoot post is desired, then consider use of a strip post (distal 1/2 of standard post) or no post.
     ** Width-  For dress shoes, a narrow width is usually needed so the upper of the shoe is not stretched or pushed outward and the devices sit flat in the shoe without rocking.
     ** Medial heel skive-  The heel skive is somewhat dependent on the heel cup depth.  During the fabrication process a heel cup depth of 10-12 mm can only allow a 2 mm heel skive.
     ** Forefoot accommodations-  Due to the limited depth and width of the forefoot in dress shoes, any forefoot accommodations should be modified or removed entirely.  For the most part, 1/16" (1.5 mm) modifications are likely the most appropriate accommodation thickness. 
     ** Topcover-  Once again, due to the volumetric limitations of dress shoes, a thin topcover is optimal.  Plastics such as polypropylene can be worn without topcovers, but most graphite products need some type of topcover such as leather or vinyl.

The next time you want to reorder a dress orthotic, keep these points in mind to assure patient satisfaction with fit and function.
 

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