Ideal arch support in bespoke shoes

[DWFII]

@DWFII

Naturally, my heel wear out on the inside since I'm pronating inward. Indeed,

They aren't 100% perfect but this is as good as I can ask for. Believe me I've tried everything and short of going for full-on medical clod-hoppers which will be so large they wont work as dress shoes, this to me is a fair compromise

Alan

So...as I surmised, some chronic and 'pathological' pronation is still occurring.

Thing is...and here I'm speculating (again not a doctor) ...a medial wedge might eliminate both the wear on the heel and the distortion of the quarters. [If your foot is 'walking over' the medial quarters and you are wearing your heel on the medial side, the issue is still extant--it's pathological. If the arch supports were working, both of those problems would disappear. IMPO & IME.]

I don't envy you. Even with my flat feet and marginal pronation, I don't have any significant problems. I do have a Morton's neuroma from an old injury when I was jumping out of airplanes, and can testify that foot problems suck. They can rob you of a good measure of your energy and vitality.

 

[Alan Bee]

So...as I surmised, some chronic and 'pathological' pronation is still occurring.

Thing is...and here I'm speculating (again not a doctor) ...a medial wedge might eliminate both the wear on the heel and the distortion of the quarters. [If your foot is 'walking over' the medial quarters and you are wearing your heel on the medial side, the issue is still extant--it's pathological. If the arch supports were working, both of those problems would disappear. IMPO & IME.]

I don't envy you. Even with my flat feet and marginal pronation, I don't have any significant problems. I do have a Morton's neuroma from an old injury when I was jumping out of airplanes, and can testify that foot problems suck. They can rob you of a good measure of your energy and vitality.

@DWFII

As you yourself admit, I don't know of any remedy to resolve pronation entirely. Even external orthotics don't correct 100%. But I will tell you since I've began wearing orthotics and custom shoes with inbuilt support, my knee pain and occasional swelling has gone away completely.

Also, the inside sole wearing I referred to earlier was before orthotics. Now my heels wear more evenly with the right foot still showing more wear at the ball of the foot (a bit more pronation) than the left when viewed from under the sole.

Indeed foot disorder can be a real pain **********. St. Crispins are the only shoes I can wear a whole day without feeling any pain at all. All the others, (mostly Edward Green), even with medical orthotics, my foot gets tired about half way through the day.

Alan

 

[paulraphael]

The NY Times did an investigative report on the state of podiatry a few years ago. They sent several people with different issues to several different podiatrists, and each one got as many different diagnoses and prescriptions as there were doctors.

This is explained by another article I read that included interviews with a few orthopedic scientists. They said that the science of the foot is pretty new, and we really don't understand much. The scientists—who are not fighting for patients and are not under pressure to overstate their knowledge—said that even the most basic questions are unsettled. Like, is it better to run in running shoes or to run barefoot? Part of what thwarts their research is that the foot is so adaptable. It adapts so well to different conditions, it's very difficult to know which conditions are ideal.

Currently, no one can look at your foot and be certain what kind of arch support will make you feel best or will alleviate your medical problems. You're either going to get lucky, or you're going to go through some trial and error.

Trying to get perfect arch support from bespoke shoes sounds like a hell of a gamble. I would have neutral shoes made that have room for an orthotic (prescription or over the counter). Then you can try different things.

Arch support is about more than shape. It's about the rigidity and the directional collapse characteristics of the support. Your arch expects to flex when you walk. The question is how much, and in exactly what directions. Anyone who claims to know is bullshitting you.

Someone upthread mentioned that humans did not evolve with arch supports. Which is undeniably true. They also didn't evolve walking and running on pavement, and they didn't evolve during a period when many of them lived past 30. So it's unclear how useful this observation can be.

 

[Phileas Fogg]

I don't know what your credentials are...I'm asking...but with 50 years of studying feet, making and fitting shoes, I don't see the logic for this assertion--it runs counter to basic foot mechanics.

At heel strike (the first point of contact in a normal gait) the shoe hits the lateral corner of the heel. Weight is then transferred along the lateral side (and the lateral long arch) to the lateral ball joint and the fifth metatarsal. At which point, the weight of the body rotates (?) revolves (?) medially across the metatarsal arch to the first metatarsal and thence to push-off...which, in a normal foot involves the first phalange (big toe). After which the foot is no longer in contact with the ground.

The medial long arch exist to prevent the weight of the body collapsing the foot to the medial side before the metatarsal and phalanges can be engaged. People who pronate severely have a hard time walking simply because the foot is already collapsed long before the weight of the foot reaches the toes--forefoot and push-off.

As I said in a previous post I am a shoemaker, not a doctor. If you are or have other privileged knowledge, I would welcome a clear rationale for your statement.

leaving my qualifications aside for a moment, you’re essentially correct.

Initial contact is made with the hind foot supinated at which time is unlocks, allows for pronation to occur while the weight transfers later (outside edge) to medial (inside edge). The foot then again supinates making the first ray rigid and allowing for a strong lever for push off.

the OP was wondering whether with a bespoke shoe the arch of the shoe should be molded to fit snug against the arch. This would keep the arch from doing what it’s supposed to do; absorb load. By not allowing or otherwise inhibiting midfoot pronation the shoe will cause discomfort and/or injury.

Your understanding of foot mechanics is excellent! And you’re correct in your statements. if a person is already on pronation, then I don’t think the shoe should correct that. That should be the orthotic device. The orthotic device will do better and correcting the load transference and allow the shoe to be the shoe.

 

[DWFII]

Both of the previous two comments are well reasoned and well thought out.

That said, an article in a newspaper (maybe esp. the NY Times) is not definitive and seldom even in-depth or accurate. I can't tell you how many times I've seen investigative pieces on single malt whisky, for instance, that were so lightweight and poorly researched as to be, despite being ostensibly "investigative", almost entirely bogus and a monumental waste of time.

For what it is worth, people--scientists, makers and just interested amateurs--have been studying the foot for centuries, even millennia.

Most of what we don't know is what happens to gait and to foot structure when we subject the foot to environments and conditions that are not natural to it. Furthermore it isn't that feet are adaptable so much...although they are, at least in the short term...but that no two feet are identical even on the same body. Which speaks to your last paragraph @paulraphael . And yes, it was me who pointed out that people didn't evolve wearing (or needing) arch supports.

And I would still like to know your credentials, @Phileas Fogg...I shared mine.

 

[paulraphael]

For what it is worth, people--scientists, makers and just interested amateurs--have been studying the foot for centuries, even millennia.

When the scientists say the science is young, what they mean is that the body of evidence-based research is young and that it's thin and unsettled. It's like we have millennia of research on the body generally, but doctors were prescribing bloodletting just 200 years ago, and germ theory didn't even really exist until the 1880s.

There's never been piles of research money for podiatric science and gait analysis. If you look on PubMed at the peer-reviewed research, you'll see that most of the papers come to weak conclusions, and many of them disagree with each other. It's little wonder that podiatrists disagree with each other. They're practicing medicine based on science that's still primitive.

This doesn't mean that people don't know anything. You can make shoes or orthotics based largely on empirical experience, and find that they work well for many people. But you're not going to know what will work for everyone. Neither does the podiatrist who's charging $400 a visit. There's an element of chance here that people should be prepared for.

 

[Phileas Fogg]

It’s not chance. And it’s not primitive.

As to the above queries, I’m not a podiatrist.

Sometimes rendering a diagnosis is relatively easy; you have a pain in your shoulder, it hurts to lift it. You get an MRI and it shows a torn rotator cuff. Odds are this is the source of the pain and dysfunction.

But what of imaging comes back negative. Then you have to play detective and use clinical reasoning. What are the mechanical issues? What is affecting the kinematics of the joint?

I’m sure the NYT reporters are patting themselves on the back but this is essentially sloppy journalism at best. Sources of pain and loss of function are multifactorial and due to a range of issues. The clinician must use his reasoning skills to determine which funding is relevant and which is marginal. It’s not that simple.

 

[DWFII]

When you consider that the foot is one of the most architecturally complex structures in nature and then you add in not just 'humours'...such as water retention and the varying degrees of rigidity of ligaments and muscle tone...and then, on top of all that add movement (gait), it is actually quite amazing how much is known about the foot.

It is not...despite a contemporary impulse to reduce everything to what can be quantified in bits and bytes...a static item. What is known about the foot and certain sure today will invariably be different tomorrow.

When what is known about the foot is defined as "primitive' and accepted as such, you end up defining skill, or experience and even wisdom as primitive, simply because such concepts are, esp. for those enamored of modernity and technology, somewhat ineffable.And ultimately unquantifiable.

 

[paulraphael]

When what is known about the foot is defined as "primitive' and accepted as such, you end up defining skill, or experience and even wisdom as primitive, simply because such concepts are, esp. for those enamored of modernity and technology, somewhat ineffable.And ultimately unquantifiable.

Well, I'd suggest that there are much more complex systems in the body than the foot, and we have deep knowledge (quantified, repeatable) of many of these.

Much of it comes down to where the serious research is focussed. People aren't dying from plantar fasciitis or uneven heel-wear. Much of the research into gait gets done by sports scientists, and sports science generally gets low funding. The studies are usually small and short-term, yielding low-quality data.

For reasons that don't need much explanation, most of the research money gets spent on either major matters of public health (deadly diseases, etc.) or treatments that are highly profitable (drugs for chronic conditions, etc.). There isn't much left over for orthotics science or bespoke shoe design! So these remain more in the realm of traditional, empirical understanding.

Edited to add: I don't mean "primitive" as a dismissal. I'm trying to make a distinction between traditional / empirical / craft-based knowledge and evidence-based knowledge. The former can be effective, but often results in different and conflicting bodies of knowledge among different groups of practitioners, and knowledge that often doesn't know its own limitations. Evidence-based knowledge is subject to peer-review and has to be repeatable, and has to account for its limitations.

So you get podiatrists and pedorthists who claim to have all the answers, and orthopedic scientists who say "we really don't know a whole lot." This is, paradoxically, evidence that the scientists know more. Their standards for knowing a lot higher.

 

[DWFII]

FWIW, I did say "architecturally." As with so many "ineffable" sklil or experienced based systems, God (or the Devil) is in the details.

There are, by most accounts, five arches in the foot and it bears and transfers the weight of the body through an extraordinary rage of motions and conditions. It is said, esp. with regard to women's shoes, that at heel strike more pounds per square inch is brought to bear than the Empire State Building.