Office practice: footwear and orthotic therapy

The evaluation of a patient with a foot disorder should include a careful history and examination of the foot. A more extensive evaluation may be indicated as many systemic diseases may initially involve the foot. The patient's shoes are most important and frequently correlate well with the foot pathology. Appropriate radiographs which should including weightbearing views are essential, and selected laboratory studies may be indicated. Although it may be practical to divide the foot into the components of forefoot, midfoot, and hindfoot; these three areas are functionally connected. A deformity in one area usually affects the other areas of the foot. Office procedures should include practical care of the nails and hyperkeratotic lesions which are easy to trim. Shoes must be of appropriate size to fit the forefoot and heel. The shoe may require modification or orthotic devices to accommodate existing pathology.