1/7/2013 9:26 AM
I had a patient come in today for dispensing of new orthotic devices. He had worn orthoses for years and was starting to get a return of his plantar fasciitis symptoms and so a new pair was made. I did not made the previous pair for him.
The older orthoses were gapping quite significantly from his arch and were also about a centimeter narrower than his foot. The new devices were the full width of his foot and were made with a minimum fill with 2 degrees of inversion. This resulted in orthoses that conformed very closely to the arch of the foot. In addition, when I took the cast of the foot the first ray was plantarflexed to the end of its range of motion which enhances arch height.
In summary, the new orthoses had a much higher arch than the old pair.
When the patient first wore the orthoses, he complained that he felt he was not getting enough support from the new orthoses. He complained that the arch did not feel high enough and felt lower than his old devices.
I had him sit in the chair and I placed his foot in neutral position with the first ray plantarflexed and held the old orthoses up to his arch and showed how they gapped significantly from the arch. I then took his new pair and showed how they conform extremely tight to the arch.
I explained to him that the reason the new devices felt more comfortable is that they were wider and so we were spreading the force over much larger surface area.
This patient demonstrated wider orthoses allow you to prescribe a more supportive orthosis, one that conforms closely to arch of the foot, and yet have less chance of patient’s complaining of arch height irritation than narrower orthoses that have a lower arch.
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