We had this question come in from a ProLab client today:

QUESTION:
I have a question regarding a prescription for the patient. She has b/l bunions with pain sub second. If she likes these orthotics I will be ordering another pair for her. The first pair she wants to fit into flats for work. Do you have any suggestions for sub second pain that would fit into flats?

ANSWER:
You have two good options for flats. The first being a graphite dress orthosis and second being the Cobra orthosis.

The advantage of the graphite is that it will have more surface area under the arch than the Cobra. This makes it a bit more effective at transferring pressure off of the metatarsal heads.

The advantage of the Cobra is that it sits lower in the shoe than the graphite so you are less likely to have the patients heel slip out of the shoe The other other advantage is that the Cobra orthosis will also fit into high heels whereas the graphite only fits into flats.

My personal preference is for the Cobra. Over the years I have just had a lot less problems with shoe fit with the Cobra.

For sub-second pain I would make a couple of modifications:
1. Prescribe a minimum cast fill. This results in an orthosis that conforms closer to the arch and will thus do a better job at transferring pressure off of the metatarsal heads.
2. Add a 1.5mm poron extension to the sulcus for just a little extra cushioning

To order this device, check off “Cobra” in Part A of the form. In Part B, check off “minimum’ under “cast fill”. Finally, in the Forefoot Extensions section, check off “Sulcus”, “Poron” and “1.5mm”.