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Author: Dianne Mitchell Created: 5/16/2011 9:38 AM
Orthotic Therapy Blog

By Dianne Mitchell on 8/15/2013 3:24 PM
I see a fair number of runners in the office for functional foot orthotics and get the frequent request for lightweight and "not so hard" orthotics . In these cases, I find that the features of the ProAerobic Specialty device are great.

This device includes a polyproplyene shell which is flexible (3mm) and it is back-filled from the ground up to the arch with EVA. It also incorporates an EVA rearfoot post for cushion/shock absorption at heel strike. This is light weight device and it offers dissipation of the stress of high impact activities such as running. My runners are really happy in ProAerobic orthotics.

I often modify the ProAerobic prescription to incorporate a deep heel cup and wide shell for additional support and control. Something to consider ...
By Dianne Mitchell on 8/13/2013 3:08 PM
A rigid flat foot was just molded here in the office. Historically this patient was in a pair of insufficent devices which he continued to have pain with. The goal is pain relief / reduction. Thoughts for the rx writing ...

- capture the arch in as close to subtalar neutral as possible without inverting the patient, as this is a rigid deformity and the patient will not tolerate a device which requires motion he doesn't have.
- order a wide device with a medial flange (you can always make the device narrower in the office at the time of dispensing if it is too wide) this will add a supinatory torque and not allow the patient to maximally pronate over the device
- many of these patients will have prominent navicular tuberosities so I mark them before casting and order sweet spots for added cushion
- order a deep heel cup and, pending available motion in the midtarsal joint, I will add a medial skive of 2-4mm for a additional supinatory torque
By Dianne Mitchell on 8/8/2013 2:52 PM
I see a lot of patients with lesser metatarsal head pain in the office. Today a great example of 2nd metatarsalgia came in. This patient is really active in cycling and climbing and constantly loads the forefoot in these activities and wants to continue them. He has tried metatarsal cookies / pads and bars without any success and wants options ... what else can you do?

Well, it is important to note that these above modifications were tried on the flat insole of his shoes, no functional foot orthotics have been attempted. This patient was actually sent to me for functional foot orthotics since he was failing the other items.

First, a well molded foot with a orthotic prescription including "minimal arch fill" might very well in and of itself transfer stress from the ball of the foot into the arch and off of the painful site and be enough for the patient. Other things to consider for the forefoot of the device could be anything from simple Poron or EVA padd ...
By Dianne Mitchell on 8/6/2013 2:44 PM
Saw a child in the office today for functional foot orthotics, who presented with hyper-flexible planus foot and a really prominent navicular tuberosity. This patient has had a history of orthotic irritation at this site. A couple things to think about while casting and writing the order for the devices.
Make sure to cast this flexible flat foot in STJ neutral and plantar flex the 1st metatarsal (for this particular patient, this casting position easily recreated the arch and resulted in a nicely balanced cast.) Next, since the patient told you about navicular irritation, mark the cast in this location and order a sweet spot for cushion and pain relief here. Also make sure to prescribe for cast inversion and a medial skive as needed to take the patient out of maximal pronation. A deep heel cup is necessary with these cast corrections to ensure that the orthotics hang onto the heel. I am ordering a 20mm deep heel cup to do this.
By Dianne Mitchell on 8/1/2013 2:39 PM
Patient presented today for orthotic molding. Patient has a really prominent fascia band with a single fibroma in the midsubstance of both arches. These are presently non-painful and the patient wants to keep it that way ... What can you to with the orthotic perscription??
Add a plantar fascia groove.

This is easy to add! Before casting the patient, mark the fascia with lip stick or betadine solution (something that will transfer to the plaster easily during casting!) This helps the lab identify the proper location of the fascia for the groove to be located and offloads the facsia beautifully to keep patients pain free!
By Dianne Mitchell on 7/16/2013 9:12 AM
Patient presented for second opinion of her 1st MTPJ pain. This is an athlete with functional foot orthotics. The main question of the patient was whether or not she was "due for a new pair" ... as the pain in the big toe wasn't going away despite efforts to "pad" the pain area.

On evaluation of the patient: minimal hindfoot pronation with a functional hallux limitus and associated medial hallux and 1st MTPJ callusing.

Prior to pulling the orthotic devices out of the shoe, what do we expect to see on the orthotic? This could be a simple orthotic shell with great hindfoot control and a simple top cover and could potentially include a reverse morton extension, as this modification allows plantarflexion of the 1st metatarsal and therefore increased ROM thru the 1st MTPJ during the gait cycle.

Periodically I see addition of padding beneath the 1st MTPJ in an effort to literally pad the painful region. In this particular in ...
By Dianne Mitchell on 7/11/2013 9:22 AM
Patient presented today with complaint of callusing on her orthotics.
By Dianne Mitchell on 5/23/2013 7:22 AM
A patient came in today with 5th toe pain. This is a patient who has functional hallux limitus with transfer metatarsalgia and associated pains. She presented with a pair of great custom molded functional foot orthotics, with a shell that supported and corrected her foot appropriately. A minor modification to the soft materials could make this orthotic more effective. I added a top cover and a 3mm cork reverse Morton's extension. While this fit fine in the athletic shoes she had in the office, she headed out for a hike the following weekend in different footwear and reported back to the office the following week with new symptom of 5th toe pain.

Clearly the top cover with the added cork extension was too thick. A simple, quick fix for this is to leave the accommodation in place and simply mark the location of the 5th toe in weight bearing on the device. Next, thin the portion of cork below the marking with the grinding wheel. The patient loved it!

Before removi ...
By Dianne Mitchell on 5/20/2013 7:06 AM
I see a bunch of kids in the office for orthotics and many of them see me frequently for new top covers. The most frequent reason, is: the orthotics got wet and the cover either came off or smells or looks poor. I was also getting similar complaints with the rearfoot post becoming saturated. Typically this involves a puddle at recess that got played in and the shoes are soaking along with the socks and the orthotic device. As everything dried out that evening, parent and child observed damage.
By Dianne Mitchell on 5/16/2013 7:54 AM
A woman came into the office today for custom orthotics and wants them to fit in as many shoes as possible. She understands the types of flats she should be in and really didn't want to have to buy a bunch more shoes to accommodate the orthotic.
Some thoughts ...
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