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

By Dianne Mitchell on 10/28/2013 9:36 AM
I order a fair amount of low profile athletic shoe (cleat/skate) or dress orthotics. A nice shell material option is carboplast. Whereas graphite is stiff and hard, carboplast offers some give, or flexibility, without failing and cracking and is still nice and thin. The lab uses a 2mm (175lbs or less) and 2.6mm (176lbs or more) thick carboplast. My patients are happier with this material and I especially enjoy carboplast more if I need to adjust it in the office. Try it out! The lab is substituting carboplast as the new "graphite" but I write in "carboplast" in the shell material box on the Prolab Prescription form.
By Dianne Mitchell on 10/24/2013 9:28 AM
Patient came in today with a painful metatarsalgia to the central metatarsals 2-3-4. She happened to be wearing her functional foot orthotics which appeared appropriate for her foot shape and type. What can you do in the office to help with pain?

Couple of options:

- add a top cover for padding
- add a forefoot extension of simple poron or soft EVA for paddling beneath the top cover for reinforced padding
- add a metatarsal bar just proximal to the metatarsal heads in order to attempt offloading the painful metatarsal heads

I usually trial these above options in the above order.

I also examine the patient for equinus deformity and start a stretching program.
By Dianne Mitchell on 10/21/2013 9:16 AM
I frequently see patients in the office with under-corrected orthotics. Many of these devices simply do not contour the arch. Instead there is a gap between the arch of the orthotic and the patients arch. One in-office fix is to add arch fill to the device. I use Korex to add height to the top of the orthotic to fill in the gap. Once the gap has been filled in, you can add a fresh top cover.
See the September issue of Podiatry Management for additional in-office tricks!
By Dianne Mitchell on 10/17/2013 9:04 AM
Molded a patient today in the office with two rather different feet. One cavovarus foot with a bunion deformity versus the contra-lateral foot that has a resting calcaneal stance position that is nearly perpendicular (slight eversion) to the ground without a bunion deformity.
When writing the orthotic prescription I like to make sure the lab understands that those two pretty different looking casts are correct and should be different from each other to yield two different orthotic devices. You can let the lab know this information on your prescription form both by writing the diagnoses at the top of the form and also marking the YES box to denote the asymmetry.
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 ...
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