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Mar 1

Written by: Larry Huppin, DPM
3/1/2010 3:07 PM

I had three new patients today who presented with relatively new foot orthoses received elsewhere. All were continuing to have pain and had questions on whether the orthoses were appropriate for their feet. Two of the patients had plantar fasciitis and the other metatarsalgia.

Each of the three orthoses were gapping significantly from the arch of the feet and one was flexible enough that it collapsed entirely with finger pressure.

Significant literature supports the use of “total contact orthoses” that conform closely to the arch of the foot to both reduce tension on the plantar fasica and to transfer pressure off of the forefoot. None of these orthoses were conforming to the arch of their respective feet.

This is sometimes a difficult situation. The patient has already paid a lot of money for custom orthoses and now you want to recommend a new device. I find, however, if this is explained correctly to the patient they are almost always willing to do whatever is in their best interest.

First, demonstrate to the patient how an orthosis should conform to their foot (it helps to have high-arched sample orthoses in each treatment room) and then demonstrate how their current pair gaps from the arch of their foot.

Let the patient know that they have three choices.
1. You can modify the current orthoses. I explain that this is not an optimum solution, but it may help. I make sure that they understand that I will not guarantee comfort and do not know how long the modifications will last.
2. They can return to their other practitioner and see if they will redo the orthoses
3. We can make them a new pair. I will guarantee that these will conform as they should to the arch and also we guarantee comfort.

With these choices, you are simply providing the patient with the information they need to make an educated decision. I find that once the patient understands why the first pair isn’t working as well as they should and how the orthoses I make them will work better, they usually choose to have me make a new pair.


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