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Oct 27

Written by: Cherri Choate, DPM
10/27/2010

Off-loading and cushioning various pathologies on the plantar foot can be challenging. A variety of options exist that may offer the practitioner ways to mix and match them to best address the individual patient's needs. Off-loading, cushioning and accommodating are common goals, but may be addressed differently. The three areas to be considered are the orthotic plate, specials additions and topcovers. 
    
Orthotic plate

  • Sweet spots- indentations within the plate that are usually filled with a soft material such as Poron
Note:  if you do not want this indentation filled, make a note on the prescription form
  •   Plantar fascial groove- a groove shaped indentation that matches the location of one of the band of the plantar fascia
  Note:  it is important to mark the groove area on the cast to improve odds of matching the location 
 
  • Soft tissue expansion-  if there is a more diffuse area or mass, then you may need to ask the lab to increase the soft tissue expansion or fill in that area so the plate does not conform tightly
Note:  this is common in and around the heel area

 
 Special additions

  •  Aperture or Horseshoe Pads-  specially shaped pads added to the top of the plate, usually made of poron
 Note:  the location and shape of this need to be clearly marked on the cast and prescription form
  •  Heel pad- a soft pad added to the heel cup, usually made of poron 
 Note:  any soft pad can be added to any location on the plate, but the shape and location need to be specific 
 

Topcovers

  • Soft medial flange- an extension of the medial arch area of the topcover that is shaped like a medial flange; it adds padding above the level of the orthotic plate and can act as a transition within the shoe

  • Topcover layers-  adding layers together on top of the orthotic can offer padding without risk of the patient feeling edges of apertures
            Note:  adding layers can lead to issues with shoe fit as the device can become quite bulky

The next time you need to off-load or cushion, consider the options above to imporve your orthotic success.
            
           

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