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Jul 30

Written by: Larry Huppin, DPM
7/30/2009 1:16 PM

A client called today with a question regarding a patient who is experiencing painful callus on the lateral heel secondary to wearing her orthoses.  The orthoses are otherwise working well.

There are three reasons that patients may develop lateral heel edge callus from orthotics.  To correct this problem you must first diagnose which of these is causing the issue.

Cause #1Orthotic heel cup is simply too narrow for the foot. 
Diagnosis:  Place the pateint on the orthosis. Center the patient's heel in the heel cup.   If the lateral edge of the heel cup is placing excessvie pressure on the heel, then the heel cup is simply too narrow
Correction:  You can try lowering the heel cup, but it is likely that this device will have to be remade.  Mark the area on the heel cup and send the orthosis back to us with instructions on how much wider (in mm) the heel cup needs to be.  
Prevention:  To prevent this problem in the future, take a weight-bearing caliper measurement of the heel and send that to us on the prescription form. 

Cause #2:  Orthosis is not sliding all the way back in the shoe
Diagnosis:  Place orthosis in shoe and confirm that the posterior orthosis is tight against the posterior heel counter. 
Correction:   Have patient get a larger shoe AND / OR lower heel cup and increase bevel on post  We strongly recommend that you have a grinder in your office that will allow you to make adjustments yourself.  If you don't, send it back to us for adjustment.  There will be a charge for the adjustment.  

Cause #3:  Patient's heel is sliding laterally into the lateral wall of the heel cup
Diagnosis:  In the absense of the above causes, and in the presence of the heel sliding lateral when you have the patient stand on the orthotic, this is the likely cause.  
Correction:   You must reverese the slide by applying a counter force.  You can try adding a valgus wedge to the bottom of the heel post.  Try it with felt first.  If that works, use firm EVA.   Also, a valgus forefoot extension often helps.  

ProLab's medical consultants are experts at troubleshooting orthotic problems.   ProLab clients have exclusive access to a medical consultant every weekday at no cost.   

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