I saw a patient a few weeks ago who had come back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. When I had her stand on the devices, I noted that she had a quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup.

I always try to avoid this problem by measuring the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and I found that in this situation I had forgotten to take the measurement and send it to the lab. By measuring it, I almost always avoid this problem.

It has to be kept in mind that the laboratory has no way to determine how much soft tissue expansion there is at the heel when they receive a non-weightbearing cast. That is why we consider it very important to measure the width of the patient’s heel in stance as part of an evaluation for orthotics.

Over the years, I have learned that if the heel cup is too narrow and causing irritation, there is essentially no way to adjust that. You cannot grind the orthosis to make it wider and you cannot really heat adjust the device to make it wider in the heel cup. In this situation, this orthosis just needs to be remade.

I measured the width of her fat pad in stance and sent in a prescription for a new orthosis. She picked that up last week and she has done very well.

Because this was my fault for not sending the measurement to the lab, it was my responsibility to pay for the second orthosis. Had I sent the measurement and the lab had not followed those instructions then it would be the labs responsibility to replace that orthosis. This is one of the reasons we think it is in both the patient’s best interest and practitioner’s best interest to take this measurement on all patients.

ProLab takes a scientific approach with our orthoses by integrating evidence-based medicine into orthotic therapy. Our team of Medical Consultants regularly evaluates the medical literature pertaining to orthotic therapy and biomechanics. ProLab clients are encouraged to contact a medical consultant whenever they have questions about an orthotic prescription.

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