A ProLab client called recently for a consult regarding a patient who is an 11-year-old soccer player and experiencing pain at the styloid process bilateral. The child has a metatarsus adductus foot type and a styloid process that is prominent both plantarly and laterally. Our goal for treatment is to decrease pressure on the styloid process and tension on the peroneus brevis.

I suggested a vacuum formed polypropylene orthoses with a minimal cast fill. Vacuum formed polypropylene was suggested because we will have the ability to add a sweet spot for the styloid. Minimum fill was selected because it will most effectively transfer pressure from the lateral foot to the medial foot.

Along with the sweet spot for the styloid process we also requested additional lateral expansion to be added to the positive cast at the styloid process. This will result in a slightly wider orthoses at the styloid and allow it to better accommodate the enlarged styloid process.

The patient’s soccer shoes were sent to the lab, so heel cup height and the width of the orthosis will be maximized. In other words, they will be made to be as large as possible and still fit in the soccer cleat.

Finally, we added a full length EVA top cover. The top cover is to be glued on the heel of the orthosis only, so that the sweet spot for the styloid can be easily modified without having to pull off the top cover. Once we are sure the orthosis is comfortable, the top cover can be glued down.

ProLab clients are encouraged to call one of her medical consultants with any questions regarding orthotic prescriptions for their patients.