Adjusting Orthoses: Simple Solutions To Common Complaints
Troubleshooting orthoses is a vital skill when a patient returns with a complaint about the prescribed device. This author presents a guide to remediating common problems, including addressing arch irritation, how to add valgus extensions and keys to adjusting orthoses for shoe fit.
There are several skill sets that are required for an accomplished practitioner of orthotic therapy. Those include the ability to analyze a patient’s biomechanics in a manner that allows for the determination of proper mechanical therapy; the ability to write an orthosis prescription that addresses the patient’s issues; and the ability to take a proper cast or image of the foot. The final critical skill set, and the one that I will address in this article, is the ability to troubleshoot and adjust orthoses.
Over the past decades, there has been a decreased emphasis in podiatric schools and residencies on orthotic therapy education, including education focused on orthotic troubleshooting, modifications and adjustments. In addition, most podiatric continuing education programs poorly address orthotic therapy.
Practitioners who wish to advance their orthotic therapy practice have several options to enhance their skills. One of the most effective and easiest methods is to use orthotic labs that have podiatric consultants on staff. Look for labs that have a podiatrist available for consultation every business day and then use them. At least initially, request a consult on every patient for whom you prescribe orthoses. Not only will you likely write a more effective prescription but you will be learning at the same time. The best labs will have consultants who closely follow the literature pertaining to orthotic therapy. Also, look for labs that encourage you to send pictures and videos of your patients to the consultants.
Other methods to enhance skills include visiting the offices of podiatrists who specialize in orthotic therapy and, if you can find them, attending seminars that incorporate an orthotic therapy component.
What Basic Troubleshooting Skills Should You Have?
There are a few basic troubleshooting skills that every orthotic practitioner should be able to easily perform in the office. These include adjusting for arch height in cases of arch irritation or when the patient feels the orthosis is pushing them too far laterally; adding covers and cushioning; adding modifications such as metatarsal pads and heel lifts; and adding forefoot extensions such as reverse Morton’s extensions.
In order to perform these adjustments, there are a few basic pieces of equipment and materials that every orthotic practitioner should have in the office. This includes a grinder and a method to polish orthoses after grinding. A gluing station, preferably with a hood, is necessary. Practitioners will also need materials to add cushion and accommodation. Most offices should be able to get by with the following accommodation materials:
• Korex for Morton’s/reverse Morton’s extensions, varus/valgus extensions, aperture
• Poron for cushioning
• Self stick metatarsal pads
• Self stick wedges
Talk to the podiatric consultants at your orthotic lab about the most useful equipment and materials to use in the office for orthotic modifications. If you have the option, a visit to an orthotic lab can provide a useful lesson on orthotic adjustments.