How To Overcome Obstacles With Custom Orthoses

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How To Overcome Obstacles With Custom Orthoses
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Author(s): 
Guest Clinical Editor: David Levine, DPM, CPed

   Dr. Fritz notes his children have sports orthotics for basketball as well as orthoses that work well with school shoes. “I have given them options and, in return, they have given me an education and insight into pros and cons associated with different devices,” notes Dr. Fritz.

   

Q:

How does a shoe affect the function of an orthotic device?
   

A:

For Dr. Warkala, the shoe is the base of the support for the orthotic. As he says, excessively worn shoes create motions that are not desirable for the entire lower extremity as well as the orthotic. He recommends that patients keep a close eye on how their shoes are wearing and how their previously painful conditions are doing.

   “No matter how perfect an orthotic device is, it is only as good as the shoe in which it is placed,” asserts Dr. Levine. “In my opinion, shoes cannot be emphasized enough to our patients.”

   When writing orthotic prescriptions, Dr. Levine says DPMs often focus on degrees of varus, valgus and rearfoot post motion. However, he says this is all completely negated if the shoe is inappropriate or excessively worn. Dr. Levine emphasizes that the shoe needs to function with the foot, not against it, and that custom molded orthotic devices must fit the foot as desired. He adds that the orthoses also need to fit the shoes and he says this can sometimes be an issue depending upon the shoes patients select. Once the physician has addressed all of these factors, Dr. Levine says there is a very good chance of achieving the initial treatment goals.

   Dr. Fritz cites a patient with a severe hyperpronated foot type. He says the well intended and designed orthotic devices for such a patient may be lost if one places the device in a thin, soled “bobo” style sneaker. He says a straight, wide lasted sneaker (such as the New Balance 1122, Brooks Beast or Brooks Addiction) will provide a wider base of support for the orthotic and the patient’s foot. Dr. Fritz says the shoe last must conform to the patient’s foot, noting that straight lasted and curve lasted shoes can add to the orthotic benefit and to the overall fit.

   Patients with diabetes need extra depth shoes with accommodative features, according to Dr. Fritz. He says shoe rigidity, sole materials and counter materials may add to the function of the orthotic in controlling abnormal foot motion. Dr. Fritz encourages clinicians to take the heel height of the shoe into account with the fabrication of the orthotic device, especially when it comes to women’s fashion, in order to allow for proper seating and post elevation.

   Dr. Fritz emphasizes communication with patients about problems and expectations.

   “The discussion increases orthotic success in any practice. The days of fabricating an orthotic and handing it to the patient to deal with the shoe fit problems are over,” says Dr. Fritz. “The podiatrist who understands the interrelationships between shoes and orthotics will have more successful outcomes. Communication, education and understanding between the podiatrist and the patient are paramount for success.”

A Guide To Using Rigid Materials In Orthoses

   

Q:

Rohadur had been the material of choice many years ago. How often do you use a material that rigid now for your patients? If you do use rigid materials, how do you decide when to use them?
   

A:

In general, Dr. Levine says rigid devices will be successful in situations in which the patient has a lot of subtalar and midtarsal joint flexibility as rigidity provides more control of the foot. Materials such as Superglass, TL2100 and others provide the rigidity needed, according to Dr. Levine. He notes the contour of the orthotic device also contributes to rigidity. In a foot with a low arch, materials do not function as rigidly as in a high arched foot, explains Dr. Levine.

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