How To Overcome Obstacles With Custom Orthoses

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

   Depending on the rigidity needed, Dr. Levine says polypropylene is one of many materials that can work well. He adds that different thicknesses of polypropylene indicate different rigidities. Although there are conflicting findings in the literature, Dr. Fritz says many feel rigid materials including polypropylene are superior for control. He uses a rigid component or at least a semi-rigid component in 75 percent of all the orthotics he fabricates in his office. The semi-rigid component often can be a thin polypropylene shell that will help eliminate deformation, according to Dr. Fritz.

   Dr. Warkala uses rigid materials like carbon fiber composite materials for about 5 to 10 percent of his patients. He bases the decision to use rigid materials on biomechanical exams as well as the types of shoes in which the orthotics will be worn.

   Dr. Fritz cites other materials such as the graphite materials provide excellent support. Dr. Fritz uses graphite rigid materials less than 40 percent of the time as an exclusive orthotic material. He frequently selects these materials for biomechanical control and notes they fit well in fashionable shoes. Dr. Fritz says the two main reasons for the exclusive use of rigid materials are for functional control of foot deformities and that rigid materials take up very little space in a shoe. Dr. Fritz notes patients will often choose combination materials and cushioned top covers for overall comfort and specific sports activities while some patients prefer full-length orthotics and an extra element of cushioning. He selects orthotics based on the symptom complex and pathology, foot type, sports activity and shoe style. Ultimately though, Dr. Fritz says the patient chooses the orthotic based on performance and comfort.

Dr. Levine is in private practice and is also the director and owner of Physician’s Footwear, an accredited pedorthic facility, in Frederick, Md.

Dr. Fritz practices at Allentown Family Foot Care in Allentown, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Warkala practices in Sewell, N.J. He is certified in primary podiatric medicine by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.

For related articles, see “Secrets To Fabricating Custom Orthotics” in the June 2004 issue of Podiatry Today or “Key Insights On Orthotic Materials” in the September 2003 issue.

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