Pertinent Roundtable Insights On Indications For Orthotic Management
Choosing the most effective type of orthotic device for a given condition can be tricky as one must consider factors that include materials, potential modifications and cost.
Accordingly, the panelists discuss possible indications for OTC orthoses, conditions that are particularly challenging to treat with orthotics and the role of functional foot orthoses in managing bunion deformities.
Q: Are all prefabricated, over-the-counter (OTC) foot support systems essentially the same? Are there unique characteristics of any of the devices which makes them better suited for certain foot problems?
A: All three panelists note the variety of OTC orthoses available. Kevin Kirby, DPM, notes that OTC orthoses are made from a variety of materials, have a large range of medial arch height and heel cup contours, and have considerable variation in cushioning, shape and shoe fit.
Dr. Kirby notes that OTC orthoses with increased medial arch height would be more appropriate for patients who have symptoms such as posterior tibial tendonitis/dysfunction related to increased subtalar joint pronation moments. He says OTC orthoses with increased heel cushioning may provide some relief from symptoms for patients who have plantar heel pain due to plantar fat pad atrophy.
One should base the recommendation for an OTC orthosis on the shape of the patient’s foot, the biomechanical etiology of the symptoms, the activities and the shoes in which the patient intends to wear the orthoses, suggests Dr. Kirby.
Michael Burns, DPM, says most prefab orthoses are made of soft material and some are composed of a material that maintains its shape independent of the shape of the shoe. He notes that most OTC orthoses are designed to cushion the foot but not stabilize it. If cushioning is the main goal, Dr. Burns notes a soft device may be adequate but he tends to use firmer (shank independent devices) orthoses to increase stability.
“Unlike custom-molded foot orthoses, OTC orthoses are not specifically designed for each foot’s unique three-dimensional plantar contours and they are not specifically designed to reduce the pathological internal and external forces that are causing a patient’s pain,” cautions Dr. Kirby.
In addition, Dr. Kirby says OTC orthoses are made of softer, less durable materials than most custom-molded foot orthoses. Accordingly, Dr. Kirby points out that OTC orthoses must be replaced and remodified every six months on average whereas more durable custom-molded foot orthoses will last an average of over 10 years. The ability to modify an OTC for a specific condition is important, according to Richard Blake, DPM. He prefers the YourSole device. Dr. Blake cites the device’s stability, deep heel cups, stable medial and lateral arches, and the fact that the orthosis is heat moldable and full length. Furthermore, he notes that the arch area is deep enough for necessary reinforcements and one can easily grind the material for accommodations.
Q: When should one utilize a prefabricated device?