Pertinent Roundtable Insights On Indications For Orthotic Management

Author(s): 
Guest Clinical Editor: Ronald Valmassy, DPM

A: Dr. Blake calls functional orthotics a “double-edged sword” when it comes to bunions. On the positive side, he notes they can shift weight laterally and proximally, unloading the first metatarsal head. On the negative side, he says functional orthoses can crowd shoes and place a dorsiflexory force on the first metatarsal, limiting propulsion and further jamming the first ray.
Sometimes, functional devices act solely as an attachment for a reverse Morton’s extension. If the foot continues to pronate on a plastic orthotic, Dr. Blake says the first ray gets jammed. In cases like these, he says full pronation support is better than 70 or 80 percent support.
When it comes to reducing joint pain associated with either hallux abducto valgus (HAV) or functional hallux limitus, Dr. Burns cites the efficacy of functional orthotic control. When the first ray is flexible, he feels it is helpful to plantarflex the ray a bit when taking the impression. As he notes, OTC supports are often not adequate and if the symptoms persist, he wants the patient to try custom functional control before deciding that orthotic control will not be adequate treatment.
“This is always a bit of a dilemma when suggesting a patient try an OTC support,” says Dr. Burns. “If the response is not adequate, I always wonder if a custom device would relieve the patient’s symptoms and I am hesitant to recommend surgical intervention until the patient has given it a try.”
As Dr. Kirby notes, functional foot orthoses may help slow down the progression of bunion deformities if the first intermetatarsal angle is not already too large. However, he says when the first intermetatarsal angle is too large, even a well designed foot orthosis will have little effect in slowing down the progression of a bunion deformity.
“I have never seen a functional foot orthosis reduce the severity of a bunion deformity,” maintains Dr. Kirby.

Q: Are functional foot orthoses more beneficial before or after corrective surgery for bunion deformities?

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