Current Insights On Orthoses For Achilles Tendinosis, Plantar Fasciitis And Posterior Insertional Spurs

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Guest Clinical Editor: James Clough, DPM

   Dr. Clough typically sees a 70 percent decrease in pain in about three weeks with plantar fascia stretches, ice and insoles. With insoles, OTC devices are his preferred choice unless there is significant rearfoot eversion. He uses a P4 Wedge to control the first ray and allow the foot to transition from a loosely packed position at heel contact to a closed packed position at toe off.

   If this transition cannot occur and the foot stays in the loosely packed position during propulsion, Dr. Clough points out there is pathologic pressure on the plantar fascia, abductor hallucis and flexor digitorum brevis, and subsequent pain in the heel. He notes the stable higher arched foot with the foot in the closed packed position provides relief of the strain of the plantar fascia and subsequent pain reduction.

   “So long as the first ray functions and I have a moderate contour of the arch to the foot, I see tremendous results,” says Dr. Clough. “In rare, very difficult cases, an orthotic with minimal fill is required to get a good contour of the device to the foot structure along with a P4 Wedge.”

   Dr. Williams will use a metatarsal pad for most patients with plantar fasciitis along with a kinetic wedge modification. When necessary, he will use a forefoot valgus post for those with large amounts of lateral column dorsiflexion excursion.

   Dr. Clough is in private practice in Great Falls, Mt. He is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. Dr. Clough is the inventor of the Cluffy Wedge (P4 Wedge) and the President of the Cluffy Institute.

   Dr. Horsley is an Assistant Professor and the Department Chair of Podiatric Surgery and Applied Biomechanics at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in Chicago. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Past President of the American Academy of Podiatric Sports Medicine, and a Fellow of the American College of Foot and Ankle Surgeons. Dr. Richie is in private practice in Seal Beach, Calif. He also writes a monthly blog for Podiatry Today at .

   Dr. Williams is in private practice in Merrillville, Ind. He is a Diplomate of the American Board of Podiatric Surgery. Dr. Williams is also a Past President and Fellow of the American Academy of Podiatric Sports Medicine.

1. Dananberg HJ, Shearstone J, Guillano M. Manipulation method for the treatment of ankle equinus. J Am Podiatr Med Assoc. 2000; 0(8):385-9.

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