Debating Current Issues In Orthotic Management

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Online Exclusive: When It Is Necessary To Recommend Multiple Types Of Orthoses

Q: Do you recommend multiple types of foot orthoses for patients and why?

A: For the most part, Bruce Williams, DPM, uses EVA devices but will also use polypropylene devices for more rigid control or for shoes with less available space. He does not make orthoses for specific sports but treats specific problems with a specific prescription or modification. He uses ankle foot orthoses (AFOs) for extra transverse plane control.

The recommended orthotic usually depends on the patient, the activities the patient pursues and the shoes he or she will use, according to Charles Mutschler, DPM. As an example, he says an Iron Man athlete will need different devices in running shoes versus cycling shoegear.

“I have found that more and more patients want to have the convenience of not having to swap their orthoses from one shoe to another,” says Kevin Kirby, DPM. To that end, he suggests that such patients get a second pair of orthoses.

Furthermore, Dr. Kirby notes that many of his female patients like to wear sandals during the summer so he recommends they purchase sandals with a removable insole. He will subsequently send these to the orthotic lab to have a second pair of orthoses tailored to the sandals.

Since many athletes will need multiple pairs of orthoses for their sports shoes/boots, Dr. Kirby will design orthoses to fit as many shoes as possible as long as the devices do not compromise the function or comfort of the orthosis inside the shoe.

Dr. Kirby adds that many patients, especially his more stylish female patients, need a special orthosis just for their

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Dr. Williams is a Diplomate of the American Board of Podiatric Surgery. He is a Fellow and the current President of the American Academy of Podiatric Sports Medicine. Dr. Williams practices in Merrillville, Ind.

Dr. DeHeer is a Fellow of the American College of Foot and Ankle Surgeons, and is a Diplomate of the American Board of Podiatric Surgery. He is also a team podiatrist for the Indiana Pacers and the Indiana Fever. Dr. DeHeer is in private practice with various offices in Indianapolis.
For further reading, see the exclusive online sidebar, “When It Is Necessary To Recommend Multiple Types Of Orthoses,” at www.podiatrytoday.com.

To access the Podiatry Today archives or get information on reprints, visit www.podiatrytoday.com.




References:

1. Evans AM. The flatfooted child — to treat or not to treat: what is the clinician to do? JAPMA 98(5):386-393, 2008.
2. Davis IS, Zifchock RA, DeLeo AT. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. JAPMA 98(5):394-403, 2008.

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