Essential Pearls On Effective Orthotic Modifications

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Author(s): 
Guest Clinical Editor: Patrick DeHeer, DPM

   A: Dr. Williams usually places such patients in a Cam Walker or surgical shoe. If patients cannot wear such devices, he will utilize a metatarsal pad of soft material and an accommodation under the head of the affected metatarsal. Although he feels it is probably better to give total contact and support, Dr. Williams notes a lack of published data on this approach.

   For a patient with a plantarflexed metatarsal head, Dr. Mutschler prefers offloading the area via accommodation.

   As Dr. Kirby notes, metatarsal stress fractures result from excessive bending of the metatarsals during weightbearing activities. He says such fractures will nearly always occur at the most narrow portion of the metatarsal shaft, the metatarsal neck, where the bending stresses within the bone are at their greatest magnitude.

   Therefore, Dr. Kirby notes the best foot orthoses to heal or prevent metatarsal stress fractures are constructed with a metatarsal pad or other similar modification. The metatarsal pad should be directly plantar to the fracture site. He says this placement will decrease the bending moments on the metatarsal shaft by reducing the ground reaction force on the metatarsal head and increasing the ground reaction force on the plantar metatarsal neck.

Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Ca. He is in private practice in Sacramento, Ca.

Dr. Mutschler practices at Advanced Footcare in Miami, Fla. He is a member of the American Academy of Podiatric Sports Medicine and is board certified by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. Dr. Mutschler is the team podiatrist for St. Thomas University in Miami.

Dr. Williams is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified by the American Board of Podiatric Surgery. He is a Fellow and the current Secretary/Treasurer of the American Academy of Podiatric Sports Medicine. Dr. Williams practices in Merrilville, 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.

Editor’s note: For further reading, see “A Closer Look At Orthotic Technologies And Modifications” in the October 2005 issue of Podiatry Today.

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