Pertinent Insights On OTC Orthoses And Orthotic Modifications

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Prefabricated orthoses can provide improved support and other key benefits for patients with conditions such as plantar fasciitis. In addition to sharing their insights on OTC devices, these expert panelists provide pearls from their experience on common orthotic modifications that can have an impact.

Q:

Do OTC orthotics play a role in your practice? If so, how much and what do you look for in an OTC device?

A:

All three panelists use OTC devices. Ray Fritz, DPM, uses OTC arch supports at the time of the first visit if indicated. In addition to treatment for symptoms and immediate relief, patients often need additional support, according to Dr. Fritz. Lawrence Huppin, DPM, regularly uses prefabricated orthoses but notes that the most desirable features of a prefab device vary depending on the patient’s pathology.

   To treat common conditions like plantar fasciitis, metatarsalgia and first metatarsophalangeal joint complaints, Dr. Huppin says a prefab orthotic should have enough rigidity to resist deformation, a relatively close contour to the arch of the foot, a deep heel cup, a medial skive, a bit of forefoot valgus correction and a rearfoot post. He calls this a “functional prefab orthosis” and says it is the type of adult prefab device he uses most in his office.

   Similarly, Dr. Fritz uses OTC devices for those with plantar fasciitis and notes these devices help the patient realize the benefit of support. He adds that this helps his patients better appreciate the value of a custom orthotic, which may be the next treatment option. Dr. Fritz can also evaluate patient adherence and tolerance for a possible custom device based on the behavior of the patient while he or she wears an OTC device.

   Dr. Fritz uses four to five different brands that vary in length and bulk, and notes that some are better for different foot types. Contours, arch height, bulk and cost vary. His patients can try two or three different types, and he encourages them to select a device based on fit and comfort. His large office staff can assist in selecting devices and fitting the patient. Dr. Fritz cites the importance of having products readily available for patients along with appropriate assistance and instruction. As his patients do not have the time to get out and pick up recommended products, he cites the importance of starting fittings immediately.

   When it comes to children, Dr. Huppin says the most common condition he treats with prefabs is pediatric pes planus. In these cases, Dr. Huppin selects a device that has a deep heel cup, medial flange, medial skive and a rearfoot post. He often incorporates the same features into custom orthoses for pediatric flatfoot.

   Ronald Valmassy, DPM, calls OTC orthoses “extremely helpful” in potentially improving the patient’s gait or symptomatology. He typically uses an OTC support with additional forefoot or rearfoot varus or valgus posting, which he applies in the office.

Q:

What common orthotic modifications have you found to be the most effective?

A:

Both Drs. Valmassy and Fritz will use plantar fascia grooves. As Dr. Valmassy notes, a plantar fascial groove ranging from 2 to 6 mm in depth can be beneficial for patients who have symptomatology in the medial slip of the plantar fascial band.

   Dr. Fritz says another use for a groove for a tight plantar fascial band is for patients who say the orthotic is too hard and irritates the arch. As he explains, this is sometimes the case in the high arch foot type with inflammation along the central band of the plantar fascia.

    “Patients have come to my office with several sets of functional orthotics stating that they are too hard and they cause pain,” notes Dr. Fritz. “The easy way out is to make a composite device.”

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