I had a patient come in recently for dispensing of new orthotic devices. He had worn orthoses for years and was starting to get a return of his plantar fasciitis symptoms. Another podiatrist provided the previous orthoses.
The older orthoses were gapping quite significantly from his arch and were also about a centimeter narrower than his foot. The new devices were the full width of his foot and were made with a minimum fill and 2 degrees of inversion. This resulted in orthoses that conformed very closely to the arch of the foot. In addition, when I took the cast of the foot, the first ray was plantarflexed to the end of its range of motion, which also enhances arch height in the resultant orthosis.
In summary, the new orthoses had a much higher arch than the old pair.
When the patient first wore the orthoses, he complained that he was not getting enough support from the new orthoses. He complained that the arch did not feel high enough and felt lower than his old devices.
I had him sit in the chair, placed his foot in neutral position with the first ray plantarflexed and held the old orthoses up to his arch. I showed him how the old orthoses gapped significantly from the arch. I then took his new pair and showed how they conform extremely tight to the arch.
I explained to him that the reason the new devices felt more comfortable is that they were wider and that we were spreading the force over a much larger surface area.
This patient demonstrated that wider orthoses allow you to prescribe a more supportive orthosis that conforms closely to the arch of the foot, and yet are much less likely to cause arch irritation than narrower orthoses that have a lower arch.
Editor’s note: This blog was originally published at http://prolaborthotics.com/Default.aspx?tabid=90&EntryID=427  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .