I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had a prominent styloid process.
When considering an orthosis for a patient with a prominent styloid process, you have to determine where the styloid needs accommodation. To make this decision, you must first determine whether the styloid is prominent laterally, plantarly or both. Lateral and plantar styloid prominences require different accommodation.
For a laterally prominent styloid, ask your lab to add extra lateral expansion to the orthosis at the styloid so the orthosis will extend laterally under the entire styloid process. This prevents the lateral edge of the orthosis from irritating the foot at the styloid.
If the styloid is prominent plantarly, use a sweet spot accommodation. A sweet spot is a pocket or indentation built into the orthotic shell. Subsequently, this indentation is filled with Poron for cushion. This is an effective accommodation for any plantar prominence.
If the styloid is prominent both laterally and plantarly, then add extra expansion at the styloid along with a sweet spot.
A prominent styloid may need further orthotic modification in that area after dispensing. To make modifications simpler, prescribe the top cover to be glued on the heel only. This provides easy access to the mid-portion of the orthosis to further modify as necessary.
Editor’s note: This blog was originally published at http://www.prolaborthotics.com/Default.aspx?tabid=90&EntryID=447  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .