I recently saw a patient who came back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis.
When I had her stand on the devices, I noted that she had quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup. I always try to avoid this problem by using calipers to measure the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and found that in this situation, I had forgotten to take the measurement and send it to the lab. By measuring the weightbearing fat pad of the heel, I almost always avoid this problem.
Keep in mind that the orthotic laboratory has no way to determine how much soft tissue expansion there is at the heel when it receives a non-weightbearing cast. That is why it is important to measure the width of the patient’s heel in stance as part of an evaluation for orthotics. You can find more information how to do that and order a caliper at http://prolaborthotics.com/Default.aspx?tabid=90&EntryID=157  .
Over the years, I have learned that there is essentially no way to adjust a heel cup that is too narrow and causing irritation. You cannot grind the orthosis to make it wider and you cannot really heat adjust the device to make it wider in the heel cup. In this situation, one just needs to remake the orthosis.
I measured the width of her fat pad in stance and sent in a prescription for a new orthosis. She picked it up and has done very well since then.
As this was my fault for not sending the measurement to the lab, it was my responsibility to pay for the second orthosis. Had I sent the measurement and the lab not followed those instructions, then it would be the lab’s responsibility to replace that orthosis. This is one of the reasons I think it is in both the patient’s and the practitioner’s best interest to take this measurement on all patients.
Editor’s note: This blog was originally published at http://www.prolaborthotics.com/Blog/tabid/90/EntryID/449/Default.aspx  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .