Patients present with heels that should be held inverted, not vertical like the Gold Standard (Type A), or just less everted (like Type B).
To summarize the last few weeks, the posts are about defining these 6 orthotic corrections. Today will be Type D, and next week Type C, to finish out the six basic types of correction. Here is the 6 types:
Type A: Gold Standard (for most getting the heel vertical by setting the heel vertical)
Type B: Designed to make an everted heel less everted
Type C: Designed to make an everted heel markedly less everted
Type D: Designed when the heel should be inverted
Type E: Designed to make an inverted heel less inverted
Type F: Designed to make an inverted heel markedly less inverted
Most of the time when we see an inverted heel, we want to push it towards vertical.
And, it is rare to see an inverted heel, that does not give some symptoms from the patient of rolling to the outside of their foot. And, better yet, when you add a temporary lateral heel skive, or Denton modification, or valgus wedge in the office, they feel so much more stable. These are your Type E and F patients. You need to push them from inverted to less inverted, and more stable.
So who is this patient that needs Type D, needs to be held inverted with no intention to push them towards vertical. What is the main reason to set the heel inverted at the position you want them at? Even my severe pronators, where I prescribe a 35 degree inverted orthotic device, or a 5 degree inverted device with 4 mm medial Kirby skive, I am really only trying to get them less everted.
Type D is needed in a patient that either can not get their heel to vertical, or heel verticality would be maximally pronated. Type D is the first orthotic device I have mentioned that you really must measure RCSP.
These heels are easy, next week I will go over the steps for bisecting the heel, and measuring RCSP. Let's discover who needs Type D.
