Most often the process of creating a highly effective functional foot orthosis is straightforward if performed properly by an experienced and knowledgeable practitioner. However, the end product may not initially meet the standard requirements for correction of deformity or patient satisfaction. Following a minimum break in period for a new pair of orthotic devices, adjustments may be necessary to achieve the intended goals of treatment. Rather than return the devices to the lab for adjustment, I suggest some simple remedies that can be performed in the clinic, on the spot.
High volume, biomechanics based practices should be equipped with a work area dedicated to adjusting and modifying orthotic devices, with trained staff, including a grinder, heat gun and exhaust fan. A scaled down version of this work area can be created simply and relatively inexpensively if supplied correctly.
Many common pre-cut pads used to modify orthotic devices are available to be stocked and ready to use within the office. They are available either in a dense felt material or polyurethane foam (PPT/Poron). Keeping on hand a supply of these various pads facilitates quick and easy orthotic adjustments. The pads include adhesive backing in most cases, however I recommend keeping a tube of cement (Barge) handy to reinforce adherence of the pads and keep them from shifting during use. Felt and polyurethane is also available in sheets, in a variety of thicknesses to facilitate creating custom accommodations as needed. The following listing of pads should suffice in supplying a mini orthotic workshop.
- Heel lift pads, ⅛” and ¼”
- Heel wedges, left and right, small, medium and large
- Arch pads, 1.5 mm, 3mm, 4.5 mm
- Callus pads, U shaped and oval, ⅛” and ¼”
- Met pads 2-4, 1.5 mm, 3mm, 4.5 mm, 6 mm
- Dancer’s pads, left and right
Examples of these pads are available on the KevinRoot Medical website under “custom modifications”. To further equip your orthotic workshop, I would suggest keeping on hand ⅛” and ¼” latex cork to create temporary posts and lifts. 3mm Neoprene, vinyl and leather and plastazote to repair/replace top covers. Materials are available through various suppliers.
Next time your patient complains of the heel cup being too hard, or you determine the arch height of the orthotic device is too low, consider making your own adjustments in the office. These adjustments can be temporary, as a trial, with follow up return of the devices to the lab for a more professional and permanent solution, or they can be permanent if desired.
