Designed originally by Dr Jane Denton, it provides incredible support to the lateral column
The Denton Modification is a simple, yet powerful, lateral arch fill. It goes from the extrinsic rearfoot post distally to the end of the plastic under the 4th and 5th metatarsals. It is utilized with any orthotic devices prescribed with varus tilts of some sort, and of course for any patient with any supination tendencies. It is called termed "Lateral Frame Filler". This is a phrase that laboratories may understand better.
Back in the day, perhaps 25 years ago, when I was testing the limits of inversion with the Inverted Orthotic Technique, I was always going too far. I was making pronators (with all their problems) into supinators (with a whole new set of problems). Of course, this was not good, so I struggled daily in my office adjusting out this over correction of pronation. Since the varus was intrinsic to the plastic, I had to use other methods like narrowing of the medial width, inskiving the medial heel post, lowering the medial heel cup, or adding temporary padding along the lateral heel cup (a temporary lateral Kirby skive of sorts). Dr. Denton, my partner of 37 years, introduced me to this lateral arch fill, and my problem was largely solved. Today, the Denton Modification can be prescribed for all supinators, or the myriad of patients I call my medial/lateral instability patients. These are patients that technically pronate too much, but have some lateral column instability issues produced (for example) by lateral ankle ligament injuries, weak peroneals, activities requiring them to be excessively on the lateral side of their feet, high degrees of tibial varum or genu varum or subtalar varus. The Denton Modification fills in the space under the lateral column, but does not act as a valgus wedge to pronate. It blocks supination tendencies but does not pronate the subtalar joint.
The Denton Modification is meant to support the lateral side of the foot, blocking lateral instability, but not causing a valgus wedge effect of pronation.
Here the plantar surface is seen under the 4th and 5th metatarsals.
