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Saturday, December 28, 2019

Arch Adjustments on Custom Orthotic Devices

Arch Adjustments are Necessary for Good Orthotic Devices

     My patient yesterday needed several arch adjustments to her custom orthotic devices which took me 30 minutes (between adjustments, gait evaluation, and patient's feedback), and another patient needed adjustments to her arch for the third visit in a row. Why is this needed after I took the appropriate impression cast and wrote a great prescription (in my humble estimation)? I will focus on the medial arch in this post. It is by far the most talked about aspect of any orthotic device, yet sometimes the least important in terms of what an orthotic device is supposed to do. 
     I always tell my patients when they receive their new orthosis that there is a period of breaking in as the body gets used to the new positioning. Even if a patient has been a long time orthotic wearer, a new orthotic device should always be treated with this respect. It will make changes, hopefully all positive, but those changes may pull and push and compress and stretch tissues that complain some.
That being said, the breaking in process should never be painful. The 0-2 range of mild ache or discomfort is fine. If there is pain, the patient is advised not to wear the device until I have time to analyze why.
     The 4 typical reasons that patients need their medial arch adjusted are:
  1. Nerve sensitivity from low back, tarsal tunnel, or another cause. These patients do not want any orthotic pressure on the sensitive arch structures. They need nerve treatment much more than the mechanical treatment of arch support.
  2. Plantar fascial bow stringing at heel lift. A small groove needs to be placed along the plantar prominent medial slip of the plantar fascia.
  3. When the pronation is still excessive with the orthotic devices, so the medial column collapses into the medial arch causing pain. This is not related to fit as the orthotic device can seem like a perfect fit onto the relaxed foot. When the patient walks or runs, you can see that the foot still pronates excessively on the device. Temporarily you must lower the arch, unless it is simply that they need more stable shoes. Permanently, if the powerful pronation force needs more control, a higher arch with or without an inversion force at the heel is needed. I know, to the patient, it is counter intuitive.
  4. The arch fill makes it too rigid. Many labs make orthotic devices where the medial arch is filled from the ground up with material. It can be rather soft material but this fill removes the flex of the arch. This flex can be crucial for comfort. When this seems to be the case, I remove half of the arch fill at first telling the patient that I can always put it back. 

     
     

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.