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Orthotic Adjustment Guide

Topics

Arch Pain

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  1. Transition between heel and arch may be too abrupt- lower the transition between arch and heel.
  2. Arch contour may be too high causing pressure in patients arch- lower the apex of the arch
  3. Arch contour may be too low allowing patient to pronate onto arch of device- raise the arch.
  4. Shell length may be too long which lifts MHs up and forces patients arch down onto arch of device. Shorten the distal edge of the shell.
  5. There may be too much varus posting on the device- lower varus posting in FF and/or RF.
  6. Pitch of rearfoot post may be too great causing the orthotic to seem too high in the arch. In this case, lower the pitch of the rearfoot post so that the post sits flatter (less of an angle from back to front).

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Medial Ankle/Knee Pain

Usually a patient will experience medial ankle or knee pain when the devices are still allowing them to pronate. To correct this, increase the varus posting in the forefoot and/or rearfoot.

Lateral Ankle/Knee Pain

Usually a patient will experience lateral ankle or knee pain when the devices are turning the feet to far outward (supination). To correct this, decrease the varus Posting in the forefoot and/or rearfoot.

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Metahead Pain

  1. Shell length may be too long which pushes up on the MHs and does not allow them to bend. In this case, shorten the shell.
  2. Patient may have a neuroma. In this case, add a met pad at the innerspace in which the pain is occurring.
  3. Patient may have metatarsalgia. In this case add a met pad to lift up and float the painful metaheads.
  4. Transition at distal edge may be too abrupt. In this case, lower the transition at the distal edge.
  5. The distal edge is painful to patients MHs. In this case, the shell may be too long and should be shortened. The patient may also have very sensitive feet which padding may help, or possibly a sulcus length extension.
  6. The patient feels a lump where the extrinsic forefoot post is. In this case, lower the extrinsic forefoot post, or make transition less abrupt.

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Heel Pain

  1. The heel cup may be pinching or digging into the heel- remake the orthotic wider in the heel, possibly with a deeper heel.
  2. Patient may have heel spurs- add a heel spur accommodation.
  3. Patient may still be experiencing plantar fascial pain where it meets the calcaneus. In this case raise the arch to better support the fascia.
  4. The pitch of the rearfoot posts may be too high- lower the pitch of the rearfoot post.

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Excessive Breakage

  1. Heavy patient- the arches may need to be reinforced or the shell needs to be made thicker or with stronger material.
  2. Outgrowth- childrens orthoses that break in the heel cup area are almost always due to outgrowth. If the devices are close to a year old and broken, the patient needs to be recasted.
  3. Abnormal usage- if the patient uses ladders, shovels, or anything which would cause stress to the bottom of the orthotic, it will probably break. This type of breakage is not covered by our warranty. Some solutions are to use a shell with a little more give to it such as polypropylene or reinforce the arch with something durable like crepe.

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Bulk

  1. Heel pops out of shoe- heel of orthotic may be too thick. Make sure rearfoot posts are thinned out as much as possible. If there is extra cushioning in the heel, thin it out. If there is arch reinforcement, remove some or all of it. Occasionally, the heel may pop out of the shoe when the orthotic is not contoured properly for a dress shoe. In other words, the heel of the orthotic should sit on a higher plane than the distal edge, so that the device does not rock in high heels.
  2. Top of the foot is pushing up on top of shoe- the rearfoot posting may be too thick and needs lowered. Also, the orthotic shell or the distal edge may be too thick, and need to be thinned out.
  3. Forefoot is being squeezed by shoe- some devices will have a full length extension and can be removed. If the patient needs the full length extension due to accommodations, try to thin it out as much as possible. Another possible cause for bulk in forefoot is an extrinsic forefoot post. This posting can either be thinned out or removed depending on the patients needs. If youve tried the above adjustments and there is still too much bulk, try cutting a hole in the heel. This takes away the initial heel contact point so that the orthotic sits further down in the shoe. If the device is a dress device, and all other options have failed, change the device to a Dress Class I.

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Orthotic Slippage

  1. Orthotic may be too narrow- add a full length top cover to fill up the toe area in the shoe. If that does not work this device may need to be remade wider.
  2. Orthotic may be too short- add a full length top cover to fill up toe area in shoe. If that does not work this device needs to be remade longer.
  3. Patient has outgrown orthoses- patient needs to be recasted.

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Orthotic does not fit in Shoes

  1. Forefoot extension is too wide or too long- trim top cover smaller, preferably to a supplied insole or shoe.
  2. Shell is too wide and pushes out on medial counter of shoe- Narrow shell from distal edge through arch area.
  3. Heel area is too wide and spreading out heel counter of shoe- narrow orthos in heel area.

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Lateral Border Pain

There is probably too high a contour along the lateral border of the device or the lateral skive is too prominent. For each of these cases, lowering the lateral border or removing the prominent skive should eliminate the problem. Another source of pain along the lateral border may be that the orthotic has too much valgus posting in the forefoot. In this case, lower the valgus forefoot posts.

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"I've been using Allied OSI LAbs for several years. They have consistently produced both high quality orthotics and friendly, helpful customer service. I wear the Eagle and feel great in them. Their orthotic selection is diverse and meets the varying needs of my patients. I highly recommend Allied OSI Labs." - Dr. C. Thomas DeRoche


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