Mar
24
Written by:
Cherri Choate, DPM
3/24/2010
I had a conversation with a friend and colleague today about my concept of the "hybrid" orthotic. His question was regarding a patient of his that was diabetic, but very active and suffering from symptoms secondary to flexible flat feet. This patient had been casted for custom orthotic in the past, but he continued to have problems secondary to his flat feet. My friend and I discussed the merits of treating this "diabetic" patient with something other than a "diabetic" device. We both decided that he would be better served to be treated as a patient with flexible flat feet who also had diabetes. My friend had already casted him in a NWB neutral position so his intention was to provide functional control with some components of cushioning. We ultimately chose the Featherweight device with some accommodative type components. The most important choices are highlighted below:
1) 1/8" VF shell to provide stability and motion control
2) EVA arch fill to allow more rigid control, but with the option of removal or reduction of fill if device is too rigid
3) Functional device to offer component for more control with cast correction
4) Diabetic topcover to offer both cushioning and accommodation of prominent areas
Years ago, Chris Smith, DPM and I wrote an article about this subject and it continues to be a point of discussion. It certainly seems that future research needs to address the advantages of these "hybrid" orthotic devices for many different patient bases.
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1 comments so far...
Re: The "Hybrid" Orthotic
I have worn probably 2 dozen different types of orthotic devices ranging from prefabs of all sorts to fully custom using all different casting techniques and materials. In my personal experience, and what seems to be the most satisfying for patients is a device that conforms very closely to the idealized neutral suspension position, that is with minimal arch fill, a flexible shell, and arch fill with some kind of foam, usually EVA. Other motion control features are used rather aggressively such as heel skives and inversion. This to me is the "hybrid" type of orthosis. It conforms very well, but is not so hard that the foot is punished for wanting to move. Extra cushioning/accomodative materials can be added for the diabetic foot. This type of device should be firm enough in the diabetic patient to permit mechanical control of skeletal movement. Since neuropathy is likely present in such a foot, the neuromuscular adaptations that would otherwise occur, require an orthosis that is firm enough to exert some control, but forgiving enough to prevent excessive pressure points, and of course, have a close conformation to the shape of the plantar foot to best disperse pressure. All in all, in my experience, it is better to have something more forgiving with higher fidelity to the plantar foot, than a more rigid device that is "toned down" to avoid irritation.
By Jeff Hagen on
4/2/2010
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