5/17/2012 9:43 PM
Modifying diabetic accomodative orthotics is similar to modifying a standard functional foot orthotic. I had a patient in the office earlier this week with 5th metatarsal base pain and irritation on his custom molded accommodative inserts. Interestingly, this is a neuropathic patient, so he was really concerned about the fact that he had pain and what looked like a skin lesion.
His multi-density, custom-molded accommodative orthotics had deep heel cups that extended laterally right up and beyond the 5th metatarsal base, and along the superior edge of the orthotic was a line of callus and redness. Luckily, there wasn't a wound; this patient acted quickly and noticed this on his daily (morning) foot check.
The simple fix was to take the device to the grinding wheel and end the heel cup more proximally, such as at the cuboid level. I covered this modification location with moleskin to add a soft material/cover. I commonly see this with diabetic inserts, and in general with patients who have really prominent styloid processes. This is a quick and successful fix for patients and they leave the office pain free. I instruct patients to continue their daily foot / skin checks and call the office if this isn't working and we have them come back in as needed. So far ... this patient is happy!