Written by: Larry Huppin, DPM
8/13/2009 10:01 AM

A relatively common orthotic complaint is a patient who feels the arch of the orthosis too far proximal.  Essentially they feel excessively pressure under the distal aspect of the first metatarsal shaft. 

To fix this problem, first ensure that the orthosis is sliding all the way back into the shoe.  If it is not, the device will be sitting farther distal than it should leading to the complaint.   If the orthotic does not sit all the way back in the shoe, consider lowering the heel cup a few millimeters or having the patient get a wider shoe.

If the orthosis does sit properly in the shoe, you can eliminate the feeling of excessvie pressure distally by thinning the orthotic shell in the area where they feel excessive pressure.   Gently grind it thinner until the flex increases slightly.  Then have the patient try the orthosis.   Take a little bit at a time until it feels comfortable. 

Obviously you must have a grinder in your office in order to do this modifcation.  

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