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Nov 29

Written by: Larry Huppin, DPM
11/29/2010 1:01 PM

A client today asked for a recommendation for a patient with sub 1 and 5 rheumatoid nodules.

First, all orthotic practitioners should be aware that there are several good studies supporting the use of orthotic therapy in patients with RA. You can find some of rheumatoid arthritis articles listed here

Our goal when treating patients with painful sub-metatarsal nodules is to transfer pressure off of the involved metatarsal heads – in this case met heads one and five.

Here is our recommendation:

  • Material: Semi-rigid polypropylene. Other materials, such as firm Plastizote would also work. The material simply must be rigid enough to resist deformation in order to effectively transfer force
  • Heel Cup Depth: If the heel is rectus, use a standard depth. If everted, use a deep heel cup.
  • Width: A wide orthosis will better transfer pressure off of the metatarsal heads onto the arch of the foot
  • Inversion: 2 degrees inversion will slightly raise the arch in order to better transfer pressure off of the metatarsal heads onto the arch
  • Post: EVA for a little shock absorption at heel contact
  • Topcover: Diabetic topcover to provide cushion
  • Forefoot Extension: 3mm Poron to sulcus for additional met head cushion
  • Special Additions: Metatarsal Bar to transfer more pressure off of the met heads.
We then suggest letting the patient wear the orthosis for a couple weeks. You will then see indentations in the cover where excessive pressure is occurring under 1 and 5. At that time you can add a piece of 3mm Korex under met heads 2, 3, 4 in order to further unweight 1 and 5. In addition you can build up the metatarsal bar as necessary.

If you have questions on orthotic prescriptions for any pathology, ProLab clients have no-charge access to our medical consultants


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