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Jan 20

Written by: Larry Huppin, DPM
1/20/2011 9:06 AM

I spoke to a client yesterday who was making orthoses for a runner with plantar fasciitis. He wanted to prescribe an orthosis with a maximum arch fill so that he could be sure that the orthosis did not cause any irritation to the arch of the foot.

I think this illustrates a huge problem in podiatry – prescribing orthoses to avoid the need to troubleshoot, rather than prescribing for best clinical outcomes. The best evidence on orthoses for plantar fasciitis indicates that devices that conform closely to the arch (minimum cast fill orthoses) are more effective at reducing tension on the plantar fascia. The downside of these orthoses is that there is certainly more potential that the orthosis could cause some arch irrititation. If this occurs, it is extremely easy to adjust for an arch that feels too high. Simply grind the orthosis thinner in the arch to increase flex in the arch. This is demonstrated in the video below.

Of course, if you don’t have a grinder this is difficult to do and you must send the orthosis back to the lab for adjustment.

This leaves the podiatrist with three choices:

  1. Prescribe orthoses that follow the best evidence in the literature, and also have the troubleshooting skills and equipment necessary to make adjustments when necessary.
  2. Prescribe orthoses that follow the best evidence in the literature and send the orthosis back to the lab when an adjustment is necessary. This is doable, but very inconvenient for the patient and expensive for you.
  3. Prescribe orthoses that do not meet evidence based medicine standards and will not likely provide your patient with optimum outcomes but are less likely to ever need an adjustment.
Which are you going to choose?

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