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Jan 9

Written by: Larry Huppin, DPM
1/9/2012 7:43 AM

 As do most orthotic labs, we offer a number of different choices for dress shoes. Over the years, I have tried many different devices including the graphite dress orthotics, the Holethotic and the Cobra orthotic. A few years ago, I was most commonly using the graphite dress. I have now, however, migrated to using the Cobra almost exclusively for women’s dress shoes.

The Cobra offers a number of advantages in women’s dress shoes. The first is that it is simply smaller than any of the other devices. In addition, unlike any of the other orthoses, it is flexible in the heel with the ability to bend in the sagittal plane. This allows it to easily adapt to different heel heights. So, not only does it fit into flats, but my patients can wear it in heels. It can even be used fairly easily in four, five, and six-inch heels.

I do not think the Cobra orthosis is a true “functional” orthotic, in that it does not provide any significant rearfoot control. It can be considered functional, however, if you start looking at the primary goal of the orthoses. In most cases we are using the orthoses for problems such as hallux limitus, metatarsalgia, and plantar fasciitis. In these three pathologies the tighter the orthosis conforms to the arch of the foot, the more effective it is at reducing symptoms. If the patient has metatarsalgia, then a device that conforms closely to the arch of the foot is going to more effectively transfer pressure off the ball of the foot. If the patient has hallux limitus or bunions, then a device that conforms tightly to the arch of the foot, especially near the posterior arch, allows the first ray to plantarflex more effectively. For plantar fasciitis patients this high arched orthosis prevents collapse of the arch and subsequent lengthening of the arch that increases tension on the plantar fascia.

To prescribe a Cobra orthosis that conforms tightly to the arch, check off “Cobra” under speciality orthosis and then prescribe minimum cast fill and two degrees of inversion. This will result in Cobra orthosis that conforms tightly to the arch of the foot.

If the arch feels somewhat too high, it is very easy to simply grind out a little bit of the EVA fill that comes as part of the Cobra orthosis and increase the flex of the device.

ProLab takes a scientific approach with our orthoses by integrating evidence-based medicine into orthotic therapy. Our team of Medical Consultants regularly evaluates the medical literature pertaining to orthotic therapy and biomechanics. ProLab clients are encouraged to contact a medical consultant whenever they have questions about an orthotic prescription.

For an easy way to stay up-to-date on evidence-based orthotic therapy, subscribe to our free E-Journal. Your will receive a monthly email synopsis of the research that impacts your practic


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