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Feb 16

Written by: Larry Huppin, DPM
2/16/2012 11:21 AM

 I had a patient present today with a complaint of a two-year history of digital numbness and tingling during activity. This was occurring on the right side only. It tended to get worse with increased activity such as hiking and running. He also found that shoes that had a lower heel height differential tended to decrease his symptoms. He had tried a number of over-the-counter arch supports and shoes without any significant improvement of his symptoms.

His examination was significant for the fact that he had a higher arch on the right foot than on the left. He had mild hammertoes on the right and none on the left. He had mild and generalized callus formation under all of the metatarsal heads on the right and no callus formation on the left. He was slightly more pronated on the left than on the right.

All of these findings point to the fact that he is experiencing more pressure under the metatarsal heads on the right foot than on the left. This increased force on the ball of the foot likely leads to a traumatic neuritis that occurs when he increases force by increasing speed or carrying a heavier load.

I explained all of this to the patient and explained that our treatment goal was to transfer pressure from the ball of his foot, and redistribute this force to other parts of the foot. I explained that this would require an orthosis that conforms very close to the arch of his foot. I also explained that we can use modifications on the orthoses to further decrease force under the ball of the foot; this includes a Poron extension under the metatarsal heads. Poron acts to slow velocity and thus decrease force. We can also use a metatarsal bar on top of the orthosis to transfer pressure from the metatarsal heads to the metatarsal necks and shafts.

Below is the prescription that we wrote for this patient:

Click here to view the orthotic prescription for numb toes.

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 practice.     


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