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Mar 24

Written by: Larry Huppin, DPM
3/24/2014 3:24 PM

We have a question from a ProLab client today:   

I have a patient who is 70 yo male with a chronic neuropathic ulcer on the plantar medial 1st MPJ/base of the hallux
Severe HAV/limitus with adult semi-rigid flatfoot

What orthotic would you suggest the adult flat foot with a reverse mortons? I need to get the pressure off the medial MPJ


ANSWER:   
I think that would be an excellent choice - with a couple changes. Here is my recommendation:

PTD pathology specific orthosis with the following changes (so check off PTD in part A and in Part B, change the following:)

  • Minimum fill
  • Invert the positive castt  (the inversion and min fill will allow the first ray to plantarflex more thus decreasing functional hallux limitus
  • Diabetic Topcover instead of EVA
  • Add a metatarsal bar under "special additions"
  • Order a pack of PTFE patches at the same time you order the orthosis. After the patient has worn the orthotic for a couple weeks you will see an indentation at the point of maximum force. Place a PTFE patch here to reduce friction forces. The PTFE is critical for this Rx as it is the only thing that will reduce friction.
More information on PTFE can be found here.

We have a 10 minute educational video on the "Top Five Orthotic Modifications for Treating Hallux Pinch Calluses and Medial Hallux Ulcers" in the client section of our website. You can log in here and follow the links to the video.  

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