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Apr 14

Written by: Larry Huppin, DPM
4/14/2014 9:01 AM

 We had a question come in today from a ProLab client who recently started using the ProLab 3D Digital Foot Scanner.   Here is his question and my answer:   

QUESTION:
This scanner is fun to use. With regard to the orthotics - any suggestions for him?  I performed a 1st metatarsal phalangeal joint fusion on the right. I was thinking a proaerobic with a mortons extension.

Also I never had such an interest in orthoses as I do now since I have been using the scanner. Just wanted to see if you had any suggestions on good literature on orthoses.

Thanks again for all your help

ANSWER:
I'm glad you're liking the scanner. We actually have two in our clinic for our three doctors so we never have to wait to use it. I can't imagine going back to plaster.

In regard to your patient:
I think the Proaerobic with a Morton's extension would be a logical choice with one modification.

The Proaerobic normally comes with a standard cast fill. Given that 2nd MPJ overload is going to the most likely long term issue for this patient I would suggest checking off the box for "minimum cast fill" in addition to "Proaerobic". The orthosis will then conform closer to the arch of the foot and be more effective at transferring pressure off of the metatarsal heads.

There is another option that would make it easier to make any modifications that might be necessary.

The Proaerobic includes both a topcover and a bottom cover. This makes for a very finished looking device that is easy to slide in and out of shoes. The disadvantage is that the bottom cover makes adjusting the orthosis more difficult.

The most common adjustments I do for a patient with this pathology are to sometimes add a metatarsal bar or metatarsal pad to further decrease pressure on the lesser met heads and I will also often modify the Morton's extension by making it thicker or thinner as needed to best support the first ray.

If you want the ability to easily make these adjustments here is another prescription option for this patient:

  • Vacuum formed polypropylene, semi-rigid
  • standard heel cup
  • Wide width (if for an athletic shoe) or standard width for more casual shoes
  • Minimum cast fill
  • EVA rearfoot post
  • Soft EVA cover to toes (I choose "black" since most patients like this color better)
  • Check off the box for "glue cover posterior only". In this situation we will not glue the front half of the cover. This gives you the ability to easily add a metatarsal pad if it is needed later. Also you can easily adjust the Morton's extension. When I do this I always tell my patients ahead of time so that they know what to expect. I also let them know that as soon as we have the orthoses working the way we want we will glue the cover down.
  • Morton's extension
Let me know if you have any questions about the prescription. In addition, if you are interested, I can set up an online meeting at your convenience and we can go through the prescription form in detail and discuss some best practices for writing prescriptions for specific pathologies. About 30 minutes is an adequate time to do this.

In regards to your question on orthotic literature, we have a lot of links to literature on orthotic therapy on our website.  Try these two pages to start:
 
 
 
In addition we have a series of short (10 - 15 minute) recorded webinars on orthotic therapy for specific pathologies.  All are evidence based.   You'll need to log into the client only area of the website using your account number as your username and your zip code as the password.    You can find those webinars here: 
 

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