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Jun 21

Written by: Larry Huppin, DPM
6/21/2012 5:54 AM

Prescribing orthoses for patients with plantar fibromas can be challenging. In general, our treatment goal is to reduce tension on the plantar fascia and then reduce pressure on the plantar fibromas. This can lead to a Catch-22 situation; orthosis that conform closely to the arch of the foot can help reduce tension on the plantar fascia, but they may also increase pressure on the fibroma. Luckily, there are some fairly straightforward orthotic modifications that can lead to an excellent clinical outcome for these patients.

To decrease plantar fascial tension, you will want to prescribe the initial orthosis so it conforms closely to the arch of the foot when the foot is casted in a neutral position with the first ray plantarflexed. This will result in a device that conforms very closely to the arch of the foot and will help decrease flattening of the foot, which in turn will decrease tension on the plantar fascia. We also would recommend a wide orthosis so that the orthosis acts to spread force over a larger surface area. If the heel is everted in stance or in gait, you will want to incorporate prescription items that will limit heel eversion. For example, this might include a deep heel cup and a medial heel skive.

You also want to prescribe a topcover with a bottom layer of cushion and a top layer that can be modified with a grinder to create a pocket for the plantar fibroma. Contact a ProLab medical consultant for suggestions on specific topcover combinations.

Once you receive the orthotic back, you will add an accommodation for the plantar fibromas directly into the cover. We recommend that you do this in the office where you can ensure that the accommodations are exactly in the right position. The easiest way to do this is to mark the plantar fibromas with lipstick and then hold the orthosis up to the foot so that the lipstick transfers to the topcover. It is then quite simple to grind the accommodation directly into the topcover. Your ProLab medical consultant can teach you how do to this in your office, or you can send the orthoses back to ProLab to have it done. Once the accommodations are added, you will add a final, extremely thin cover on top of the current cover to finish the device.

We recommend against adding the accommodations for the fibromas directly into the orthotic plate. Not only does this increase the rigidity of the orthotic plate, but it is actually very difficult to get those accommodations in the exact position when having to transfer the marks from the foot, to the negative cast, to the positive cast, and then finally into the orthotic itself.

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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