Patient presented today with complaint of callusing on her orthotics. Specifically she was callusing along the plantar medial border of her arch. This is a pronated, flexible, flat footed individual on a rigid polypro orthotic device, posted with EVA and no top cover.
While the orthotic contoured the arch well non-weightbearing, in stance the device was rather narrow and under-corrected, which resulted in her pronating right over the medial edge. This resulted in friction and callusing with activity with these devices.
What to do … the patient really needs a new pair of wide enough devices for her foot, but in the office I try salvaging devices and then, when the patient is ready for the expense of a new pair of devices, I know what works well for the patient (and what might not work.)
In this case, the patient needs a wider device and pronatory control. I added a medial flange to the device using korex (1/8″ thick) and a top cover over both the korex and the plastic. This places the medial edge of the orthotic more on the medial side of the arch/hindfoot and the callus should diminish with time and also created a supinatory torque.
On the patient’s new device prescription I would make sure to order a wide device with minimal arch fill and a deep heel cup and likely some inversion of my cast with medial skiving (based on my biomechanical exam) and finally post the device for added balance and control (0/0 EVA.) I do additionally order a medial flange to be incorporated in the plastic and then narrow the device down as needed during my orthotic dispensing appointment.