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Arch Callusing on Functional Foot Orthotic

Arch Callusing on Functional Foot Orthotic

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.

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