I use a lot of prefabricated orthosis in my practice. They are usually my first line treatment for a majority of the mechanical conditions I treat including plantar fasciitis, hallux limitus, and metatarsalgia. My go-to device is the ProLab P3 prefabricated orthosis. It is only prefab in the market that incorporates valgus forefoot correction and a medial heel skive along with a rearfoot post and deep heel cup. These are the same modifications I would prescribe when treating these most common problems that are treated with orthotic devices. For more detail and references on why these features are important, you can go to the following pages for information on these specific pathologies: hallux limitus, plantar fasciitis, and metatarsalgia.
I also like the fact that the P3 prefabricated orthoses have a higher arch than other prefabs and are somewhat more rigid. This makes the devices much more effective at decreasing tension on the plantar fascia, pressure on the forefoot, and allowing the first ray to plantarflex as needed when treating hallux limitus. However, on an occasional patient this means that the device might need a little adjustment. These devices are very easy to adjust. The only problem I ever run into, and this is rare, is the occasional patient who feels like the arch feels too high. In that situation, all I have to do is to grind the orthosis slightly thinner in the arch. I thin it from the bottom. By simply grinding a little bit of the polypropylene away, I make the device more flexible and thus decrease the force that the orthosis is applying to the arch of the foot.
There are two other adjustments I commonly do to these devices. For patients with metatarsalgia, I will sometimes add a poron extension under the metatarsal heads to increase cushioning. Cushioning slows velocity of the forefoot as it hits the ground and decreases force under the forefoot.
For hallux limitus, I will commonly add a reverse Morton’s extension to the ProLab prefab. These obviously require one of the prefabs with covers such as the P3 Sport.
If a patient requires much more modification of a prefabricated orthosis then that is usually a sign that they are better candidate for a custom orthosis.