A rigid flat foot was just molded here in the office. Historically this patient was in a pair of insufficent devices which he continued to have pain with. The goal is pain relief / reduction. Thoughts for the Rx writing …
– capture the arch in as close to subtalar neutral as possible without inverting the patient, as this is a rigid deformity and the patient will not tolerate a device which requires motion he doesn’t have.
– order a wide device with a medial flange (you can always make the device narrower in the office at the time of dispensing if it is too wide) this will add a supinatory torque and not allow the patient to maximally pronate over the device
– many of these patients will have prominent navicular tuberosities so I mark them before casting and order sweet spots for added cushion
– order a deep heel cup and, pending available motion in the midtarsal joint, I will add a medial skive of 2-4mm for a additional supinatory torque