A ProLab client last week sent in a pair of orthotics for adjustment and included his chart note, which read as:
This 55-year-old female returned several months after being fitted for prescription orthotics. She recently began to wear the orthotics reversed in her sneakers (the left device in the right shoe and vice versa) and peroneal tendonitis quickly resolved. She feels as though the current orthotics when worn in the proper shoe allow her foot to shift laterally. She would like to begin running again and is wondering what her options are. Can the orthotics be adjusted to increase the medial shift or decrease the lateral tilt?
This is a great question and very interesting case. In fact, there are some very simple adjustments that can be done that should help the patient and our client achieve their goals.
In general, most custom orthotics are designed as anti-pronation devices. Another way to put this is they tend to encourage supination.
In particular, in a case such as this where the patient is feeling that they are being pushed into a greater than comfortable lateral tilt, it would be very logical to think that the peroneals, particularly the peroneus brevis, would try to resist this excessive supinatory force.
We do not want her wearing the orthosis in the wrong shoes long term. While I am sure they do a great job in taking some tension off the peroneal tendons, particularly the peroneus brevis, the potential for long-term discomfort, blister formation and other problems is certainly great. Instead, we recommended the following adjustments be made to the orthosis:
The arch of this polypropylene orthosis should be thinned slightly by grinding the device from the bottom. By thinning, it will increase the flexibility and decrease the orthotic reactive force being applied to the medial foot, which will decrease supinatory torque being applied.
We are going to add a 3-degree valgus wedge to the heel post.
We are going to add a 3 degree forefoot valgus extension.
I advised our client that after the patient has worn this for a couple of weeks if she is still having peroneal tendon symptoms then he can use 3 mm sticky felt to create additional wedging to add to the lateral heel and the lateral forefoot. He can give her several pieces to take with her and she can slowly build up the amount of wedging until she finds the level that is comfortable. When she finds that level then we can add additional permanent wedging with Korex.