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The Art Of In-Office Orthotic Modification
After reading a recent article, “Beyond the Rearfoot” by Brant McCartan, DPM, I got to thinking of the different in-office padding and offloading techniques that I have learned and used during my short career.1 The art of quick modifications of a generic over the counter (OTC) insert or custom molded orthotic was something not impressed upon me outside of a few classes in school and then again during my fellowship year by my director and mentor. During that time, I tried to find and learn different tricks to treat my patients, and allow them to walk out with a device to start helping eliminate their pain or treat their pathology.
Armed with my office’s over-the-counter orthotic of choice, some rolls of felt (1/8-inch and ¼-inch), scissors and various pads (e.g., scaphoid, metatarsal, dancers, etc.), I try my best to understand the patient’s issue and develop a way to make a OTC orthotic “custom” without the initial expense of custom. I find this method helpful so I can send the patient out with a ready to wear device. If this proves to be helpful, we have a model to create our real custom device after regarding the specific needs for the foot.
Besides the aforementioned article, another helpful one I found was “10 Orthotic Modifications You Can Perform in the Office” by Dianne Mitchell, DPM.2 As Dr. McCartan alluded to, we may lose the “art” of orthotic making in many instances during our residency training but it is an integral part of our practice thereafter.
If we can share our experiences, tricks and thought process behind why we do what we do (i.e., a smaller, narrower neuroma pad versus larger, wider metatarsal pad for forefoot offloading in a neuroma situation; proper pad placement for neuroma or metatarsalgia pathology), the “art” of orthotics and their modification can become a less foreign or daunting concept for those attempting to learn and apply these techniques.
Questions for Discussion:
Do any of the readers have any helpful hints and tricks that they have used for certain pathology, or general comments? Any good resources such as an article, website, or textbook, that others should read?
Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm.
References
1. McCartan B. Beyond the rearfoot. Podiatr Manage. Available at https://podiatrym.com/pdf/2017/9/McCartan917web.pdf . Published September 2017.
2. Mitchell D. Ten orthotic modifications you can perform in the office. Podiatr Manage. Available at https://www.podiatrym.com/pdf/2013/11/Mitchell913.pdf . Published September 2013.
