How to Evaluate the Orthoses Prescription

How to Evaluate the Orthoses Prescription
Arnold Ross, DPM
There are untold numbers of patients who are either unable to tolerate orthoses or who are not getting symptomatic relief from them. KLM is often asked to evaluate many of these patients and assist in improving the results of the orthoses therapy. The field surrounding orthoses and their application is highly subjective. To keep evaluations as impartial as possible, I use a three-point system for accomplishing objectivity:
Material
Fit
Correction
The Material
When assessing orthoses, look first at the material used for making the appliance. While the material must be rigid enough to support the patient's weight and control abnormal forces causing the problem, it must also be tolerable for the patient. Soft covers may be necessary, and in severe cases, softer materials may be used.
Orthoses Fit
Second in the evaluation process is examination of the orthoses relative to the contour of the foot. With the foot held in the neutral position, the orthoses is held softly to the foot and its shape compared to the shape of the patient's neutral foot. The result should show an orthotic that is closely contoured to the foot. If any gaps exist, the foot may pronate abnormally and this may create uncomfortable pressure points. Ideally, the shape of the foot and the shape of the orthoses should be identical. The only deviation should be in the forefoot, distal-medially for varus correction and distal-laterally for valgus correction Undesirable gaps may be the result of improper casting by the doctor or improper cast correction by the lab.
Cast Correction
Third, the amount of correction is studied. To check this criteria, the patient is placed prone in the chair, with the foot held in neutral by grasping the toes. The orthotic is then held to the foot and the relation of the anterior edge of the orthoses and the theoretical weight-bearing surface is examined These coordinates should be close to parallel. If they are not, the orthoses has either not enough or too much balancing. Although these are the three main factors for effectively evaluating orthoses, there are some minor factors that may also affect the patient's comfort and function. The most common example is arch pain. If everything is in order and the patient is experiencing abnormal arch pain, two things may be possible:
1. The medial edge of the orthotic needs to be lowered.
2. The patient has a tight medial band of plantar fascia and the orthotic needs to accommodate for it.
Certainly no single solution exists to solve orthoses problems. Utilization of this system for evaluation has, however, provided a solid basis for greater success in orthoses applications. If you have a patient who is not being helped by their orthoses, or if you would like to learn more about objective orthoses evaluation, call the lab. Our business is servicing your biomechanical needs

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