Using Prefab Orthoses To Determine If Patients Can Tolerate Custom Orthoses

I had a patient come into our clinic who was experiencing plantar fasciitis. Along with that, she has a long history of knee and hip pain. She has had the diagnosis of some mild osteoarthritis affecting the medial knee.

We did discuss the use of custom orthotic devices to treat her problem but I am always concerned whether patients with a history of knee, hip and back pain will tolerate orthoses. Certainly, in many situations, orthotic devices can help these symptoms but they also can make those symptoms worse.

We discussed the options, including potential risks and complications, and decided it would be a good idea to try a pair of prefabricated orthoses before proceeding with custom orthotic devices. This would give us a chance to evaluate how her proximal joint pain might be affected by using an orthotic device before investing in a custom orthosis.

In fact, she did call me soon after and let me know that she developed knee pain about five days after starting to wear the prefabricated orthosis. I had her take the orthoses out and once she is pain-free, we will have her break them in again but this time using an extremely slow break-in. If she still develops proximal pain, then I will modify the prefab devices by thinning them to increase the flexibility.

Certainly at this point, it would seem contraindicated to try and proceed with a custom orthotic if she cannot yet tolerate a prefab.

I would recommend that all practitioners of orthotic therapy keep a size run of quality prefabricated orthoses. When these prefab devices are semi-rigid, have a rearfoot post, a medial skive inferiorly and a relatively high arch, they can be the perfect devices to test the effects of orthotic therapy.

Editor’s note: This blog was originally published at https://www.prolaborthotics.com/Blog/tabid/90/EntryID/339/Default.aspx and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com .