Most of the physicians I provide orthoses for would rather I follow up with their foot orthoses ( FO ) patients than have them back in their office with every little issue . This is especially true with surgeons . In most cases , this is due to their patient load and the need to focus on their surgical patients .
We know that foot orthoses are very effective at controlling , reducing and eliminating many foot and ankle issues . So why do I continue to see study results written on the application of custom foot orthoses for many of these common , easily treated , foot / ankle pathologies without decisive results ? Why do patients continue to have issues if a foot orthosis is the way to relief ?
Throughout the years , I ’ ve seen patients leave a pedorthic facility or other clinic with their new foot orthoses and no follow-up appointment scheduled . In most cases , the patient is encouraged to follow-up “ as needed .” The main issue here is that , even though we all know the orthosis is totally alterable and adjustable , this point is not always conveyed to the patient . Another issue I have seen is a prescription for a foot orthosis to treat a specific pathology , but the patient receives a “ cookie cutter ” Total Contact Insert ( TCI ) with no specific relief or supportive features beyond that of the TCI .
For the past 25 years , I ’ ve told every patient that “ If you any issues , questions or concerns , just let me know .”
All my first-time patients get full-length , total-contact inserts , made out of a tri-lam and lite thermo cork . This device is perfect for reaching goals because it is totally adjustable . Many practitioners will chime in here and say that every custom-made orthosis is totally adjustable — they may be right , but this is how I handle my patients . I add mid-foot support to all my orthoses to better support the plantar fascia from origin to insertion , which may be interpreted as an extra-long Jones bar that runs from just distal of the calcaneal to just proximal of the metatarsal heads . The sides of heel and mid-foot to just proximal of the metatarsal heads totally encompass the plantar aspect of the foot while achieving a subtle medial / lateral presentation . In other words , the FO comes up a little along the sides of the foot to grant some medial / lateral control . The FO is and should be specifically trimmed to the patient ’ s pathology . I adapt orthotics for better mid-foot support for those with plantar fasciitis , and I provide more lateral wedge and less medial arch for those with pes cavus issues . I may grind or add a heel to metatrsal elevation for those with Achilles tendonitis . For me , taking a generic FO into the room for a patient with a known pathology is a step toward a practice service failure .
For the past 25 years , I ‘ ve told every patient that “ If you any issues , questions or concerns , just let me know . If the FO does something it ’ s not supposed to do , such as make you feel as if you ’ re tipping outward or inward or make you feel too high , too hard , too far forward or too far back , just let me know .” And it ’ s also important to tell them : “ The way to let me know is to call the office and make an appointment to see me as soon as you can — or better yet , let ’ s make a follow-up appointment as you leave to assure we see the results that you and your doctor are expecting .”
Current Pedorthics January | February 2012 27