Modifications

Patients can sometimes have difficulty adjusting to custom orthotics and can present with a variety of complaints. We've created a chart that outlines the 23 most common complaints, the possible causes and suggested orthotic modifications.

 

COMPLAINT POSSIBLE CAUSES MODIFICATIONS
“Edge” effect under metatarsal heads
  • Orthotic is too long
  • Leading edge of orthotic not bevelled
  • Shorten orthotic
  • Bevel orthotic leading edge
“Edge” effect under metatarsal shafts
  • Forefoot post may be too thick
  • Thin down post
Unremitting pressure at the calcaneal inclination angle (proximal longitudinal arch)
  • Compensated equinus condition
  • Add heel lift
    Use more flexible orthotics
Long Arch discomfort/medial border “edge” effect
  • Compensated equinus deformity
  • Weak, absent or ruptured posterior tibial muscle
  • Unnecessary forefoot varus post
  • Device is over posted in the rearfoot
  • Reduce rearfoot post
    Use flexible orthotics
    Add heel lift
  • Add forefoot varus post to sulcus
    Add Skive rearfoot post
  • Remove post
  • Reduce rearfoot post
Calf muscle discomfort
  • Compensated equinus deformity
  • Acquired calf muscle shortening
  • Lower longitudinal arch
    Change to flexible orthotic
    Add heel lifts
  • Add heel lifts
Achilles tendonitis
  • Supinated orthotic devices
  • Excessive rearfoot varus post
  • Acquired calf muscle shortening
  • Forefoot equinus
  • Reduce varus posting
  • Reduce rearfoot varus post
  • Add heel lift
  • Add heel lift
Knee pain – medial side
  • Unnecessary/excessive forefoot varus post
  • Excessive rearfoot varus post
  • Equinus deformity, early genu recurvatum
  • Arch rise too high
  • Remove or reduce forefoot varus post
  • Reduce rearfoot varus post
  • Remove rearfoot post
  • Change to more flexible device
    Lower arch
Knee pain – lateral side
  • Excessive rearfoot varus post
  • Orthotic is corrective
  • No post for rigid forefoot valgus deformity
  • Reduce rearfoot varus post
    Increase pronation grind off (heel cup)
  • Reduce post
    Change to more flexible devices
    Lower longitudinal arch
  • Add forefoot valgus post
1st MPJ pain
  • Reduced range of hallux dorsiflexion due to hallux limitus
  • Excessive forefoot varus post
  • Patient sliding laterally off orthotic
  • Erroneous Morton’s extension
  • Add dancer’s pad
  • Remove forefoot varus post
  • Lower long arch
  • Remove extension
Plantar fascial pain
  • Longitudinal arch too high
  • Compensated equinus deformity
  • Acquired calf muscle shortening
  • Rigid foot type
  • Unnecessary forefoot varus post
  • Reduce arch
  • Add heel lift
    Reduce long arch
    Use more flexible material
  • Add heel lift
  • Use soft orthotic
  • Remove post
Tibial sesamoid pain
  • Unnecessary/excessive forefoot varus post
  • Medial distal edge of orthotic too long
  • Remove or reduce post
  • Add 1st ray cut-out
Popliteal area pain
  • Compensated equinus deformity and early genu recurvatum
  • Reduce control
    Lower longitudinal arch
    Add heel lift
    Use more flexible devices
Posterior-patellar pain
  • Unnecessary/excessive forefoot varus post
  • Supinated orthotic
  • Compensated equinus
  • Calf muscle shortening
  • Remove or reduce post
  • Lower arch
  • Add heel lift
  • Add heel lift
Lesser metatarsal head discomfort
  • Unnecessary/excessive forefoot varus post
  • Remove or reduce post
Subtalar joint discomfort
  • Unnecessary/excessive forefoot varus post
  • Failure to add forefoot valgus post for rigid forefoot
  • Poor candidate for rigid orthotics
  • Remove or reduce post
  • Add forefoot valgus post
  • Substitute more flexible devices
    Lower longitudinal arches
Posterior tibial pain
  • Not enough varus correction
  • Device too narrow
  • Add forefoot varus post
    Add medial arch support
  • Increase orthotic width
Lower back pain or spasm
Headache/nausea
Temporomandibular joint (TMJ)
  • Over correction or intolerance to appropriate correction which is causing upper body realignment
  • Remove or reduce posts
    Reduce wearing time
    Use more flexible devices
    Re-evaluate and go slowly
Heel slippage (Orthotic lifts foot out of shoe)
  • Device too thick in rearfoot
  • Shoe heel counter istoo low
  • Device too wide
  • Reduce rearfoot bulk
    Thin down post
    Decrease orthotic width
  • Replace with appropriate shoe with higher heel counter
  • Decrease orthotic width
Squeaking of shoes
  • Appropriate movement of orthotic
  • Apply talc, wax, soap, etc. to orthotic devices or into shoes
    Decrease orthotic width
Lateral shoe overriding in forefoot
  • More rigid foot with excessive orthotic posting
  • Curve lasted shoes
  • Reduce posting
    Use more flexible devices
    Add valgus forefoot post to sulcus
  • Use straight lasted shoes
Breakdown of lateral heel counter
  • Over-posted rearfoot varus
  • Lack of posting in rigid forefoot valgus deformity
  • Reduce post
  • Increase forefoot valgus post
    Remove rearfoot varus post
Breakdown of medial heel counter
  • Neuromotor impairment
  • Internal tibial/femoral torsion deformity lacking pronation control
  • Re-evaluate patient and orthotic
    Shoe needs
    Out-flared heel on shoe
  • Change to more rigid orthotic
    Increase rearfoot posts
    Remove any forefoot posting
Shin Splints (anterior compartment)
  • Too much varus correction
  • Decrease rearfoot varus post
    Lower arches

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