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
|
|
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
|
|
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
|