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

Modifications

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Modifications

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