Footbionics versatile shape means that many versatile modifications can easily made. More advanced modifications require a grinder to finish these properly however we do have a range of Footbionics "Quick Kit" orthotic additions that make life a lot simpler and quicker for you to modify. Quick Kit are preshaped additions that can be applied easily wihtout the use of a grinder. Each orthotic modification is based upon a clinical need to either improve foot position or to reduce pain. Often the orthotic will be adequate on its own however we do recommend that you further customise the device for the patient. Remember that during fitting Footbionics can be heat moulded for a more custom fit.
This is a modification used to control the rearfoot of the orthotic. These posts are usually of a denser material and extend approximately to the plantomedial calcaneus distally. When selecting foam for this posting you can also regulate the amount of control by choosing a thicker material. Using a rearfoot post medial to the subtalar joint axis is important if trying to reduce excessive subtalar motion. Given our orthotic design is nicely rounded in the heel a good supination moment around this axis can be achieved. Our Quick Kit Rearfoot Additions are a fantastic post that can be fitted in seconds with no grinder!
Rearfoot control is regulated by the following;
- Length of the posting i.e. longer provides more control
- Thickness of the posting i.e. thicker provides more control
- Firmness of the posting i.e. denser provides more control
- Positioning of the posting i.e. medial to the STJ axis provides more control
Lateral rearfoot wedging is now more common in orthotic therapy particularly with medial knee joint osteoarthritis. The results of a lateral post can be dramatic in terms of pain relief and despite this post being somewhat contradictory it is often well worthwhile. On this basis the function of the foot is disregarded somewhat at the expense of pronating the foot inward. This can be a compromise particularly if the patient already is significantly pronated before adding this wedge.
A heel cup is a simple addition that essentially stabilises the rearfoot both medially and laterally without altering the rearfoot position. This is a nice way to reinforce the rearfoot of the orthotic if required. We generally use a medium density material for a heel cup as this is much more tolerable for the patient.
Arch additions are often required in orthotic therapy to provide additional arch, tarsometatarsal or midtarsal joint support. These can be used as a modification in isolation however are usually added in conjunction with some form of rearfoot posting as this enhances comfort. The arch addition extends from the distal medial calcaneus to the proximal aspect of the 1st metatarsal head. A softer foam density is usually well tolerated and care must be taken when using firmer densities as blistering or irritation can occur. Taper the arch addition well with a grinder at its distal edge.
As with the rearfoot posting the thickness of the addition can be varied to provide more or less control. The width of the pad usually does not extend beyond the midline of the orthotic. Most of the arch pads are positioned medially however can be used laterally in ankle sprain sufferers, cuboid syndrome, or sports where lateral foot instability occurs. Footbionics Quick Kit Arch Additions make life easy and look like they have been finished professionally.
In podiatry there has been a complete turnaround in forefoot posting. Medial forefoot posting is infrequently utilised as it is considered to impede the windlass mechanism for which 1st ray plantarflexion needs to occur. The lateral forefoot post is a handy addition that can provide considerable forefoot stability without blocking this 1st ray movement. Typically the post will be added at the level of the lesser metatarsal heads and extend proximally to the styloid process or to the calcaneocuboid joint. Extending the pad from the 5th to 2nd met heads laterally for maximum effect.Given that the patient will feel this pad through the orthotic the use of a medium density foam is preferred. There is usually a limit to the thickness of this pad with any greater than 6mm being a challenge for most footwear. Take a look at our Quick Kit Forefoot Additions as these can be trimmed and fitted in seconds.
Met domes are a very handy modification for the podiatrist to rapidly offload regions of the forefoot. Usually these are loacted just proximal to the lesser metatarsal heads 2-4. Studies have shown that a simple pad can reduce loading in the metatarsophalangeal joints by up to 40%. Providing a pad of an appropriate shape, thickness and position is important depending on the pathology being treated. Trim the distal pad shape to contour with the metatarsal parabola. A 4-5mm thick pad of a medium density is a good option for most metatarsal head offloading or neuroma management. Often such pads can be placed on their own inside a dress shoe if there is no room for an orthotic. Use a white marker pen on the foot to highlight the area to protect. Have the patient quickly pace the shoe on and weightbear. The white marker should transfer to the shoe - exactly where you want the pad located. Check out our Footbionics Quick Kit Met Pads that are self adhesive and ready to apply in seconds.
The mortons extension is primarily used to restrict or limit first metatarsophalangeal joint extension. This pad is particularly effective for dorsal or impingement type pain or generally resting an inflammed joint. The pad was named after Dudley Morton who considered this pad appropriate in patients with short first metatarsals and where the 2nd met head was loaded more. The use of a medium density foam pad approximately 2-5mm thick is shaped to extend from the mid shaft of the 1st met to the distal interphalangeal joint. Generally a pad of a tolerable medium density foam is used and of a thickness that can reduce symptoms and yet still allow for room inside the shoe.