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Temporary /permanent orthoses treatment plans

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Pod on sea, Mar 25, 2011.

  1. Pod on sea

    Pod on sea Active Member

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    If you determine that your patient/client requires orthoses and is likely to need them in the long term and they have never worn orthoses do you prescribe a temporary pair or a permanent pair at the first consultation?...and why?

    I mostly prescribe a temporary pair to confirm therapeutic effect/ patient tolerance. If necessary adjustments can be made before precribing a permanent (mostly fully custom-made) pair. There are various drawbacks with this approach. Equally, prescribing a custom- made orthotic straight off can have issues too. I'm just interested in what others do.
  2. hkpod

    hkpod Active Member

    I often pad up their shoes with some semi-compressed felt on the first consult as it still surprises me what some people will/will not tolerate despite what my 'measurements' tell me. Also, they have usually presented as they are symptomatic and I want them in the those padded shoes for the majority of the time (at least initially). Even if they haven't brought the 'correct' shoes with them I get them to drop them off for me.

    I then get them to write down (remember?) at what point they felt most comfortable with the padding. Usually, I get this info via a quick phone call just to be time efficient. This just gives me some indications as to arch height & ideal material for orthoses. I know this can seem a little hazy but it gives me a lot of feedback.

    That being said, I do like to take a template on the first consult if I am planning on having them go into semi-custom devices (modified formies, etc). and then combine that with their feedback so I can issue formies on the second consult or customs on the third consult.

    Haha, I started writing this thinking I would give a quick response but the more I think about it the more ifs & buts there are......I guess the above is what I usully do if I can!

    I'll be interested to read other responses as I have read some negative info from clients on a local review site here in HK complaining about pods issuing orthoses (at exorbitant prices) on the first consult that the patients' can't wear as they are too uncomfortable/bulky/hard, etc.
  3. As always with me, It depends.

    If I'm reasonably confident of the effect I'll go straight in with custom casted. If its Paeds I'll go straight in with casted. If I'm not sure how much good I'm going to do (as with most LBP for eg) I'll generally try a modified pre fab before I spend either the patients or the NHS' Money.
  4. RobinP

    RobinP Well-Known Member

    Ditto although, of late, I find myself using modified prefabs as definitive devices.

    I've had several occasions where I have made custom having had good success with prefab and wanted to make something more definitive, only to have it fail. Unable to provide the necessary forces for whatever reason.

    Just my thoughts

  5. Agreed. Its very hard to get something which is both soft and durable. And I use a lot of soft in my insoles.
  6. 2whiskers1

    2whiskers1 Member

    I usually pad the insole of clients shoe with semi-compressed felt and see how they go for a couple of weeks before ordering orthoses. More often than not, their problem resolves. Working in the public sector, this is often a cheaper way as I have found clients don't want to pay for temporary orthoses. The team I work in don't favour pre-fab orthoses much.
  7. Why do you favor soft, I use soft but manly in the forefoot region, when looking at head of the mets and back a lot more hard.- Since you work with kids a lot wondering why soft ? I would have thought something else .

    as for prefab vs custom depends - but a lot more tape 1st then custom for me at the moment i reason as I make my own devices so have control over the process to hopefully get a more custom device.
  8. I do use a lot less soft since I've been in paeds. Still a fair bit though. A lot of the Paeds I see have some fairly major deformity and polyprop just blows holes in them. But yes, I do like my simples, especially for the elderly and deformed. You do comprimise with the control, but the comfort is hard to match. I'm sure I remember reading something somewhere that initial comfort was a substantial predictor of orthotic success.

    Tell you what Mike, email me your prescription and size and I'll knock you up a pair of squodgies for when I see you. I;m still wearing that bloody insole in my right foot by the way. How long is that experiment running for?!
  9. Sorry I think we can take it out now............. :drinks
  10. I'm kinda used to it now.

    I'll take it out. Be interesting to see if anything happens.
  11. RobinP

    RobinP Well-Known Member

    What is a squodgie....I'm presuming something technical?;)

  12. Sqodgie. Noun. A shank dependant device made of no less than 2 different densities of material with at least one type of poron involved - not a casted device - a device made WITHOUT using pre fabricated components.

    Also known as

    "what kind of wet purposeless dog is this?!"


    "oooo they're ever so comfy dear!"
  13. Griff

    Griff Moderator

    I've got a pair on order and am quite excited.

    Although if they don't make me a category 1 golfer within 3/12 then I suspect they'll end up in the orthoses graveyard (the box under my bed) with all the others...
  14. RobinP

    RobinP Well-Known Member

    A.K.A "going high and soft"
  15. Along with the magic bracelet ian ;)

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