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Archived Comments for: Foot orthoses: how much customisation is necessary?

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  1. Need for custom orthotics vs. prefabricated orthotics

    Eddie Davis, Private practice

    2 March 2010

    I agree that prefabricated orthotics can provide a similar therapeutic benefit to custom orthotics in a number of scenarios. I wore eyeglasses with a very high degree of correction before I underwent refractive surgery in 2006. Now, I need wear only reading glasses obtained from a retail store. Recently, I had an eye exam and the optometrist informed me that I would do somewhat better with a prescription pair. I obtained the prescription pair but did not feel it worked as well as the "prefab" pair.

    I prescribe three categories of foot orthotics in my practice: prefabricated, customized prefabricated and true custom orthotics. The decision as to which category to choose is based, in part, upon the nature of the prescription required by the patient. My heel pain/plantar fasciitis patients with rather average looking feet often do well with the prefabs or modified prefabs. Other categories of patients must have a custom device. For example, a patient with functional hallux rigidus/limitus often requires a device which effectively reduces forefoot supinatus perhaps including modifications such as a first ray cutout and extrinsic forefoot valgus posting. Another example, a patient with a history of Charcot arthropathy with a residual calcaneo-cuboid concavity; the orthotic shell need accomodate for that. It would be most challenging to create a study that compare custom vs. prefab when the prescriptions require a higher degree of customization.

    Perhaps the debate need shift to elucidate the scenarios where custom is required and where prefab might suffice. An untoward effect of the failure to do so is that ammunition is provided to corporate and governmental policymakers who have had an anti-conservative foot care bias which I believe is prevalent in the US.

    Competing interests