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Table 5 All accepted statements from the Delphi survey on prescription of customised FOs for symptomatic flexible pes planus in the adult

From: Consensus-based recommendations of Australian podiatrists for the prescription of foot orthoses for symptomatic flexible pes planus in adults

In the prescription of FOs for symptomatic pes planus, the following can be prescribed when… Agreement (%) Round accepted
Inverted cast pour [heel in an inverted position] The focus of treatment is increased rearfoot control (e.g. excessive rearfoot eversion/varus) 88.3 2
The STJ is medially deviated (frontal plane dominance) 70.8 2
There is tibialis posterior dysfunction 79.1 2
There is a high supination resistance 81.8 3
Neutral cast pour [heel in a vertical position] To reflect the foot position accurately 75.0 2
When rearfoot control is adequately addressed in this position 91.7 2
When inversion cannot be tolerated 81.8 3
Medial heel (Kirby) skive When there is medial deviation of the STJ axis 91.6 2
When additional rearfoot control required 100.0 2
With tibialis posterior dysfunction 75.0 2
With high supination resistance 86.3 3
Allows increased control without bulk 86.4 3
Greater anti-pronation force required at sustentaculum tali 86.4 3
To increase the calcaneal inclination in the sagittal plane as well as some inversion in frontal plane 81.8 3
No rearfoot post When footwear accommodation is a concern 75.0 2
Extrinsic rearfoot post To increase stability of device 91.6 2
Extrinsic rearfoot post (inverted) To increase rearfoot control (medially deviated STJ, high supination resistance) 79.2 2
In tibialis posterior dysfunction 90.9 3
Minimal arch fill To ensure foot posture captured is appropriately maintained 75.0 2
To achieve full amount of correction (when foot ROM allows) 79.1 2
Maximum arch fill In the presence of range of motion limitations 72.7 3
When there is a severe flat foot deformity (e.g. weight bearing medial cuneiform) 86.4 3
Medial flange In the presence of large midfoot transverse ROM (talus and/or navicular) 82.6 2
With tibialis posterior dysfunction 75.0 2
When increased medial control is required (midfoot support) 81.8 3
No forefoot post In the presence of forefoot supinatus when the supinatus can be reduced 72.7 4
Intrinsic forefoot post In the presence of forefoot valgus 70.8 2
To balance forefoot to rearfoot misalignment 79.2 2
When the inverted rearfoot position offers sufficient support to the symptomatic pes planus foot 72.7 3
With severe forefoot supinatus or osseous varus 90.9 3
Extrinsic forefoot post In severe midfoot collapse or fixed inverted forefoot deformities 77.3 3
Forefoot post balanced to perpendicular Standard practice outside of fixed forefoot deformities 75.0 2
To encourage the forefoot to be parallel with the supporting surface (offers stability) 81.8 3
Maintains rearfoot to forefoot balance 95.4 3
1st MTPJ cut out In the presence of a plantar flexed 1st ray 72.7 3
Plantar fascial groove When the plantar fascia is tight 83.3 2
When the plantar fascia is prominent (bowstrings) 91.7 2
When the plantar fascia is irritated or painful 100.0 3
To minimise risk of irritation 81.8 4
Metatarsal dome When forefoot pain exists (e.g. neuroma, bursitis, hyperkeratosis, metatarsalgia) 87.5 2
In the presence of digital deformities (claw/hammer toes) 83.4 2
If previously had success with a metatarsal dome 81.8 3
Cuboid filler Symptomatic lateral column or midfoot (e.g. subluxed cuboid) 90.9 3
Heel aperture In the presence of plantar calcaneal bursitis 79.0 4
A rigid, semi-rigid and flexible device Patient weight/size (increased weight = increased rigidity required) 91.7 2
Degree of control required (increased control = increased rigidity required) 87.5 2
Activity levels (increased activity = increased rigidity required) 77.3 3
Perceived tolerance of patient to rigidity 90.9 3
Footwear limitations 72.7 3
Available ROM/joint integrity 81.8 3
Longevity required from device 72.7 3
Stability is gained with maximum rigidity 72.7 3
  1. Notes: STJ = subtalar joint, ROM = range of motion, MTPJ = metatarsophalangeal joint.