Today we will continue our review of the various pads and cushions available to customize your orthotic devices within the FootID Pro application. Many of these simple, yet effective additions not only increase the effectiveness of the orthotic devices, they also tend to increase the patient’s compliance due to increased comfort, and less disability by directly addressing the specific painful areas of the foot. Cushioning and offloading of prominences and supporting of weakened structures are time tested remedies that will only serve to benefit your patient above and beyond increasing their biomechanical efficiency.
“Pads and Cushions” is the sixth column of options within the FootID Pro configurator. We left off in the previous post at “Heel Pad” and “Heel Spur Pad” and now move on to the next field which is “Medial Flap”. A medial flap is an extension of the cushion, bottom cover, and top cover that begins just proximal to the medial arch and extends medially outward, mimicking the shape of a medial flange. It is soft and more accommodating than a rigid flange built into the shell. It is ideal for patients with semi-prominent navicular bones or flexible flat foot deformities that will not tolerate a rigid medial flange. Good examples of when the medial flap should be used include Posterior Tibial Tendon Dysfunction, Lisfranc’s Injuries, Charcot deformity, or a case of significant transverse plane deformity with significant media displacement of the Talo-Navicular complex coupled with midfoot and forefoot abduction. For extra medial arch support it may be coupled with a wide arch profile frame, or a Scaphoid Pad.
For the sake of continuity, we will now skip down a few fields within the configurator to “Scaphoid Pad”. A scaphoid pad is a Myolite padding added to the medial side of the superior frame and runs along its medial longitudinal arch. The padding begins at the medial distal rearfoot, terminates just past the medial 1st metatarsal base and extends laterally in a curved shape that typically does not pass the lateral cuneiform, replicating an arch’s negative space. It functions to cushion and support the medial longitudinal arch tissues. Clinical Indication is Posterior Tibial Tendon dysfunction, overpronation, and Accessory Navicular. They can be beneficial when a high arch frame is not tolerated well, a nice clinical pearl is some cases is to lower the frame in the medial arch and replace it with the same thickness of Scaphoid pad to maintain the arch level, yet make it much more tolerable. Some examples of when a Scaphoid pad is useful, is the reducible Cavus foot, and the over-pronated foot with a hypermobile first ray (metatarsus primus elevatus). Scaphoid pads are available in 1.5 mm to 6 mm thicknesses. By clicking the chain link icon in the top center of the field will allow you to designate left and right foot versus bilateral.
“Myolite/Plastazote Layer” A Myolite layer is a soft full length cushioning that covers the superior side of a devices’ heel cup and extends to the device’s selected length (mets, sulcus or toes). A Plastazote layer is an extra soft full length cushioning that covers the superior side of a devices’ heel cup and extends to the device’s selected length (to mets, sulcus or toes). The posterior, medial and lateral edges of the cushioning are skived and blended into the trimlines of the frame. This cushioning sits beneath the top cover and does not come into direct contact with the patient’s plantar foot. Myolite functions to increase comfort, add performance cushioning and disperses pressure. Clinical Indications include sensitive feet, leg length discrepancy and anatomy requiring offloading and pressure relief. Plastizote provides extra soft cushioning and conforms quickly to the patient’s foot shape. Clinically indicated in Diabetics, hypersensitive feet as well as other neuropathic states. Both full length cushion options are available in several thicknesses. One notable difference between the two options, is Myolite tends to maintain its resiliency over time, whereas Plastazote will compress and need to be augmented from time to time.
