Many doctors prefer to make their own adjustments to save additional time and expense. Also, the correct amount of adjustments necessary can be more accurately judged since you are in close contact with your patient. To make adjustments, some equipment and supplies are needed. These can be purchased from any podiatry supply house: a motor with a drum sanding wheel, a spot heater for plastics, a pair of scissors, and a ball peen hammer. Materials include adhesive felt, cork, korex, sponge, Barge cement, and thinner. Before applying any permanent corrections, it’s usually best to add the corrections with adhesive felt. That way, patients can try it immediately in the office, and if it’s not comfortable after they leave the office, they can remove it. If a patient has worn the felt comfortably for two weeks, you or the lab simply need to apply the corrections permanently.

Leather Orthotic Adjustments after Felt Trial Period

All adjustments should be made on the bottom of the orthotic in order to preserve the contour of the orthotic. Bottom covers are removed by applying glue thinner with a brush. After about 30 seconds, the cover is peeled off, being careful not to tear it. If resistance is encountered, apply additional thinner and let saturate for a few minutes. Add additional thickness by using any of the materials previously stated. The type of material used depends on the amount of firmness the patient can tolerate. The material is cemented to the device following instructions listed on the Barge container. Where there is too much pressure concentrated in one area, remove the filler material using the sanding machine. Make sure you remove only as much as required. If the area involved has celastic under it, the area can be softened and reduced in height by using a small hammer or your hands to soften the celastic. All adjustments should be made on the bottom of the orthotic. The ball peen hammer can also be used to pound down the high spot.

Special Corrections

When a patient complains of the heel raising out of the shoe, skive or grind down the device just anterior to the heel. When the orthotic is too wide for the shoe, skive down the sides of the device, usually about twice as much on the medial border, to narrow the base of it. Usually it is not necessary to trim the edges but simply thin them.

Wken orthotics slip from side to side in the shoe, add material to widen the base of the device. Again use adhesive felt first before adding the material permanently. Because slippage is usually medially, material should be added on this side to block it from displacing medially. When the orthotic slips forward in the shoe, thin down through the longitudinal arch at the midtarsal just anterior to the dorsal inclination of the calcaneus.

Thermoplastic Orthotic Adjustments

If orthotics are too long, grind off distal aspect, making sure to follow bevel lines of the orthotic and metatarsal length pattern. If the plate is too wide, it is usually best to remove width from the medial side, again following the contour of the orthotic.

Additionally, posting can be applied as needed. Temporary posting should be applied with adhesive felt, then cork or korex can be added for permanent control, sanding to the desired amount of varus or valgus posting. Usually pressure irritation, when encountered, is at the borders of the orthotic. When this is the case, a spot heater can be used. Unithotics™, Bio/Balance™ Sports, Women’s Pump, Heel Stabilizers, and Microthotics™ can be pounded with a hammer at high impact to reduce or raise the areas. Heat moldable orthotics such as Bio/Graphite™ and the Classic Functional orthotic can be heat molded to change the shape. A potholder or glove can be used to protect your hand from heat while molding. Apply only as much heat as needed to make the edge pliable. Too much heating will burn the plastic, causing it to be more susceptible to cracking. You now can lower the area to the desired amount needed to reduce pressure.

Adjustments by Our Lab

If you prefer to return the orthotics to our laboratory for adjustment, your and your patient’s observations as to the difficulties the patient is having should be given. The patient usually complains of lack of support or of too much pressure in certain areas of the foot. Advise our lab how much additional correction should be added to the orthotics or how much correction should be reduced at certain areas of the foot. It does not help us for you to simply state that the orthotics are not comfortable. Tell us why they are uncomfortable. We charge a nominal fee for adjustments to cover material, labor, and postage. We feel that adjustments are necessary for one of three reasons: our lab can misinterpret instructions, sometimes the doctor’s instructions or casts are at fault, or the patient fails to cooperate with the doctor as to the selection of the proper shoes.