Comprehensive guide to orthotic modifications including heel skive, forefoot posting, metatarsal pads, and specialized features with clinical indications.
Removal of medial heel material creates lateral ground reaction force, producing supination moment. Effective for controlling excessive pronation and supporting medial arch structures.
Indications: Excessive pronation, PTTD, medial arch collapse
Contraindications: Lateral ankle instability, rigid supinated foot
Removal of lateral heel material creates medial ground reaction force, producing pronation moment. Used for excessive supination or to improve shock absorption.
Indications: Excessive supination, lateral foot pain, poor shock absorption
Contraindications: Medial arch collapse, excessive pronation
Elevates medial forefoot to create pronation moment. Useful for forefoot varus compensation or when medial loading is desired during propulsion.
Indications: Forefoot varus, excessive supination, lateral loading patterns
Contraindications: Forefoot valgus, medial overload conditions
Elevates lateral forefoot to create supination moment. Addresses forefoot valgus or excessive medial loading during the propulsive phase.
Indications: Forefoot valgus, lateral chain overload, excessive pronation
Contraindications: Forefoot varus, lateral ankle instability
Dome-shaped elevation proximal to metatarsal heads redistributes forefoot pressure. Effective for metatarsalgia and Morton's neuroma symptoms.
Indications: Central metatarsalgia, Morton's neuroma, forefoot pain
Contraindications: First ray pathology, hallux limitus
Continuous elevation across multiple metatarsals provides broader pressure redistribution. More aggressive intervention than individual pads.
Indications: Diffuse metatarsalgia, diabetic forefoot ulceration
Contraindications: Normal forefoot function, athletic activities
Elevates first ray to address functional hallux limitus and improve first ray function.
Use: Functional hallux limitus, first ray hypermobility
Carbon fiber extension under first ray to facilitate propulsion and reduce hallux dorsiflexion demand.
Use: Hallux limitus, turf toe, first MPJ arthritis
Deep heel containment for improved stability and shock absorption during heel strike.
Use: Heel instability, plantar fasciitis, calcaneal fat pad atrophy
Complete contact under medial arch to provide maximum support and pressure distribution.
Use: Pes planus, PTTD, diabetic foot protection
Consider referral when multiple orthotic modifications fail to address symptoms, structural deformities progress, or complex multiplanar corrections are required.