NZOPA Case Study
OTS (of the shelf) Orthotics vs Custom Orthotics
Name: Wayne Newman
Phone: 029 124 0660
Email: wg.newman@yahoo.com
Date: ¬¬¬¬¬¬¬¬¬ 31 – 01 – 2021
Event Number: WGN-2021-352588
Sectin1: Job Details
Start Date: 29/10/2019
Finish Date: 12/06/2020
Referrer/Prescriber: Private Orthopedic referred with Bilateral Metatarsalgia – offload 2,3,4 Metatarsal Heads
Section 2: Abstract
Patient A is 57-year-old women, retired and extremely active. Privately referred from an Orthopaedic Surgeon due to pain in her MTHs bilaterally since her recovery after having Bunion Surgery in November 2018. Fully recovered from surgery now and would like to get back to running. Reported that the plantar surface in the forefoot regions on both feet become sore with increased activity, which has never happened before when running. Initially fit with OTS Orthotics, which did seem to work but ultimately were not enough. Later measured up for Custom Orthotics which provided enough support and off-loading necessary for high activity such as running.
Section3: Initial Assessment
Clinical Presentation
Subjective:
Patient A referred to for Orthotics from Orthopedic Surgeon. Had corrective Bunion Surgery in November 2018. Fully recovered from surgery now and would like to get back to running. Has found that the plantar surface of her forefeet around 2nd & 3rd MTHs becomes sore with increased activity. Never had pain previously.
Objective:
Patient presents with neutral feet. No misalignment present and ROM is WNR, except hallux ROM which is reduced from the corrective surgery. Pt’s gait pattern is normal except for slight reduction in toe off, which potentially might be increasing pressure at MTHs. Padding over MTHs appears adequate.
Patient did not bring her running shoes to appointment today – but confirms that they are quite old shoes and would need replacing.
Orthotic/Prosthetic Prescription & Aims:
– Support medial arches while allowing active pronation,
– Off-load metatarsal heads,
– Limit 1st Ray activation
Discussion with Multidisciplinary Team:
N/A
Section 4: Literature Review
Article 1
Over-the-Counter (OTC) Insoles vs Custom Orthotics | Berkeley Wellness
/self-care/over-counter-products/article/need-orthotics-try-otc-versions-first
Article 2
Custom orthotics vs. over-the-counter — it’s about more than cost | Great Basin Orthopaedics
Article 3
Prefabricated (Over-the-Counter) Orthotics versus Custom Orthotics – FootEducation
Section 5: Consultation details:
Consultation 1 (initial meeting) (29 October 2019)
Subjective:
Patient A seen today for assessment for foot orthotics. Was referred privately but may be eligible for DHB funding. Admin to determine funding status.
Patient reports having pain in her MTHs both feet since her recovery from bunion surgery in Nov 2018. Fully recovered from surgery now and would like to get back to running. Has found that the plantar surface of her 2nd-3rd MTHs becomes sore with increased activity. Never had pain previously.
Objective:
Patient A presents with neutral feet. No misalignment present and ROM is WNR, except hallux ROM which is reduced from operation. Pt’s gait pattern is normal except for slight reduction in toe off, which potentially might be increasing pressure at MTHs. Padding over MTHs appears adequate.
Unfortunately Patient A did not bring her running shoes to appointment today.
Treatment:
No treatment supplied. Patient is suitable for OTS orthoses with addition of metatarsal domes and leather top cover. Best suited to shock stops.
Advice:
Advise Patient A that we will investigate funding. Patient A is happy to pay privately otherwise.
Plan:
Rebooked for next week for fitting of OTS orthoses.
Consultation 2 (6 November 2019)
Subjective:
Patient A seen for modifying and fitting of customized shock stop foot orthotics.
Objective:
Has bought in neutral Asics sport shoes for insole fitting.
Treatment:
Modify small shock stop FOs with size 2 kidney met domes and cover with leather top covers. Fit to pt. Reports strange but not uncomfortable and is happy to trial.
Advice:
Advise Patient A to build up tolerance to FOs with low impact short activities before running with them.
Plan:
Review booked for a month. Patient A would like a second pair made for her casual shoes if insoles have been successful.
Consultation 3 (12 December 2019)
Subjective:
Review appointment today
Objective:
The Orthotics provided have worked well, has off-loaded the metatarsal regions but not enough. Right seems to be better than left now, even though Patient A tends to roll a little more that side. Both rigid hallux and these need to be blocked (Ganley Orthotics will do the trick). Then the shoes need to be changed (these are around 18 months old and have collapsed in both metatarsal regions and are too short) . . . size 9. And HOKA shoes will lessen the aggravation to the forefeet by limiting flexion.
Treatment:
Nothing today
Advice:
Patient will get new shoes, trial the current Orthotics and see how it goes for now. But we do have the new plan.
Plan:
Next appointment on 16 January @ 13:30
Consultation 4 (16 January 2020)
Subjective:
Review appointment today
Objective:
Patient A has started to run again, using the Shockstop Orthotics full time – started running again around 5 km a day – and all going well.
Treatment:
Measured for Ganley Orthotics (167 cm, 59 kg)
Advice:
Patient is awear of the cost for the Ganley Orthotics
Plan:
Fitting appointment once the Orthotics are done.
Consultaion 5 (14 February 2020)
Subjective:
Fitting Ganley Orthotics today @ OCW
Objective:
Patient A did get a set of HOKA Sport shoes and she loves them, they function exactly how I had explained. Left foot did seem to roll a little laterally and Patient A will watch this.
Treatment:
Just shaped the forefoot section to the shoes.
Advice:
Patient A is not to go running initially with The Ganley Orthotics for around a week or so till she gets used to the activeness of them and the 1st ray support.
Plan:
Review on request – and a set of Ganley Cobra Orthotics for dress shoes.
Consultation 6 (21 May 2020)
Subjective:
Assessment / Review Orthotics and Footwear today.
Objective:
Ganley Orthotics are perfect, HOKA shoes are causing some concerns (callous medial planter corner of both 4 toes), this started after a month (the HOKA seen to be a little narrow in the forefoot region). Walking around 10k a day (including trail walks)
Treatment:
Ganley Orthotics (Cobra) – previous scan
Advice:
New Asics (2E/4E)
Look after the callous
Plan:
Order – Fitting appointment when Orthotics arrive.
Consultation 7 (16 June 2020)
Subjective:
Fitting Cobra Orthotics today @ OCW
Objective:
Patient A has got the wider sport shoes and the concern is all gone, everything is going perfectly.
Treatment:
Trimmed the forefoot section only.
Advice:
Patient A to please make sure everything if functioning well, and that we have little to no aggravation when doing high intensity training.
Plan:
Discharged from care – Review on request.
Section 6: Critical Appraisal of Case Study
What have you learned from this case?
Well the case study actually confirmed what I already know and that is, Custom Orthotics are definitely much better due to the nature that they are Custom. But, Custom is not always available to our Patients for many reasons and thus OTS Orthotics are supplied due to the cheaper nature of them
What could have been done better?
Maybe price of the Custom Orthotics can come down for Private Patients?
Does this study contribute to prosthetic/orthotic research/evidence?
No not really . . common knowledge.
* Patient Consent is Available
