Allied Orthotic Adjustment Guide

Continuing our discussion from last week. Patients may have problems or issues with their custom orthotics. Here we talk about what can be done to solve their issues.

Metahead Pain

There are several things that can be wrong with an orthotic or the patient that will cause pain in the metaheads. Some of them are…

  1. Shell length is too long which pushes up on the meataheads and does not allow them to bend. In this case we can shorten the shell.
  2. Patient may have a neuroma. In this case add a metapad at whatever innerspace the pain is occurring.
  3. Patient may have metatarsalgia. In this case, add a metapad to lift up behind and float the painful metaheads.
  4. Transition at distal edge may be too abrupt. In this case, lower the transition at the distal edge.
  5. The distal edge is painful to patient’s metaheads. In this case it may be that the patient has sensitive feet and adding so soft poron padding may give some relief.
  6. The patient may feel a lump where the extrinisic forefoot post is. In this case, lower the extrinsic forefoot post, or make transition less abrupt.


Heel Pain

There are several reasons why a patient might be having heel pain due to their orthotics. Some of them are…

  1. The heel cup is pinching or digging into the heel. In this case, remake orthotic with a wider and or deeper heel cup.
  2. Patient may have heel spurs. In this case, add a heel spur accommodation.
  3. Patient may still be experiencing plantar fascial pain where it meets the calcaneus. In this case, raise the arch to better support the fascia.
  4. The pitch of the rearfoot post may be too high. In this case, lower the pitch of the rearfoot post.

Excessive Breakage

There are several things which can cause an orthotic to break that are not necessarily attributable to the lab. Such things are…

  1. Heavy patient- shell materials have weight limits. This is why client service may call on an order  the patients weight exceeds the limit. If the device breaks because of this reason you will need to either order a thicker or more rigid shell or add an arch reinforcement.  This would not be covered under warranty.
  2. Outgrowth- Children’s orthoses that break in the heel cup area are almost always due to outgrowth. Sometimes they will break or crack in the arch as well. The child will need to be re-casted, and a larger pair made. Children’s devices are only covered under warranty for one year.
  3. Abnormal usage- If the patient uses ladders, shovels, or anything which would cause stress to the bottom of the orthotic, it will probably break. This type of breakage is not covered by our warranty. A solution for this is use a thicker shell with some give like polypropylene or add an arch reinforcement to the device.


No matter the issue your patient may be having with their devices we are here to help make them perfect. If you have any questions or need any help at all call our client service line and talk to our friendly, knowledgeable reps. They are happy to help. You can also find an orthotic adjustment guide on our website.