Orthotic Solutions

Ball of Foot Pain/Metatarsalgia/Calluses/IPKs

This pleasant, 82-year-old lady came to me complaining of horrible pain under her second and third balls/knuckles/MTPJ of her her foot.

Her foot presented toes that looked like claws, with advanced calluses on the bottom surface at balls/knuckles 2 & 3 that are referred to as IPKs (Intractable Plantar Keratosis)(pictured). She came to me with my competitor’s orthotic for an opinion. This orthotic she brought had no accommodation for her calluses other than a metatarsal pad. This is a bump on the top surface of the orthotic that is believed to remove pressure off of the knuckles/calluses. It does this two ways. One, by attempting to straighten the claw-like posture of the toes by adding an upward pressure, thereby stopping the calluses from continuing to occur. Two, the upward pressure “unweights” the calluses when the foot is flat on the ground.*

Because her chief complaint was the obvious calluses, I had asked her if the previous practitioner had noticed them and if that was her chief complaint when she saw him. She said yes but that her current orthotic offered no relief. She said that he had told her the metatarsal pad would have taken care of the calluses. She noted that the calluses had done nothing but get worse over time. Because the orthotic was made very well, I did not see the reason to charge the woman $425 to be able to help her. As it was she paid over $700 for orthotics that did not help her enough.
What I did was place the orthotic over her foot, and mark exactly where her calluses lined up on the bottom of her existing orthotic. Then, taking the device into my laboratory, I used my industrial Dremel to grind out the bottom material, as well as some of the shell, creating a very deep platform for each of her respective calluses.

The difference for the patient was night and day.

*Why didn’t the metatarsal pad work? If you Google search DIY cures for metatarsalgia, clawed toes or calluses, you’ll see the call for metatarsal pad. Whereas with this patient, her calluses only became worse (unbearable even). How come?

The answer is this, her clawed toes were rigid and the upward force from the pad did nothing to straighten the toes (if anything it even added more pressure). Also, because of metatarsal pad is located immediately behind the balls/knuckles of the foot, when the heel leaves the ground (when the calluses are most vulnerable) the pad is nowhere. For specific pressure underneath balls of the foot, the best way to relieve the pressure is to create a depression(s) underneath the device.

Instead of forcing this woman to spend $425 on a pair of new orthotics (which any practitioner would have done), she was charged $100 for her adjustment.

52 year old Guyanese woman who had a under-corrected club foot surgery (Talipes-Equino-Varus) as a child. Today, this foot presents its the toes twisted inward and outer portion protruding outward. The most painful spot is the outer border of her left foot on the base of her fifth metatarsal bone (pictured by my finger in photo). The lower leg on that side is nearly 1 inch short. With her foot unable to reach the ground and her ankle fixed in downward pointing (Plantar Flexed), this painful spot hits the ground first and the foot is unable to act as a shock absorber to naturally unload that area. Feet like this cannot absorb shock, cannot compensate, and that have the most painful symptoms.
To help her, I immediately made a half inch heel lift. This will both compensate for the shortened tibia on the left side and accommodate her ankle’s naturally downward pointing fixed position. This lift will offload her painful spot, and simply help her tibia pass over her foot. Next, the insole of her shoe was modified to have a little bit of an arch pad. Previously, her foot arch is so high that it doesn’t touch the ground, this only puts more pressure on her painful spot. By giving her an arch pad, we bring the ground up to meet her foot, taking Some pressure off of her painful area. Her custom orthotic will do this much more effectively and her painful area will have a custom cradle to also not bear the same weight.
Because her leg length difference is greater than a half an inch, the patient was given advice to have a shoemaker raise the heel portion of her left shoe a half an inch to start. This will be a constant responsibility for the patient for the rest of her life, as will wearing good orthotics inside of her shoes.

Besides the surgery that she had as a child and does not remember, this is the first time this woman has showed her feet to anyone. We immediately sent her to a Podiatrist to get care on the callus of the bottom of her foot and to address any physical issues associated with her undiagnosed condition over these many years. Because her musculature of her lower leg on her left side is so atrophied, underdeveloped, and therefore tight, she most certainly needs physical therapy to regain some flexibility and musculature to help her walk more normally, and pain free.

Partial foot amputation as a child.

The missing portion of the foot creates a gait/shoe problem. The empty front of her shoe doesn’t bend properly, And her gait becomes less propulsive,and confident.

This is not a prosthesis but what’s called a “shoe filler”. It is custom-made, and fit into her shoe just like her custom orthotic that it sits upon.  The end result is a better functioning shoe, with a shoe filler that gives the patient a greater awareness of where the ground is, and therefore a more confident push off and stride.

Orthotic Solutions is hiring!
Attention: Science majors, Artists!

We are seeking a Lab assistant/Orthotic Technician

Candidate will learn classic orthotic craftsmanship techniques.
Responsibilities will include fabrication and all aspects of Orthotic practice.
Patient care, practice management, Pedorthic techniques.

Busy midtown Manhattan orthotic laboratory seeing patients directly. Technician will work directly underneath Spencer Weisbond, C.Ped.
Competitive hourly wage, lunch included, will pay to train.
Learn from the best!

Submit resume to:
[email protected]
!Equal opportunity employer!
OrthoticSolutionsNY.com