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JSPT -> RE: when do patients need orthotics (March 20, 2008 5:51:30 AM)
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I make orthotics, and here is how I decide:
1. Does the patient have a fairly flexibile foot deformity?
2. Are the patient's symptoms distal or proximal? It is my contention that the effect orthotics have are dissipated as you travel proximal. I don't think that someone's back or neck pain can be improved with orthotics. So, foot, ankle, or knee pain is more likely to be alleviated with orthotics.
3. How does the patient respond to taping? I use McConnell tape to suppor the subtalar joint and have the patient walk around for a few days with it on. If they feel better, I'm more likely to try custom semi-rigid orthotics. If the patient weighs over 200# or has a more rigid foot, I may try a rigid orthotic.
It is worth noting that I tell every patient that orthotics are 1/3 of the solution. The other two components are stretching what is tight and strengthening what is weak, and activity modification (not walking around without shoes on, etc.)
For your patient, I'd look at the hip abductors and external rotators, as well as the hip and low back extensors. I'd also have them do the ITB roller stretch. It took me awhile to figure out that in people with ITB symptoms, unless I address the entire kinetic chain, won't get better.
Hope that helps.
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