Arch pain when wearing orthotics can be problematic as it often encourages patients to ‘give up’ on orthotic therapy.
The Plantar Fascia is a fibrous tissue that does not exhibit the capacity to stretch or elongate and so often the fascia presses onto the arch of the orthotic causing discomfort.
The fascia assists in maintaining the longitudinal arch shape, however, can be an issue when it presents as a short fascia or excessively protruding fascia.
Image show Plantar fascial drop occurring at the 1st MTPJ performs the windlass mechanism during toe off phase of gait.
A tight fascia can also contribute to plantar fasciitis and heel spur syndrome due to the tension on the attachment at the calcaneus.
A Plantar fascial groove can be used when the plantar fascia is very tight or the patient indicates that the arch of the orthotic is causing pressure in the arch area.
Generally the plantar fascia position on the orthotic device is located approximately 1 cm lateral to the medial boarder of the orthotic device.
The ICB orthotic can be easily modified using a heat gun to heat the area to be deflected.
The groove can be made using metal scissors or another similar item.
When making the groove ensure that the heat is applied only to the plantar fascia position on the orthotic device to reduce any unwanted distortion of the EVA material.
For a more permanent solution the groove can be placed into the orthotic device using either a bench grinder or Dremel hand grinder.
The groove is created 1 cm from the medial aspect and runs the length of the arch of the orthotic device.
If the patient is suffering significant pain we advise the following step by step procedure to pain relief.
The first step would be to place a plantar fascial groove as this will allow the fascia a plantar drop and take pressure off the fascia.
If pain persists due to the arch collapsing on the arch of the orthotic use a bilateral Rearfoot Inversion addition which will reduce elongation of the fascia by inverting the rearfoot .
If further adjustment is required a 1st Ray cut away or 1st MPTJ deflection will be required to reduce tension on the fascia.
Both 2/3 and Full Length deflections work effectively in reducing the tension on the fascia.
Orthotic therapy is one in which some minor adjustment may be needed when treating patients.
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