The Patient

A 68-year-old female with Rheumatoid Arthritis complaining of painful metatarsal heads bilaterally.

The patient is overweight at 95 kilograms. She has maximally medially deviated subtalar joint axis.

Prescribed Orthotic Type

Specialised Rheumatoid Arthritic Accommodative Device – This is a palliative device offering maximum shock attenuation. It is used in advanced arthritic and/or hypersensitive feet in athletic, walking or extra depth footwear. The patient would have absent functional ranges of motion. Spacious footwear is required to accommodate this device.

Lab Standard Description

  • Rubberflex and Thermocork shell with a poron arch fill- providing maximum shock attenuation.
  • 18mm heel cup- to optimise rear foot control
  • Functional shell grind with a sidecut and undercut- to fit to footwear.
  • Full length 1.5 Puff/ 1.5 Poron top cover with 1.5 nyplex bottom cover- shock attenuation

Optional Specs and Posting, Additions and Modifications

4mm Kirby Skive: selected to alter the subtalar joint axis;

Type 1 cast dressing: selected for a device that allows for little tissue spread on the plantar aspect of the foot.

Metatarsal Pad (Standard): used to off-load the prominent met heads. It is a Poron pad which is centred on the 3rd met, extending 3-4mm beyond distal edge of the shell. This positioning can be changed if specified in the order form and/or marked on the cast.