Question for the pedorthists.Posted by Ed Davis, DPM on 2/21/03 at 20:13 (110249)
I recently answered John's question on the 'treatments' board concerning rocker soles.
I often order distal rocker soles for hallux limitus/rigidus. Is there any convention or standardization as to what constitutes a 'mild,' 'moderate,' or 'severe' distal rocker sole? I know what to order intuitively and know what I will get from the pedorthists I use most often but may see a different interpretation of that order when patients go to pedorthist or ortho. shoe shop out of the area.
Re: Question for the pedorthists.Richard, C.Ped on 2/22/03 at 09:19 (110291)
Almost all the doctors I work with pretty much leave the material selection up to me, unless they have something specific in mind they want to use. I do have a few podiatrists that want me to fill their scripts exactly as they want. Pretty much I decide what type of material for soles as well as orthotics after spending time just chatting with the patients. While talking, I listen and try to find out what their lifestyle is like, such as being active or just walking around the house.
I also judge on their level of pain. If the toe is extremely ridgid, I will do a good rocker sole, but I may also add a strip or carboplast in order to get a more 'solid' rocker. We also sometimes add a layer of the carbon to the orthosis, heat it, then bend it slightly to add rocker. It seems to work very well.
I usualy tell my patients what I have in mind for them, but also let them know that I most often change my mind during construction. That is when I really start thinking about what they need.
Hope that helps.
Re: Question for the pedorthists.BGCPed on 2/23/03 at 21:20 (110561)
There is no standard scale that I am aware of. I usually base it on the degree of rigidity and activity level. I also check position of 1st ray. I see too many fo that have a varus ff post on pt with rigid or plantarflexed 1st. If you post under 1st you preload the shaft and rob it of a few degrees of what motion it has left.
I like to use springlite brand graphite plates. not all people will wear a shoe with a build up that is visible. I try to get them into an athletic running type shoe then use a plate with an fo. I think in some pedorthic books they show different types of rockers but not a standard of measuring them