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Different materials for orthotics

Posted by Aly on 8/11/03 at 13:56 (126729)

Hi Richard,

Can you pls comment on the differences between the various types of materials used in orthotics?

I've just returned from seeing an orthotist who feels that it's unnecessary for me to use fiberglass orthotics as my physician requested - he feels they are more difficult to make and adjust and that I could have as good results with a different type. The price difference he's quoting is significant (I believe he's recommending plastic).

What are your thoughts on this? If it's relevant to your answer, I have very high arches and notably flexible feet. Thanks!

Re: Different materials for orthotics

Richard, C.Ped on 8/12/03 at 08:36 (126762)

I personally use EVA. It makes a wonderful functional orthosis. Even the 40 durometer I use for my 'soft' orthosis provides a great functional orthosis (contrary to some opinions). Hard plastic such as poly prop is very very inexpensive...so that might be a reason why some people use it. Others will use stuff like this because they do not think there is a better alternative for a functional orthosis. I guess it comes down to personal preference. (Old dogs...new tricks??) My preference is EVA. Others may use nothing but hard plastic. Some use ppt and poron. Also, cork posting is big with many.

I have tried many many materials, and I find EVA easier to mold, grind, and adjust. I have used fiberglass....but only as an experiment. I like the EVA because it provides excellent support as well as cushion.

What it comes down to though is the prescription. If I received a script for fiberglass...I would call the doctor first. I would not change what was written from fiberglass to EVA without consulting the doc...that is if the script was signed on the 'dispense as written' line.

Thats my opinion. I bet if you asked ten C.Peds their opinion...you will get ten different answers.

Hope this helps...

Re: Different materials for orthotics

Aly on 8/12/03 at 12:02 (126771)

Thanks, it does help.

Re: Different materials for orthotics

BG.CPed on 8/13/03 at 08:21 (126825)

2x that Richard, I use eva of different durometers for 99%. I use carbon grahphite only for things with very limited space like figure or hockey skates. You can get eva in many different forms.

I get about 2 pt a month that have some 'expert' look at the insert I made that tell them that it is no good since it is not rigid plastic. The reasons are usually it wont control the foot (nonsense) and it will wear out faster.

My devices last several years so if it is more rigid and less comfortable but lasts longer who cares? I think you are right Richard its the old thats what I learned 20 years ago so thats what I do

Re: Different materials for orthotics

Carole C in NOLA on 8/16/03 at 09:12 (127116)

From reading what PF patients have said on this board for the past two years, I have found that very few have been happy with the hard 'ice scraper' orthotics (made of fiberglass or carbon graphite, I suppose). It seems that most of those who are happy with their orthotics have orthotics made with a layer of Eva. I'm not sure if these are considered soft or semi-rigid.

You are right. Eva controls my foot just fine; it's not like it's a foam sponge or something. It's also apparently easier to get used to and wear.

As for length of wear, I wonder about that. My glasses prescription changes every couple of years, and it seems reasonable that new orthotics might be a good idea every couple of years too. Do feet need the same orthotics during PF as before or after? I would think not, but I have no idea.

Carole C

Re: Different materials for orthotics

Richard, C.Ped on 8/18/03 at 08:14 (127207)

It depends. Someone may have mega swollen feet and the foot changes shape when the swelling goes down. Also, weight loss plays a factor. I do work for OBGYN docs around town. After the baby is delivered, of course, there is reduced swelling and weight loss. If they need or want to continue wearing the orthotics, I suggest having another pair made. To save money, I have taken a new impressions, and molded the old orthosis over the new cast....making necessary adjustments as needed. It still works, and saves the patient money.

Re: Different materials for orthotics

Ed Davis, DPM on 8/18/03 at 10:19 (127213)

You must have done a good job of education with the OB's --- that is often an area that gets ignored.

Re: Different materials for orthotics

Ed Davis, DPM on 8/18/03 at 10:25 (127214)

There are hundred of thousands of patients who are very happy with carbon graphite orthotics. The ones who are not happy wind up on boards like this because they have not had success.

I have tried to de-emphasize the materials used as less important than the exam, casting and fabrication techniques. Devices made of more rigid materials are less forgiving and thus require very exacting technique.

The provider also need make a good decision on the balance between support and shock absorbtion qualities needed in a device and that area is where material choice plays a role.