A 26 year old male comes in requesting corrections and care for postural issues and hip, leg and foot pain. Using a computer molding system, we make an “impression” of the feet and send an order to have professional orthotics (shoe inserts) made.

The orthotics come back in a week, fit them in the shoe and the patient says they feel great, and right away the problem seems solved.

Patient is back a week later for a follow up, saying the orthotics feel great on the feet, leg and hip, but give him a headache. Put them on, headache but no foot pain. Take them off, no headache, but foot pain. Adjusting the patient does not seem to change things. Huh?

We get the orthotics cast again, but this time using a “less sophisticated” foam mold, and send the mold to the lab with custom instructions.  A week later, we try again, same result. Headaches, but no foot pain.  Patient feels better after an adjustment but doesn’t seem to hold the correction. This is getting expensive – for me (and the orthotic company), not for the patient!

What would you do? Cast them again? I was concerned about that. Posturally, he’s already “correct”. We have already done the right thing – twice. Would you cast a third time?

FINALLY, I had an idea. Let’s not do a “custom” orthotic this time – let’s go with a more “generic” correction.  A simple heel wedge. Aha! No foot pain, no headaches. Posturally, it’s all that it really basically needs to be, the clinical minimum, and the patient then holds an adjustment.  Keep in mind, 99.9% of cases will not behave like this – but this one did. And since we stayed on the case, it worked out.  Third time’s a charm.

So, even “the right treatment”, the treatment the patient wanted, wasn’t exactly what was needed. After we backed off in specificity a bit, with some dedicated attention, it became right.

Case presented with permission of the patient.

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