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Improving Your Musculoskeletal Health... Starting With Your Feet

Patient Management Process

The patient management process is a step-by step outline.

Initial Evaluation and Fitting the First PCI

  1. Perform initial evaluation for using Posture Control Insoles.

  1. Use evaluation form #1 INITIAL EVALUATION to determine if the patient has Progressive Postural Arthritis.
  1. Generally all patients with Morton’s Foot can benefit from using PCIs. Patients who do not have Progressive Postural Arthritis should use PCIs to help prevent its future onset. For patients diagnosed with Progressive Postural Arthritis, PCIs will be an integral part of pain reduction and slowing its progression.
  1. Proceed to evaluate the patient’s arches and FMD. Record results on the Initial Evaluation form.
  1. Select the appropriate insole:
  • General rule: 30% of the First Metatarsal Deficit (FMD) is the recommended height of the PCIs.
  • FMD less than 12 - 14 mm choose 3.5 mm PCIs.
  • FMD greater than 16 -18 mm choose 6.0 mm PCIs.
  • If the patient is a Releaser, the general rule applies.
  • If the patient is a Bracer, always start with 3.5 mm PCIs even if the FMD measures 16 – 18 mm indicating 6.0 mm. Graduate the patient to 6.0 mm PCIs in 6-8 weeks or sooner if the patient starts complaining of feeling like the foot is trying to slide laterally in the shoe. 

      Important: Never start the patient with 9.0 mm PCIs. If the patient’s FMD measurement is 22-24 mm or more, start with 6.0 mm. After 7-10 days, evaluate the patient’s gait, observing hyperpronation, to determine if the patient needs 9.0 mm PCIs.

  1. Trim and fit insoles in the patient’s shoes. Have patient test by standing and walking with the new PCIs.
  1. Establish expectations for the patient.
  1. Instruct the patient on break-in.
  1. Instruct how to use the Patient Diary and remind the patient that you will review it during the next visit.

Follow-Up Appointment

Follow-up with the patient within 10 days of fitting the PCIs. (Recommended)

  1. Evaluate the patient relative to the recorded expectations.
  1. At this time the patient should not significantly notice the presence of the PCIs in their shoes. If there is any discomfort with the PCIs, make sure the PCIs are fitted properly in the shoes, and double check that the shoes are not too wide.
  1. Use the evaluation form #2 PCI FOLLOW-UP EVALUATION, the Patient Diary and dynamic observations to determine if changes to the PCI are necessary. If the patient response has not met expectation, take some time to analyze possible other limiting factors. Have the PCIs been worn according to recommendations? Have they been worn full time, work conditions etc.

  1. Based on a conservative first approach, the ground forces always go up at the first follow-up. Have the patient save the previous PCIs to be used with shoes that may not accommodate the higher ground force or use in slippers. 
  2. Bracers may be ready to increase ground force (3.5mm to 6.0mm).
  3. Releasers with flexible arches measuring in excess of 25mm FMD may be increased to 9.0mm.
  4. Patients with very low arches may be fitted with arch supports if necessary. Patients with functional flexible arches who used arch supports to transition from traditional orthotics may have the arch supports removed.

  1. If you fit the patients with new PCIs, remind the patient of the break-in period. Use the same break-in process as before, except this time alternate between the new PCIs and the original PCIs.
  1. Give the patient a new patient diary and a reminder that you will review it during the next appointment.

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