Basic Insole Adaption

Chairside Orthotic Adaptation Guide

Real-Time Customisation for Optimal Comfort and Function

Chairside orthotic adaptation refers to the process of adjusting and modifying orthotic devices directly within the clinic or podiatry practice, typically during a patient’s appointment. This real-time, hands-on approach allows healthcare professionals to fine-tune orthotics on the spot, ensuring a more accurate fit, better comfort, and improved biomechanical performance for each individual. In Australian podiatry and orthotic practice, this technique is widely adopted for semi-bespoke and prefabricated orthotic devices such as Slimflex Orthotics, due to their affordability, adaptability and easy modification.

What Is Chairside Orthotic Adaptation?

Chairside adaptation is the process of modifying an orthotic device while the patient is present. This may include grinding, heat-moulding, cutting, or adding padding to refine the shape, contour or functional elements of the orthotic. By making adjustments immediately, practitioners can respond directly to the patient’s feedback and achieve an optimised result in a single session. This approach saves time, enhances comfort, and increases patient satisfaction compared to sending devices back for lab modification.

The Chairside Adaptation Process

1. Patient Evaluation

The process begins with a detailed assessment of the patient’s feet, gait, and overall biomechanics. The practitioner observes how the patient interacts with their orthotic device — identifying areas of excessive pressure, instability or discomfort. This initial evaluation sets the foundation for targeted and effective modifications.

2. Identifying Issues

Common issues identified during assessment may include rubbing, irritation, arch misalignment, or uneven pressure distribution. These can occur due to subtle anatomical differences, gait abnormalities or wear patterns in the orthotic. Recognising these concerns early allows for precise, problem-specific intervention.

3. Modification Techniques

Chairside adaptation involves a range of modification techniques and materials designed to improve fit, function and comfort. Typical methods include:

• Grinding: Removing small amounts of material to improve contour, relieve pressure points or adjust posting angles.
• Heat Moulding: Applying gentle heat to reshape thermoplastic or EVA orthotics for better foot conformity.
• Cutting or Trimming: Adjusting edges or shortening the orthotic to fit different footwear types.
• Padding and Additions: Bonding pads, cushions, or wedges to modify support, redistribute load and enhance comfort.

4. Real-Time Feedback

One of the greatest advantages of chairside modification is immediate patient feedback. Patients can test the orthotic as adjustments are made, describing changes in comfort, stability and alignment. This dynamic interaction enables practitioners to fine-tune adjustments until the ideal result is achieved, avoiding guesswork and multiple return visits.

5. Patient Education

During the process, the clinician explains each modification and educates the patient on proper orthotic use, care, and expected adaptation time. This education helps patients understand why certain modifications were made and promotes better compliance with treatment.

6. Follow-Up

After initial adaptation, a follow-up appointment is typically scheduled to review progress and assess outcomes. The practitioner can then make additional refinements if required, ensuring long-term comfort and functionality.

Benefits of Chairside Orthotic Adaptation

• Instant Comfort: Adjustments are made in real time, ensuring the patient leaves the appointment with a comfortable fit.
• Enhanced Accuracy: The orthotic is modified based on live feedback, improving precision and clinical outcomes.
• Improved Compliance: Patients are more likely to wear orthotics that feel comfortable immediately.
• Reduced Turnaround Time: No need to return devices to the lab for remodelling.
• Cost-Effective: Particularly useful for prefabricated orthotics such as Slimflex Orthotics, which are designed for easy modification.

Recommended Orthotics for Chairside Modification

Slimflex Orthotics are one of the most widely used orthotic ranges in Australian clinics for chairside adaptation. They are lightweight, aesthetically professional, and made from high-quality EVA materials that respond well to heat moulding and grinding. Slimflex devices can be easily modified to create semi-bespoke orthoses tailored to the patient’s specific needs—an ideal balance between affordability and customisation.

Common Components Used in Chairside Adaptation

Chairside orthotic modification often involves adding or adjusting components to enhance comfort, improve function or address specific biomechanical issues. Below are some of the most frequently used components and their applications:

Metatarsal Pads

Designed to protect and offload pressure from the metatarsal heads, these pads can be placed precisely based on patient anatomy. They are effective for treating forefoot pain, Morton’s neuroma, and general metatarsalgia. Placement should be customised during fitting to ensure the pad supports the transverse arch without causing irritation.

Valgus Pads

Valgus pads (also called medial arch supports) are inserted inside the shoe or attached to an insole to support the arch and reduce pronation. They are particularly useful for patients with flat feet or fallen arches experiencing medial foot pain. These pads are not typically recommended for diabetic patients due to pressure concentration risks.

Cobra Pads

Cobra pads combine cushioning and medial support, offering a corrective element that helps guide the foot into better alignment. They are commonly used for mild pronation control and arch reinforcement while preserving comfort and flexibility.

Metatarsal Bars

Metatarsal bars provide even pressure distribution across the metatarsal region. They are ideal for relieving metatarsalgia, reducing peak forefoot pressure and enhancing gait comfort. These bars can be shaped or adjusted chairside using basic tools to suit each patient’s needs.

Heel Raises

Heel raises are die-cut EVA pieces designed to elevate the heel. They can be used individually under the insole or bonded to the orthotic for more permanent adjustment. Heel raises are commonly prescribed to correct leg length discrepancies, reduce Achilles tension, or relieve plantar heel discomfort.

Heel Cushions

Heel cushions provide soft pressure offloading for sensitive or bony heel areas. They are often used to relieve pain from heel spurs or bursitis. Materials such as Poron 4708 Medical Blue are popular for their durability, shock absorption, and medical-grade comfort. Heel cushions can be used independently or adhered to orthotic insoles for targeted relief.

Podotech Posting Components

The Podotech posting range includes a variety of wedges, heel posts and forefoot additions designed for quick and precise stabilisation and alignment correction. These components allow for incremental posting degrees to fine-tune the orthotic’s biomechanical control. Best of all, no specialised equipment is required - most modifications can be done with scissors and double-sided tape, making them ideal for fast, efficient chairside work.

Clinical Applications of Chairside Orthotic Adaptation

Chairside adaptation is commonly used to manage and refine orthotic treatment for conditions such as:

• Plantar fasciitis and heel pain
• Metatarsalgia and forefoot pain
• Flat feet and overpronation
• Morton’s neuroma and nerve entrapment
• Leg length discrepancies
• General foot discomfort and shoe-fit issues

In each case, chairside techniques enable immediate comfort improvements, better pressure redistribution, and enhanced long-term compliance.

Best Practices for Chairside Adaptation

• Always document each modification and rationale for clinical traceability.
• Use heat-mouldable, grindable orthotics like Slimflex for best results.
• Involve the patient actively in feedback during fitting and modification.
• Ensure all materials added are skin-safe, durable, and appropriate for intended wear duration.
• Reassess gait and comfort after modifications to verify improvement.

Conclusion

Chairside orthotic adaptation is a highly effective method for improving orthotic comfort, function, and patient outcomes. Through on-the-spot adjustments and immediate feedback, practitioners can achieve tailored results that enhance satisfaction and reduce follow-up issues. Using adaptable orthotic platforms such as Slimflex Orthotics and proven components like Podotech postings, metatarsal pads, and heel cushions, Australian clinicians can provide fast, cost-effective, and professional orthotic solutions that meet the needs of every patient.