Formulation of the Treatment Plan
From findings to a plan
Convert assessment findings into a problem list and measurable goals: protect skin, reduce pain, improve fit, stabilize gait, accommodate deformity, or maintain activity. Decide whether the problem is fixed or flexible. Accommodate fixed deformity and protect insensate or thin skin; control flexible deformity when the patient can tolerate it. Select device type, materials, and shoe modifications based on body weight, activity, shoe volume, sensory status, circulation, donning ability, cognition, and contralateral limb. Consider total-contact fit, arch fill, pressure redistribution, shear reduction, rocker profile, heel lift, wedges, flares, or toe filler. Plan break-in, follow-up, and communication with the care team.
Traps
A frequent trap is choosing a rigid corrective orthosis for a rigid, bony foot with fragile skin. Other errors are ignoring shoe gear, forgetting the contralateral limb, setting vague goals, and failing to plan follow-up. Questions may test whether you know when accommodation, not correction, is the safe choice.
Worked example
A patient has a rigid plantarflexed first ray and a callus under the first metatarsal head. Forcing motion is inappropriate. The plan should redistribute pressure with arch fill and an accommodative interface, verify shoe depth, and schedule skin checks.
Rule of thumb: accommodate what is fixed, control what is flexible, and protect what is insensate.