What should be done for a patient complaining of gel insoles being too thick in the back?

Management of Gel Insole Thickness Complaints

For patients complaining about gel insoles being too thick in the back, trimming or modifying the insole is an appropriate solution, as demonstrated in this case where cutting material from the sides resolved the issue.

Assessment of Insole Complaints

• When patients report discomfort with insole thickness, particularly in the posterior portion, physical modification of the insole is a valid approach to improve comfort and function 1
• Thicker insoles, especially those exceeding 16mm, are associated with increased discomfort and adverse effects in up to 40% of patients 1
• Patient-reported symptoms should guide modifications, as there is a direct relationship between insole thickness and patient tolerance 1

Appropriate Modifications

• Trimming excess material from the sides or posterior portion of gel insoles is an effective technique to improve fit and comfort 1
• The goal of modification should be to maintain the pressure-redistributing benefits while eliminating discomfort 2, 3
• Custom modifications should be performed with attention to maintaining the functional integrity of the insole 3, 4

Alternative Options

• Offering information about commercially available alternatives is appropriate when standard-issue insoles cannot be adequately modified 5
• For patients with specific needs, directing them to sources where they can purchase alternative insoles (such as commissary options) provides patient autonomy 5
• Flat silicone insoles with universal fluid layers have shown 58% pressure reduction in standing and 37% in walking, which may be preferable for some patients 2

Follow-up Considerations

• After insole modification, confirm patient satisfaction with the changes and document agreement with the plan of care 1, 5
• If simple modifications don't resolve the issue, consider whether the patient has underlying foot pathology requiring more specialized assessment 5
• For persistent discomfort despite modifications, evaluate for foot deformities that might require different orthotic solutions 5

Common Pitfalls to Avoid

• Avoid excessive trimming that might compromise the structural integrity or pressure-redistributing function of the insole 1, 4
• Be cautious with modifications to wedged insoles, as altering the angle can affect biomechanical function and therapeutic benefit 1
• Don't overlook that insole thickness complaints may signal underlying foot pathology requiring further evaluation 5