Fig. 11. Note more than doubled sole depth (red arrows) in 25 days while wearing the modified ultimate wedge.
nary papillae were very slightly displaced dorso- proximally. The proximal sublamellar zone was broken in continuity and slightly thickened. A very slight dorsoproximal fold in the circumflex vessels was noted. No terminal or solar papillae were noted until the heel region, and the solar plexus was compressed to an extent that one cannot make out individual vessels. The DP view also showed a me- dial and lateral lack of contrast over the coronary band. A blunt stoppage of contrast was noted over the lateral coronary band that did not fully improve on the unloaded palmarodorsal view. This is a common finding when a medial or lateral sinking occurs. Oftentimes, a wall resection will be re- quired in this area as this one did. The right front had similar yet more significant anatomical devia-
390 2018 Vol. 64 AAEP PROCEEDINGS
tions and compression. The right front lateral loaded view showed a lack of filling of the coronary plexus and proximal sublamellar zone and slight folding of the circumflex network with a lack of recognizable terminal and solar papillae. Pooling of contrast outside of the vascular network was noted just below the tip of the CB. The DP view showed a lack of filling in medial coronary plexus. All areas that exhibited a lack of contrast improved on the unloaded lateral and PD.
Mechanical Treatment
Heels were trimmed parallel to the wings of the CB, leaving as much of the heel mass as possible. A small toe prop was applied to the toe pillar region of the modified ultimate on the more upright clubby
