For Systems I & II, Easy & Custom
Orthotics can be made in several ways.
One way is by standing in a foam box. (Weight bearing) We can only produce Orthotics #1 – 7 this way and do not recommend this method. In order to produce a better fitting Orthotic the foot must be in the subtalar neutral position (non-weight bearing) to get the proper alignment of the foot. (See figure # 13 on back)
With the help of these instructions, our trained staff, rotator, and several other products being designed by Foot Function Lab we can have you taking that small extra step to ensure your patients are getting the best fitting orthotics available.
(Figure 1)Patient sits on chair with legs 90 degrees to floor. Put cast box on non-skid surface. Place left foot on left side of foam box. Place heel about 1 inch from the back edge of box and center foot in the middle of the foam. (pictured in figure 1)
(Figure 2) Place left thumb in the inner-space of the navicular & talus bones on the left foot. And index finger on the left side of the talus. This way you can feel for neutral position. Next turn left box lid counter-clock wise, which will pronate the heel or clockwise which will supination the heel. Then stop turning the box when you find that the navicular & talus are properly aligned. (subtalar- neutral)
(Figure 3)Picture shows heel and in-step in neutral position. In 80% of all feet you will find that the fore foot has a varus deformity. The first, second, & third metatarsals will be above the top of the foam (Drawing in figure 3) Later when the fore foot is pushed down you must keep the angle all the way down to bottom of box. (see figure 5)
(Figure 4) After setting the foot in neutral the right hand should still be in place on in-step. Then place your left hand on the patients left knee. With both hands push knee and in-step straight down until heel is at the bottom of the box.
(Figure 5) The left hand should still be on left knee. Place right back part of palm over the heads and if your hand is narrower than the foot be sure to use the lateral part of palm on the fifth metatarsal and the rest of palm on 4, 3, & 2. This is in order to feel the fifth metatarsal when it stops at the bottom of the box. Next push all of the metatarsal heads down keeping your palm at the same angle the forefoot
was in when you set the foot in neutral. (see figure 3) until the fifth metatarsal stops approximately 2 inches at the bottom of the box. Do not roll across the heads and push the first metatarsal down.
(Figure 10) Shows a proper cast, the heel and the lateral side of the fifth metatarsal is approximately 2 inches down at the bottom of the foam. And the first metatarsal is ¼” off the bottom of the box, which matches the fore foot deformity when the foot was first set in neutral as in figure 3. It’s important to keep the palm of your hand at the angle the fore foot is in when the heads are pushed down.
(Figure 11) The plaster cast shows where the ¼” post was added into the cast to fill in the missing space. This balances the deformity in the fore foot, so your patient can toe off evenly and walk more in the middle of the foot. It helps to track the knee and hip forward.
(Figure 13) When an impression is taken by simply stepping into the box, it is impossible to know how much to raise and correct the foot. The reason you must cast in subtalar neutral is as equally important as the reason for giving your patient an orthotic. You want to control and correct the patient’s foot. For the orthotic to be made properly, we must receive an accurate impression of the foot. When you send in a corrected foot we can make an orthotic to compensate for the corrections. Just as fitting a patient with a back brace. First, wouldn’t you straighten their back, before applying a brace?
Automatic “Foam” Casting Machine to make proper casting easier.