Orthotic technique

Question 1

Intrinsic met dome/ no plaster fill between 1 and 5

Answer 1

in built met dome into the orthotic shell

Question 2

intrinisic versus exterinsic metdone?

Answer 2

is much lower bulk and it is usually used in dress shoes where thick exterinsic metdone is not accommodative

Question 3

Cubiod notch

Answer 3

• Designed to give more lateral perssure to the orthotic
  -adding latral stability and locking the foot
  locks the foot in the transition stage of heel lift to propulsion

Creating rigid liver and in generation of windlass mechanism
creates pronatory moment
advantages the peroneal

Question 4

Cuboid notch mechanism of action

Answer 4

To support the cuboid in cuboid syndrome and calcaneocuboid fault syndrome. The notch provides an upward force that resists any plantar subluxation or movement of the cuboid.
To facilitate movement of the centre of pressure medially during midstance to make use of Bojsson-Mollor’s high gear propulsion concept.
The cuboid notch will provide a pronatory moment at the subtalar and midtarsal joints.
The notch can help elevate the inclination angle of the calcaneus.
The notch will also help to pronate the putative oblique axis of the midtarsal joint and plantarflex the fourth and fifth rays – this is claimed to give the peroneus longus a mechanical advantage to stabilize the first ray.
To help prevent the foot sliding laterally off the foot orthotic if a lot of design features are incorporated into the foot orthotic to increase the supinatory moments on the foot (eg medial skive).
Clinicians are more likely to use a cuboid notch if they use a weightbearing or a semi-weightbearing negative modelling method as this modelling method lowers the lateral column.
They are also more likely to be used in traditional plaster based manufacturing systems as the standard for the addition of plaster to the lateral column to allow for foot expansion will lower the lateral arch profile in the foot orthotic.

Question 5

What is the advantage of exterinsic pad to intrinsic

Answer 5

Exterinsic pad can be added and grinded but intrinsic is not modifiable

Question 6

Plantar 5th ray grind

Answer 6

• Increase in the lateral arch height of the orthotic
  -Increase the arch height by appox 3mm

Question 7

Plantar fascial accommodation

Answer 7

• Accomodate the medial slip of the plantar fascia
• ## it also aid in stiffening of the orthotic shell

Question 9

1st ray accommodation

Answer 9

• adding more plaster to the medial distal end of the forefoot which allows the 1st ray to drop. it also has a first ray cut out. in this case we bring the forefoot post slighlty more proximal allow the shell balance and unlike the 1st ray cut out the shell does not rock

Question 10

difference between 1st ray cut out and 1st ray accommodation?

Answer 10

• Lowring of the shell from the medial cuneiform joint does allow the 1st met to drop and the shells balanced

Question 11

1st ray cut out

Answer 11

cut on the medial distal part of the shell
simply a cut away of the shell

Question 12

Extra heel expansion

Answer 12

• already there is 4mm heel expansion
• Extra heel expansion gives another 4mm in total 8mm. shoe fit should be considered as it make the orthotic very wide

Question 13

Medial flare

Answer 13

is the widening of the shell around the arch area where there is a medial buldging of the TNJ and there is concern with blistering

Question 14

Medial wrap or flange

Answer 14

extension of the arch of the foot

Question 15

Heel aperture

Answer 15

simply to lower the orthotic inside the shoe
Heel aperture would be more lateral based on the more rear foot correction required
No heel aperture in device more than 10 degress correction

Question 16

Heel stabiliser

Answer 16

3 options
full, half and mini
inly full heel stabiliser is available

Question 17

Lateral plantar grind

Answer 17

grind on the lateral aspect of the shell , used to make the shell thinner , flexibale and more accommodative in higher heel shoes

Question 18

Gait plate

Answer 18

is an extension of lateral aspect of the shell and used in children with intoeing