Simple Insole Prescription Flashcards
Heel Raise
Description: A heel raise is the inclusion of
extra thickness of material
added to the rearfoot of the
orthoses. A firm material
such as EVA is used.
Nb. The Heel Raise can be
tapered or untapered to form
a block heel. It’s length is
dependent on indication but
can be extended to the full
length on the insole if needed. Indications:
- Achilles tendinopathy. - Patella Tendinopathy. - Osgood-Schlatter’s.
- Calcaneal Apophysitis - Unilaterally for Limb
Length Discrepancy.
- Contracture of Triceps Surae or Hamstrings.
- Rigid Forefoot Equinus. - Haglund’s Deformity.
Contraindications:
- A heel counter (or toe box) in shoe too
shallow to
accommodate the
increased thickness of
the device.
Heel Pad/Heel Cushion
Description: A heel cushion is a pad which
lines the heel region of the
insole to the line of the
Sustentaculum Tali to provide
pressure relief.
It can be applied dorsal or
plantar to the device. It is
made of a soft material such
as Polyurethane Foam or low density EVA. Indications:
- Calcaneal ecchymosis or fat pad contusion.
- Heel fat pad atrophy.
- Calcaneal oedema.
- Heel spur.
- Plantar fasciopathy.
- Calcaneal
Apophysitis.
Contraindications:
- A heel counter in shoe too shallow to
accommodate the
device.
Morton’s Extension (Long)
Description: A “Long” Morton’s extension is
a pad or thickened/stiffened
area that extends from the
medial aspect of the distal
portion of the insole at the
approximate level of the
styloid process to the apex
of the hallux as a minimum
but normally to the full
length of the insole.
Normally produced from a
semi-firm or firm material,
normally around 3mm thick. Indications:
- Short 1st ray.
- Metatarsus Primus
Elevatus.
- Hallux rigidus/ 1st
MTPJ Osteoarthritis.
- Lesser MTPJ pathology secondary to poor
loading / function of
the 1st MTPJ.
- Acute Turf Toe.
- HAV (If Rigid).
Contraindications:
In the absence of 1st MTPJ pathology, this addition
should be used with caution as it can reduce / restrict normal motion at the 1st MTPJ.
Plantar Metatarsal Pad
Description: A plantar metatarsal pad is a
pad that extends from 1/3rd
the length of the 5th
metatarsal to just distal of the
metatarsal heads transversing
the width of the forefoot.
Allowing for pressure relief
of the plantar forefoot.
Normally made of a soft
Polyurethane foam or low density EVA. Indications:
- To provide cushioning to metatarsal heads 1-
5
- MTPJ capsulitis
- MTPJ bursitis,
- Fat pad atrophy
- Excessive forefoot
callus.
Contraindications:
- Flexible Forefoot
Equinus Deformity.
Forefoot Extension
Description: Forefoot addition extending
from under the metatarsal
heads through to the full
length of the insole.
Normally made of a soft
Polyurethane foam or low density EVA.
Indications:
- Increased comfort
and cushioning
- Reduced fat pad
- Anterior shift fat pad
- Bony protrusions
- Corns and Callus
- Apertures for
exostosis, corns,
ulcers, verrucae.
Contraindications:
- Functional Hallux
Limitus.
- A shoe with toe box
not able to
accommodate extra
depth.
Forefoot Extension with 1st Metatarsal Cutout
Description: A forefoot extension with
1st metatarsal cut-out
added.
A thinner or softer material
may be used to fill the
cavity.
Indications:
- Functional hallux
limitus.
- Improve Windlass
mechanism.
- Rigid plantar flexed
1st ray.
- Sesamoiditis (with
soft-material fill).
Contraindications:
- Hallux Rigidus.
- A shoe with toe box
not able to
accommodate extra
depth.
Cluffy Wedge
Description: Wedge extending from the
1
st MTPJ under the proximal
and distal phalanx, thicker
distally. Normally made of
a higher density material
such as firm EVA.
Prescribed in degrees of
angulation. Indications:
- Functional Hallux
Limitus.
- Delayed windlass
mechanism.
- Aid propulsion.
Contraindications:
- Hallux Rigidus.
- Turf toe.
Cuboid Pad
Description: An addition of poron or EVA
pad under the cuboid on the
lateral border of the insole.
Made of a soft material such
as polyurethane foam. Indications:
- Cuboid syndrome.
- Support lateral
column.
- Lateral ankle
instability.
- Peroneal tendon
pathologies.
Contraindications:
- “Excessively” Pronated
Foot Posture.
Cobra Pad
Description: A combination of the heel
spur pad and Arch filler pad
produced by layering thinner
pieces of material. It is
designed to turn all aspects of
the foot into equal
weight bearing surfaces and to
stabilize the rearfoot.
Material density is determined
by the flexibility of the foot
and can be varied along the
length of the device. Indications:
- Fat Pad Syndrome.
- Calcaneal Bursitis.
- Plantar Heel Spur.
- Calcaneal
Enthesopathy.
- Reduce lateral
column loading.
- Pes cavus (high
arch).
- Increased arch
cushioning or
offloading.
- Plantar Fibroma
(with cavity).
Contraindications:
- Rigid Pes Planus
Rearfoot Medial/Varus Posting
Description: The application of firm
material to the medial
rearfoot of the device,
intended to increase
supinatory orthotic
reaction forces under the
rearfoot. Tapers towards
lateral border.
- Increases rearfoot
stability - Increases
rearfoot control - Used for
mild to severe rearfoot
posting angles
– Normally between 2 and
6 degrees.
Can be extended up to the full
length of the device for
continued increase in medial
ORF throughout gait cycle. Indications:
- ORF medial to STJ
axis creating a
supinatory force.
- Pes planus/pronated
foot type.
- Tibialis posterior
pathologies.
- Sinus Tarsi
Syndrome.
- Tarsal tunnel
syndrome.
- Medial tibial stress
syndrome.
- CPHP / plantar
fasciopathy.
- HAV/Bunions.
- Forefoot
pathologies.
Contraindications:
- Supinated foot
postures.
- Lateral ankle
instability.
Forefoot Lateral/Valgus Posting
Description: The application of firm
material to the lateral
forefoot of the device,
intended to increase
pronatory orthotic reaction
forces under the forefoot.
Placed under the 5th
metatarsal head and
tapers towards the 1st
metatarsal head.
Normally made of EVA.
Can be extended to sulcus
for prolonged ORF’s.
- Increases forefoot
stability
- Increases forefoot control
- Used for mild to severe
forefoot posting angles
– Normally between 2 and
6 degrees. Indications:
- Pronatory force on
forefoot required.
- Provide Orthotic
Reaction Force(ORF)
lateral to MTJ/STJ.
- Rigid forefoot
valgus.
- Improve propulsion.
- Plantar Fasciopathy.
- Lateral Ankle
Instability / Sprain.
- Peroneal
Tendinopathies.
Contraindications:
- Plantarflexed 1st
ray.
- Shallow footwear.
- “Excessively”
pronated foot
postures.
Metatarsal Dome
Description: A metatarsal dome is a
teardrop shaped pad made from polyurethane foam or other suitable soft material.
It is placed approximately 5mm proximal to the
metatarsal heads and can be positioned relative to a specific metatarsal head or intermetatarsal space
depending on indication of use.
Indications:
- MTPJ capsulitis
- Plantar plate
dysfunction
- Intermetatarsal
Neuroma
- Bursitis
- Fat pad atrophy
- MTPJ synovitis
- Heavy callus over
metatarsals 2-4.
- Metatarsalgia.
- Flexible digital
deformities.
Contraindications:
- Reduced forefoot
tissue viability.
- Rigid digital
deformities.
Metatarsal Bar
Description: A metatarsal bar is a fan or “T” shaped pad made from polyurethane foam or other suitable soft material.
It is placed approximately 5mm proximal to the
metatarsal heads and
transverses from the 2nd MTPJ to the 4Th MTPJ. Indications:
- MTPJ bursitis.
- Plantar plate
dysfunction.
- Fat pad atrophy.
- MTPJ synovitis /
capsulitis.
- Heavy callus over
metatarsals 1-5.
Contraindications:
- Reduced forefoot
tissue viability.
- Rigid digital
deformities
Reverse Morton’s
Extenison
Description: A reverse Morton’s extension is a pad that extends from the distal lateral midfoot of the insole to the sulcus of metatarsals 2-5. Normally produced from a semi-firm or firm material, normally around 3mm thick.
It can be used to assist in improving windlass
mechanism function.
Indications:
- Plantar fasciopathy
- Plantarflexed 1st ray
- Sesamoiditis
- Functional hallux
limitus, 1st MTPJ
bursitis
- Heloma durum /
callus present on 1st
MTPJ.
Contraindications:
- Hallux Rigidus
Morton’s Extension
(Short)
Description: A Standard or “Short” Morton’s extension is a pad or
thickened/stiffened area that extends from the medial aspect of the distal portion of the insole at the
approximate level of the styloid process to the sulcus of the 1st MTPJ. Normally produced from a semi-firm or firm material, normally around 3mm thick. Indications:
- Short 1st ray.
- Metatarsus Primus
Elevatus.
- Hallux rigidus / 1st
MTPJ Osteoarthritis
- Lesser MTPJ pathology secondary to poor
loading / function of
the 1st MTPJ.
- Acute Turf Toe.
- HAV (If Rigid).
Contraindications:
- In the absence of 1st
MTPJ pathology, this
addition should be
used with caution as it
can reduce / restrict
normal motion at the
1st MTPJ.
