If you’re in situation where you don’t have time to do a full gait evaluation, the method detailed in this article may be helpful.

“Since orthotics with varus posts have been proven to reduce the velocity of pronation¹⁵ and gait retraining can reduce impact force,¹⁶ measuring the arch height ratio may allow for improved clinical outcomes, as the patient’s foot architecture may be more precisely matched to the ideal intervention.”

Click on the title above for the full article.

If you need continuing ed. points and can make it to this course, it is a must!

If you do orthotics on a regular basis for your patients, you will come away from this course with a better understanding of how to choose materials, choose posting angles and use different casting techniques.

Also, you will learn how to troubleshoot problems and avoid common mistakes.

I will be attending this course and I hope to see you there!

Dr. Kirby has been kind enough to share much helpful content on the Facebook page for his Podiatry practice.

There are a lot of helpful pictures and diagrams also….

Dig in and let me know if you have questions!

grind rf post 2 from Joe Vasquez on Vimeo.

Also, there are those of you that want to adjust the angle on a RF post on an existing orthotic while your patient waits.

As you see, the camera man is facing me while looking directly over the machine to get a clear view.

The first thing to notice:

4 seconds in: See how I tilt the orthotic slightly.

A little goes a long way here. It is a very slight tilt that you see. Tilting the distal, medial corner of the orthotic at the 1st met lower, or closer to your body will add a varus angle to the orthotic.

Tilting the opposite way will add a valgus angle. If you hold the distal edge parallel to the wheel, you will grind a flat angle into the heel.

27 seconds in: Notice how the sound changes when I start to contact the plastic….

When you are grinding, it is helpful to listen for the change in sound as the wheel starts to hit the plastic.

This is helpful because you will not have a sense of how much to grind off. When you hear the change in sound, it will help you to know that you are just about there!

Are you used to adjusting rf posts on your own?

Vacuum Forming Core Material from Joe Vasquez on Vimeo.

Some things to consider:

Arch Height.

If you notice that the arches on your devices are coming out higher than the arch on the cast, it could be an indication that the core shells are not cooling down on the vacuum press.

The plastic should be left on the press until completely cooled. If if is taken off too soon, the material will curl up and the arches will seem higher.

Flexibility & Width.

The plastic has to be heated at the correct temperature and taken out of the oven at the right time. 

If it is heated at too high of a temperature and/or left in the oven too long, the plastic could shrink up and thin out. This will make the shell seem more flexible than it should.

If it is heated at too low of a temperature or taken out of the oven too soon, it will not wrap around the perimeter of the cast completely and the heel will be wider than it should be.

How Arch Height Effects Flexibility.

Keep in mind that the higher arches will make the shell feel stiffer than the lower arches.

For example, you could have two patients, one with a Pes Cavus foot and one with a Pes Planus foot. They could be the same shoe size and same weight and you could use the same plastic thickness for both of them.

The higher arched Pes Cavus shell will feel stiffer than the low arch Pes Planus shell.

So just remember…. the more acute the curvatures are that the plastic is being formed to….the stiffer the shell will feel. By the same token, the milder the curvatures are that the plastic is molded to, the more flexible the shell will feel.

Stay tuned! We will be looking at frontal plane posting soon!

What do you think?  Have you considered the variables at this step in the process?

Fine Tuning With File from Joe Vasquez on Vimeo.

I am thinking…

of contours and shapes here, as in the previous step. I want to remove any abrupt curvature that could be uncomfortable.

I can add…

an increase to the anterior metatarsal arch (AMA) to support the metatarsals. Think of this as a met pad built into the shape of the shell.

Also, I can increase calcaneal angle (ICA) to raise the distal aspect of the calcaneous and lock it up into the cuboid better.  This looks like a cuboid pad built into the shell shape. This results in a stable lateral arch if the calcaneal/cuboid joint is loose.

Both of these additions would take shape in the core shell material once it is molded to the cast. Modifications of this type are referred to as “intrinsic” to the shell.  I will be addressing both of these additions more specifically down the line here on the blog.

The benefits of intrinsic additions is that they take up less room in the shoe. Be aware that they are more permanent than adding a pad on top of the shell. To make changes, we would have to remake the devices as opposed to removing pads.

In the next video, we will take a look at molding the core shell material to the casts…

Feel free to get these articles automatically delivered to your inbox by clicking here: My free subscription.

Smoothing & Shaping after Plaster Additions from Joe Vasquez on Vimeo.

• Concentrating on “feel” during this step. Trying to follow the general topography of the foot.
• Here we are also trying to create good shapes and contours, especially transitions from one area to another. For instance, the transition from the distal medial calcaneous into the proximal arch is an area that I don’t want to be abrupt.
• At this step as well as the next, some of the added plaster comes off. If it looked like a lot of plaster was added in the previous video, here is where some of it comes off.
• The next step will be filing the cast after it dries for about thirty minutes. In the filing process, the shapes and contours are fine tuned even more.
• More videos in the future! Be sure to subscribe here to receive these articles in your email inbox…

Any questions about this step? Have you seen this done before?

Artwork and Precision at Work-Plaster Additions from Joe Vasquez on Vimeo.

I Apologize.

This was the first of two days of shooting video with an unfamiliar camera. There is a bit of focusing and refocusing going on in the middle of the video. Please take your motion sickness pills before viewing! Just kidding, its not too bad, but I thought that was good enough to give you a picture of how plaster additions are done…

The Trick.

The hard part is that the plaster is drying as I am working with it. I want it to dry a little before I smooth it out more with my hands, but I don’t want it to dry so much that it is too hard to work with in my hands. Always a delicate procedure for me!

The Takeaway.

This step is critical to a comfortable functional orthotic. Because of the skill involved, you will want the same person doing this for all of your patients. If you can’t get that to happen, your best bet for consistency is to go with laser scanning.   Question: Have you seen this done before? Do have any questions about this critical step?