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Was this wrong? Put in foam box standing up.

Posted by Beverly on 5/15/01 at 13:15 (047817)

I have not been posting much... wrist problems. But this seems like an important question; so here I am.
Last week, I got fitted for my third set of orthodics... new city/new place.
I was told to stand in the foam box. Didn't you orthodics guys say not to do it that way? Can't remember for sure.
This place is immensely popular. The office was so packed I had to sit on the floor to wait my turn. Well, a crowded waiting room seems like a good sign but I was concerned about the way I was fitted. However, the person who did this was a fully credentialed orthodist... went to school, ect...
Thanks,
Beverly

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/15/01 at 13:41 (047818)

Hi Beverly,
I was taught 'not' to have the patient stand in the box. When you do this, you allow the foam to bottom out, thus defeating the purpose of subtalor neutral. I did an experiment standing in a box then having Mike push my feet down while sitting. The sitting orthosis gave much better support. The standing seemed much flatter.

I do hope they work for you though.

Richard

Re: Was this wrong? Put in foam box standing up.

bg cped on 5/15/01 at 14:02 (047821)

Richard is correct in my opinion. It also depends on what type of foot structure you have. If you over pronate or have an unstable foot this is especially a poor way to cast. It will not support your foot enough, you are taking an impression of a misaligned foot

Re: Was this wrong? Put in foam box standing up.

Pauline on 5/15/01 at 20:21 (047862)

My question is: Is it possible to get a better arch fit for a flatter foot using the foam box? I've have 3 pair of custom orthotics 2 pair
by casting, 1 by computer. Each pair exhibited too high of arch for me to wear. Adjustment after adjustment never provided a pair with a comfortable arch that would not hurt. It appears to me that the ideal foot position do design the so called proper arch for me is just too high
to begin with. I believe they were all were too over corrected.

Re: Was this wrong? Put in foam box standing up.

Dr. Zuckerman on 5/15/01 at 20:30 (047865)

The semi-weight bearing foam box method could help you if there was too much correction and the arch was too high

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/15/01 at 20:34 (047866)

Pauline,
It is hard to say. Sometimes it is who does the casting or impressions. I have had great success with the foam box. I think the type of material used will play a factor as well.
Richard

Re: Was this wrong? Put in foam box standing up.

bg cped on 5/15/01 at 21:48 (047879)

I have used foam in the past. The practitioner has alot to do with the resulting impression. If I am not mistaken the person indicated they 'stood up' in the box. That is a poor way to make a foam box impression. There is a company doing mail order that sends you a foam box to cast yourself at home. It is not something to learn in one shot on yourself.
One of the biggest flaws I see is a false ff varus where the foam floats the 1st mtp joint. If you have an unstable foot and you press down excessivly you get an elongated uneven impression.

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/17/01 at 07:55 (048055)

Brian,
I don't know about you, but I have had numerous patients come to me who said that when they received their previous orthotic, they were told to stand up. If you look at their orthosis, you can tell they did.

Richard

Re: Called to survey area pods/orthodists on method used/mixed bag

Beverly on 5/17/01 at 14:11 (048102)

After reading your replys, I decided I would play detective and call the other places in town that make orthodics and several area pods.
I asked, 'How do you make your orthodics?' One pod made them from a cast, two places said the foam box standing, another place said foam box sitting. Sounds like a point of contreversy. Everyone thought their way was the best way. Just leaves me, the poor patient, confused.
But at least this place makes them onsight and their office was packed.

They should be ready early next week. If they work, I'll let you know. I'm going to try to have more patience this time with adjustments and not giving up.

Thanks,
Beverly

Re: Called to survey area pods/orthodists on method used/mixed bag

bg cped on 5/17/01 at 18:39 (048126)

Beverly, The debate on casting methods is similar to religeous debate, The main difference is standing up in the box is not as bad if you have a high arch cavus foot. That footdoes not pronate enough, so standing e.g. wt bearing allows it to roll in a slight amount. This will keep the orthotic from 'holding' the foot in an already rigid too high arch position.

If you have flat, pronated, overflexible feet I dont think standing is good. Your problem is upon wt bearing your foot pronates or collapses too much. This is the cause of many of your foot problems. Taking a cast like this will just mimic the deformity of the foot. A device like this may feel ok cause you are just accomadating the foot. I would like to hear from any others that support wt bearing foam box casting for majority use.

I find that some people like it because it cuts down on adjustments due to the fact you are not doing much to the foot.

Re: Called to survey area pods/orthodists on method used/mixed bag

Donna SL on 5/18/01 at 14:28 (048214)

I don't think the standing position is good for any foot. What if you have a cavus foot, and a forefoot valgus, or rearfoot varus, and roll out, or in to much while standing in the box. You'll end up with an orthotic that doesn't correct anything.

Even with accomadative orthotics where a foam impression box is recommended, the person is suppossed to be sitting, and the cast done in a semi-weight bearing position.

Re: Called to survey area pods/orthodists on method used/mixed bag

Christian G. on 5/19/01 at 14:31 (048292)

Donna,
Are you a doctor,pedorthis,nurse,orthotist, or what? Have you had any medical or technical training in biomechanics?

Re: Called to survey area pods/orthodists on method used/mixed bag

Donna SL on 5/19/01 at 15:52 (048298)

No formal training. Just several years of research and self study.

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/15/01 at 13:41 (047818)

Hi Beverly,
I was taught 'not' to have the patient stand in the box. When you do this, you allow the foam to bottom out, thus defeating the purpose of subtalor neutral. I did an experiment standing in a box then having Mike push my feet down while sitting. The sitting orthosis gave much better support. The standing seemed much flatter.

I do hope they work for you though.

Richard

Re: Was this wrong? Put in foam box standing up.

bg cped on 5/15/01 at 14:02 (047821)

Richard is correct in my opinion. It also depends on what type of foot structure you have. If you over pronate or have an unstable foot this is especially a poor way to cast. It will not support your foot enough, you are taking an impression of a misaligned foot

Re: Was this wrong? Put in foam box standing up.

Pauline on 5/15/01 at 20:21 (047862)

My question is: Is it possible to get a better arch fit for a flatter foot using the foam box? I've have 3 pair of custom orthotics 2 pair
by casting, 1 by computer. Each pair exhibited too high of arch for me to wear. Adjustment after adjustment never provided a pair with a comfortable arch that would not hurt. It appears to me that the ideal foot position do design the so called proper arch for me is just too high
to begin with. I believe they were all were too over corrected.

Re: Was this wrong? Put in foam box standing up.

Dr. Zuckerman on 5/15/01 at 20:30 (047865)

The semi-weight bearing foam box method could help you if there was too much correction and the arch was too high

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/15/01 at 20:34 (047866)

Pauline,
It is hard to say. Sometimes it is who does the casting or impressions. I have had great success with the foam box. I think the type of material used will play a factor as well.
Richard

Re: Was this wrong? Put in foam box standing up.

bg cped on 5/15/01 at 21:48 (047879)

I have used foam in the past. The practitioner has alot to do with the resulting impression. If I am not mistaken the person indicated they 'stood up' in the box. That is a poor way to make a foam box impression. There is a company doing mail order that sends you a foam box to cast yourself at home. It is not something to learn in one shot on yourself.
One of the biggest flaws I see is a false ff varus where the foam floats the 1st mtp joint. If you have an unstable foot and you press down excessivly you get an elongated uneven impression.

Re: Was this wrong? Put in foam box standing up.

Richard, C.Ped on 5/17/01 at 07:55 (048055)

Brian,
I don't know about you, but I have had numerous patients come to me who said that when they received their previous orthotic, they were told to stand up. If you look at their orthosis, you can tell they did.

Richard

Re: Called to survey area pods/orthodists on method used/mixed bag

Beverly on 5/17/01 at 14:11 (048102)

After reading your replys, I decided I would play detective and call the other places in town that make orthodics and several area pods.
I asked, 'How do you make your orthodics?' One pod made them from a cast, two places said the foam box standing, another place said foam box sitting. Sounds like a point of contreversy. Everyone thought their way was the best way. Just leaves me, the poor patient, confused.
But at least this place makes them onsight and their office was packed.

They should be ready early next week. If they work, I'll let you know. I'm going to try to have more patience this time with adjustments and not giving up.

Thanks,
Beverly

Re: Called to survey area pods/orthodists on method used/mixed bag

bg cped on 5/17/01 at 18:39 (048126)

Beverly, The debate on casting methods is similar to religeous debate, The main difference is standing up in the box is not as bad if you have a high arch cavus foot. That footdoes not pronate enough, so standing e.g. wt bearing allows it to roll in a slight amount. This will keep the orthotic from 'holding' the foot in an already rigid too high arch position.

If you have flat, pronated, overflexible feet I dont think standing is good. Your problem is upon wt bearing your foot pronates or collapses too much. This is the cause of many of your foot problems. Taking a cast like this will just mimic the deformity of the foot. A device like this may feel ok cause you are just accomadating the foot. I would like to hear from any others that support wt bearing foam box casting for majority use.

I find that some people like it because it cuts down on adjustments due to the fact you are not doing much to the foot.

Re: Called to survey area pods/orthodists on method used/mixed bag

Donna SL on 5/18/01 at 14:28 (048214)

I don't think the standing position is good for any foot. What if you have a cavus foot, and a forefoot valgus, or rearfoot varus, and roll out, or in to much while standing in the box. You'll end up with an orthotic that doesn't correct anything.

Even with accomadative orthotics where a foam impression box is recommended, the person is suppossed to be sitting, and the cast done in a semi-weight bearing position.

Re: Called to survey area pods/orthodists on method used/mixed bag

Christian G. on 5/19/01 at 14:31 (048292)

Donna,
Are you a doctor,pedorthis,nurse,orthotist, or what? Have you had any medical or technical training in biomechanics?

Re: Called to survey area pods/orthodists on method used/mixed bag

Donna SL on 5/19/01 at 15:52 (048298)

No formal training. Just several years of research and self study.