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To Dr. Lee

Posted by Pauline on 7/19/02 at 16:04 (090146)

What do you mean by the term 'Aggressive Form Fit Orthotics' What makes yours different and why are they aggressive compared to others?

Re: To Dr. Lee

Dr. David Lee on 7/20/02 at 18:17 (090230)

The cast impression and the orthotic should correct well enough to hold the arch of the foot so that the tension on the PF is decreased. This will prevent chronic reinjury to the PF. Most practitioners allow, during the manufacturing of the device, 'arch fill' to make the device more comfortable for the patient when first wearing it. However, this leads to a 'looser' fit and does not correct completely for the arch deficit. Additionally, most orthotists and DPMS cast in a supine postion which can lead to a 'pronate' (flattened) cast impression.

I cast in a prone position, use no or minimal arch fill, and correct for Terra Vera. (see below)

There is a measurement published in the Journals of Podiatric Medicine called 'Terra Vera'. This refers to the invert angle of the forefoot to the ground when the subtalar joint is in neutral position and accounts for any abnormal angulation of the whole lower extremity. For complete support of the foot and optimal biomechanical function a doctor should strive to correct in the orthotic as much of this as possible. By doing so you will decrease to the highest extent the chronic pulling on the PF. If this sounds confusing to you I apologize. You can find the article authored by NA Grumbine on Medline.

Re: To Dr. Lee

Dr. David Lee on 7/20/02 at 18:17 (090230)

The cast impression and the orthotic should correct well enough to hold the arch of the foot so that the tension on the PF is decreased. This will prevent chronic reinjury to the PF. Most practitioners allow, during the manufacturing of the device, 'arch fill' to make the device more comfortable for the patient when first wearing it. However, this leads to a 'looser' fit and does not correct completely for the arch deficit. Additionally, most orthotists and DPMS cast in a supine postion which can lead to a 'pronate' (flattened) cast impression.

I cast in a prone position, use no or minimal arch fill, and correct for Terra Vera. (see below)

There is a measurement published in the Journals of Podiatric Medicine called 'Terra Vera'. This refers to the invert angle of the forefoot to the ground when the subtalar joint is in neutral position and accounts for any abnormal angulation of the whole lower extremity. For complete support of the foot and optimal biomechanical function a doctor should strive to correct in the orthotic as much of this as possible. By doing so you will decrease to the highest extent the chronic pulling on the PF. If this sounds confusing to you I apologize. You can find the article authored by NA Grumbine on Medline.