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Being fitted for custom orthotics

Posted by Aly on 8/14/03 at 11:26 (126932)

Hi again Richard,

What is the best way to be fit for orthotics? The place I went to made some type of foam impression of my feet; I read online that the best fitting is done by taking a plaster cast of the foot. What do you think of the method that was used in my case?

Thanks for all of your assistance! :)

Re: Being fitted for custom orthotics

Richard, C.Ped on 8/14/03 at 16:32 (126951)

That should be fine as long as they did not have you stand up in the foam box. Some people make a slipper cast out of plaster strips. It makes a good cast, but is a little messy. We do our impressions with the patient in a semi weight bearing position (fancy talk meaning sitting down). We do not use the foam or plaster anymore. We have a secret way to take a much much better impression. heehee.

As long as you did not stand up, or they did not push your foot to the bottom of the box, you should be ok. You do not want the impression to 'bottom out' creating a flat heel.
Richard

Re: Being fitted for custom orthotics

Aly on 8/15/03 at 08:58 (127021)

Hi Richard,

Thanks for the reply. The orthotist had me sit while he pushed down on my knee. I take it from your message that this is NOT a good way to take the impression and that I should go someplace else? I have not given him the go ahead to proceed.

Re: Being fitted for custom orthotics

Molly H on 8/15/03 at 10:22 (127025)

Hi Richard-
I have orthotics (semi-rigid) I was casted lying down on my stomach. My pods office now has a computerized pad that you walk over several times, then they make your orthotic based on that. I would like to hear your opinion on that kind as if they are better, I will get new orthotics!

Thanks
Molly

Re: Being fitted for custom orthotics

Ed Davis, DPM on 8/15/03 at 11:28 (127029)

Molly:

I have not seen a computerized system, especially a pressure mat like the one you describe result in better orthotics than the classical casting method. It is a way to get the job done quicker, not better. Patients are often impressed with the high tech aspect, until they realize that the bells and whistles are just that -- bells and whistles (in my opinion).
Ed

Re: Being fitted for custom orthotics

Ed Davis, DPM on 8/15/03 at 11:31 (127031)

Aly:

I agree with Richard that that method is generally inferior. It is POSSIBLE to get a good device by that method at times though. If you are paying a significant amount, then I would advise that it be done by the best method possible.
Ed

Re: Being fitted for custom orthotics

Aly on 8/15/03 at 11:54 (127038)

Hi Ed,

In your opinion, is plaster casting the best method?

Thanks for your help!

Re: Being fitted for custom orthotics

Carole C in NOLA on 8/15/03 at 11:56 (127039)

You are so right, Dr. Ed. I was very impressed with how focused and skilled my C.Ped was when she made my orthotics. There seemed to be a real art to it. I wouldn't trade her experience, expertise, and skillfulness for any computer.

Carole C

Re: Being fitted for custom orthotics

Richard, C.Ped on 8/15/03 at 13:51 (127051)

Hi Molly,
The only orthopedic clinic in town that does not use us (their loss...LOL...they charge more than we do) uses the computer thingy. I think its silly myself. Its the same as if you were to stand to take an impression. I dont think it can really correct any biomechanical abnormalities.

Hope that helps out!!
Good luck to ya!!
Richard

Re: Being fitted for custom orthotics

Richard, C.Ped on 8/15/03 at 13:55 (127053)

Hey Aly...
Pushing on your knee is ok as long as the person doing it did not push your foot all the way to the bottom of the box. If they did not do that...then it might come out ok. It is hard to say. Like I said before...we use a better method than the foam. We stopped using that over a year ago.
Richard

Re: Being fitted for custom orthotics

Ed Davis, DPM on 8/15/03 at 14:42 (127056)

Aly:
Plaster casting is the best method, usually, because it allows the practitioner to manipulate the position of the foot as the impression is being made.
Ed

Re: Being fitted for custom orthotics

Carole C in NOLA on 8/16/03 at 08:55 (127114)

My C.Ped who made my super-fantastic and wonderful orthotics in 2001, had me sit and had sort of like elastic straps across my knee down to the floor to keep my knee from wobbling right and left. The straps also pulled down on my leg a little. She positioned my foot and pushed down a little, firmly and carefully, but it did not bottom out.

You should tell us about your secret method that is better than foam! None of your competitors (in South Carolina, as I recall) are likely to be reading here. People that read this board are spread out all over the world. Maybe some other C.Ped would read it and be able to help their patients in Timbuktu or California or somewhere. Besides, we might all die of curiousity if you don't tell us. :)

Carole C

Re: Being fitted for custom orthotics

Richard, C.Ped on 8/18/03 at 08:11 (127206)

haha...
we are working to make it avaliable to the market soon. I believe it gets a MUCH better impression than foam as well as plaster. (IMHO)
Richard

Re: Being fitted for custom orthotics

Ed Davis, DPM on 8/18/03 at 10:17 (127212)

Richard:

I would be interested in seeing your technique.

I am still waiting for decent 3-D computerized scanning technology (you know what I think about all the 2-D computerized pressure mats).
So far, the best technology I have seen comes from Bergmann Orthotic Lab of Chicago. Their technology is good but one must use their lab only with the scanner.
Ed

Re: Being fitted for custom orthotics

BGCPed on 8/18/03 at 12:11 (127227)

I think any computerized system that you walk over is flawed. You can at times get a device that a person will wear but they are not a very accurate way to take an impression. If a person has a flexible pronated foot that flatens out at midstance than why would you want a device that allows that excess motion?

I use only one lab for rigid devices and it is Northwest Podiatric. I make 99% of mine on a computerized scanner and milling machine. It is not a dynamic mold it is non wt bearing. I can modify it on the software or by adding posts etc.

I think the reason many rigid devices end up in the closet is that many people that provide orthotics dont know as much as they should. Also many labs just crank out the same poor devices. I dont think the material is the problem its pilot error.

Re: Being fitted for custom orthotics

Ed Davis, DPM on 8/18/03 at 12:35 (127232)

BG:
Again, I think you are right on target.
Ed