Orthotic Additions & Modifications

Metatarsal Pad

Description 
A 6mm thick domed shape poron designed to lift and spread the metatarsals, recreating the transverse arch.
Uses
An excellent addition for treating forefoot/transverse arch problems such as : dropped metatarsals, metatarsalgia, hallux valgus, interdigital neuroma, interdigital bursitis, hammer toes, excessive callousing and a reduced transverse arch.
Contraindication
Rigid or immobile forefoot; tarsal coalitions.
Notes
We recommend that distal metatarsal pads be used bilaterally. The size of the metatarsal pad is determined by our technicians. This addition is usually placed centrally at the distal edge of the orthotic shell, but can be placed slightly more distal.

Full Heel Cushion

Description 
A 3mm foam pad covering the entire heel cup area.
Uses
Specifically designed for patients with plantar fasciitis, a non-centrally located heel spur, loss of fat pad or those who require additional rearfoot shock absorption.
Contraindication
Shallow heel counter in shoe.
Notes
Should only be used bilaterally, to avoid creating a limb length difference. This modification should only be placed in shoes that will accomodate extra bulk in the rearfoot. The full heel cushion should not be used in conjuction with a heel spur pad.

Heel Spur Pad

Description 
A horseshoe shaped 3mm poron pad, placed around the periphery of the heel cup area. Designed to lift the calcaneus off the orthotic and relieve pressure at the site of a centrally located spur.
Uses
Specifically used for treating patients with centrally located heel spurs.
Contraindication
A non-centrally located heel spur; shallow heel counter in shoe.
Notes
A heel spur pad should only be used for radiographically confirmed centrally located heel spurs. The heel spur pad should always be used bilaterally to avoid creating a limb length difference. The heel spur pad should not be used in conjuction with a full heel cushion.


Hole in Heel

Description 
A 1 1/4" hole cut through the orthotic shell under the calcaneus.
Uses
Designed to accommodate heel spurs in dress shoes where a spur pad may cause fitting problems.
Contraindication
A non-centrally located heel spur; shallow heel counter in shoe when used with a full heel cushion or heel spur pad or extrinsic rearfoot post.
Notes
Works optimally in conjuction with an extrinsic rearfoot post and either a full heel cushion or heel spur pad.

Hole in Heel with Foam Disk

Description 
A 1 1/4" hole cut through the orthotic shell under the calcaneus. As as option, a 3mm thick foam disk can be placed in the hole of the heel.
Uses
Designed to accommodate heel spurs in dress shoes where a spur pad may cause fitting problems.
Contraindication
A non-centrally located heel spur, shallow heel counter in shoe when used with a full heel cushion or heel spur pad or extrinsic rearfoot post.
Notes
Works optimally in conjunction with an extrinsic rearfoot post and either a full heel cushion or a heel spur pad.

Morton's Extension

Description 
A 3mm foam pad placed under the 1st metatarsal-phalangeal joint, from the distal end of the shell to the distal phalangeal joint. Designed to raise and slightly immobilize the great toe.
Uses
Designed for patients with a dorsiflexed first ray, turf toe, hallux rigidus or patients with a short 1st metatarsal (short 1st metatarsals are very rare and are not to be confused with long 2nd metatarsals).
Contraindication
Footwear with a narrow toe box.
Notes
Only available with a full length orthotic. Morton's Extension should usually be used in conjuction with a metatarsal pad.

Reverse Morton's Extension

Description 
A 3mm foam pad placed under the 2-5 metatarsal-phalangeal joints to the sulcus. This is designed to take pressure off the 1st metatarsal-phalangeal joint and slightly dorsiflex the 1st.
Uses
Designed for patients with plantarflexed first day, hallux limitis, sesamoditis, and severe forefoot valgus deformity.
Contraindication
Forefoot Varus; footwear with a narrow toe box.
Notes
Only available with a sulcus or full length orthotic. reverse Morton's Extension should usually be used in conjunction with a metatarsal pad.

1st Metatarsal Cut-Out

Description 
A cutout to the orthotic shell under the 1st metatarsal-phalangeal joint at the distal-medial aspect of the orthotic shell. This is designed to slightly plantarflex the 1st ray and pronate the forefoot.
Uses
Most commonly used with functional hallux limitus and supinators. A 1st metatarsal cut-out drops the first metatarsal down (into plantarflexion) and forces the forefoot into pronation,achieving a better toe-off and conversely a better heel strike.
Contraindication
Osteoarthritis in the 1st metatarsal, forefoot varus.
Notes
Under no circumstances should a 1st metatarsal cut-out be used on a patient with a pathological 1st toe, as this modification will act to aggravate any 1st toe pathology.

Reinforced Arch

Description 
A 3/8" (10mm) poron arch fill laminated to the plantar surface of the orthotic. This is designed to add rigidity to the orthotic.
Uses
Used most commonly when a patient is more that 280 lbs and needs more biomechanical support than our most rigid (3.5mm) orthotic can offer.
Contraindication
Narrow or tight fitting footwear; cavus/rigid feet.
Notes
A reinforced arch should be done bilaterally, and should not be used for patients less than 240 lbs. Should only ever be used with shoes that can accommodate a bulkier device.

Heel Raise

Description 
An extrinsic heel lift added to the underside of the orthotic. The lift is manufactured using extra firm posting material.
Uses
A unilateral lift is used for patients who have an anatomical leg length discrepancy. A small heel lift can also be used bilaterally to treat patients with limited ankle dorsi flexion (i.e. Equinis) or Achilles tendonitis.
Contraindication
Functional leg length discrepancy; older patients who have never worn a heel lift.
Notes
For an anatomical leg length discrepancy, please indicate which leg requires a lift. The maximum lift height is 10mm, although most shoes will not accommodate that high a measurement. Always extrinsically post the non-lifted orthotic unless space is an issue. First time heel lift users should never be corrected more than 50% of their total leg length discrepancy. When used bilaterally for limited ankle doris-flexion (i.e. Equinis) or Achilles tendonitis a 3mm lift is recommended.

Rearfoot Extrinsic Post

Description 
Extra firm posting material added to the plantar surface of the orthotic heel to further stabilize and invert the foot.
Uses
Used for moderate to severe over pronators, unstable feet, and people who weigh more than 240lbs.
Contraindication
Tight fitting footwear.
Notes
Rearfoot extrinsic posts add bulk to an orthotic and should always be used with shoes that can accommodate a slightly bulkier device. Options: Neutral: To add stability particularly for patients with rigid/cavus feet. Varus: To correct for moderate to severe over pronators.



Sandwich

Description 
A 1mm vinyl cover placed under the forefoot of sulcus or full length orthotics.
Uses
To add rigidity to sulcus or full length topcovers.
Contraindication
Footwear with a narrow toe box.
Notes
Specifically to be used for running or court shoes where reinforcement is required.

Hard Medial Flange

Description 
Medial border of the orthotic is extended upward to provide additional containment around the medial longitudinal arch (MLA).
Uses
For severely spronated, pes planus, everted foot types, genu valgum; stabilizes the subtalar and midtarsal joints.
Contraindication
Dress or narrow fitting shoes.
Notes
Suggested to be used in conjuction with an extrinsic rearfoot post in wider fitting shoes.

Hard Lateral Flange

Description 
Lateral border of the orthotic is extended vertically upward to provide additional containment around the lateral longitudinal arch (LLA).
Uses
For severely supinated, pes cavus, inverted foot types, genu varum; to increase stability and help prevent inversion sprains.
Contraindication
Dress or narrow fitting shoes.
Notes
Suggested in conjunction with an extrinsic rearfoot post in wider fitting shoes.

Medial Rearfoot Skive

Description 
An intrinsic grind at 15 degrees into the medial aspect of the positive cast to a depth of 2mm, 4mm or 6mm.
Uses
To intrinsically correct for excessive over pronation.
Contraindication
Dress or narrow fitting shoes.
Notes
Must be used in conjuction with an extrinsic rearfoot post and a deep heel cup.

Lateral Rearfoot Skive

Description 
An intrinsic grind at 15 degrees into the lateral aspect of the positive cast to a depth of 2mm, 4mm or 6mm.
Uses
To intrinsically correct for excessive over supination.
Contraindication
Dress or narrow fitting shoes.
Notes
Must be used in conjuction with an extrinsic rearfoot post and a deep heel cup.

Extra Foam Padding under Topcover

Description 
An additional layer of foam added to the topcover. The foam layer runs the entire distance from the heel of the orthotic to the distal end of the topcover.
Uses
For patients who require additional shock absorption and/or cushioning.
Contraindication
Dress or narrow fitting shoes with low heel counters.
Notes
Should only be used for sulcus and full length orthotics. Options: 2mm (1/16") Black foam, 3mm (1/8") Blue foam

Extrinsic Forefoot Post - 3/4 Length

Description 
Extra firm posting material added to the distal portion of the plantar surface of the orthotic to further stablize, invert or evert the forefoot.
Uses
Non-weight bearing forefoot varus or valgus deformity; wholefoot pronators.
Contraindication
Tight fitting shoes. ¾ length forefoot post should only be used on ¾ length orthotics, as they are much less effective than sulcus length posts.
Notes
An extrinsic forefoot varus post is strongly recommended for severe non-weight bearing forefoot varus or valgus deformity. Where space is permitted, sulcus length is highly recommended. Options: Varus or Valgus

Extrinsic Forefoot Post - Sulcus Length

Description 
Extra firm posting material added to the distal portion of the plantar surface of the orthotic to further stablize, invert or evert the forefoot.
Uses
Non-weight bearing forefoot varus or valgus deformity; wholefoot pronators.
Contraindication
Tight fitting shoes, forefoot sulcus post can only be ordered on a sulcus or full length orthotic.
Notes
An extrinsic forefoot varus post is strongly recommended for severe non-weight bearing forefoot varus or valgus deformity. Where space is permitted, sulcus length is highly recommended. Options: Varus or Valgus

Forefoot Pad to Sulcus

Description 
A soft 3mm foam pad placed at the distal portion of orthotic to the sulcus.
Uses
Used for patients that require extra cushioning under the metatarsal; loss of fat pad under metatarsals.
Contraindication
Footwear with a narrow toe box.
Notes
Should be used in conjunction with a metatarsal pad.
Sub-Metatarsal Accommodation

Description 
A 3mm foam pad placed at the distal portion of orthotic which extends to the sulcus and is cut away under the specified metatarsal head(s). This accommodation will offload the specified metatarsal(s) and balance the forefoot.
Uses
To accommodate planter warts, corns, severe callouses and dropped metatarsals.
Contraindication
Footwear with a tight fitting toe box.
Notes
When used in conjunction with metatarsal pads optimum results are achieved. To optimally place a sub-metatarsal accommodation, it is strongly advised to indicate the location on the plaster, slipper sock or foam cast with either lipstick or ink. The orthotic must be a sulcus or a full length orthotic. Options: Left/ 1 2 3 4 5 Right/ 1 2 3 4 5
Neuroma Pad

Description 
A teardrop shaped pad placed at an interdigital space to spread the specified metatarsals.
Uses
Specifically used to alleviate symptoms of interdigital neuroma, intermetatarsal bursitis.
Contraindication
Can not be used with a 3/4 length orthotic.
Notes
Metatarsal pads generally do an excellent job of relieving interdigital symptoms while also correcting the transverse arch. Only after metatarsal pads have been tried without success, do we recommend the usage of neuroma pads.

Deep Heel Cup

Description 
A 16mm deep heel cup doubling the depth of our standard 8mm heel cup depth.
Uses
Offers greater stability for severe over pronators. Assists in gathering fatty tissue under the calcaneus.
Contraindication
Shallow heel counters, tight fitting shoes.
Notes
The deep heel cup is automatically used on our KidsFlex, UCBL and medial and lateral rearfoot skives. General practice suggests that the standard deep heel cup orthotic is sufficient in assisting to prevent over pronation at the calcaneus.

Soft Medial Flange-Topcover Style

Description 
A soft winged extension off the medial longitudinal arch of the orthotic.
Uses
To pad the sharp medial edge of the orthotic shell to decrease the likelihood of blisters and callouses from forming.
Contraindication
Notes
This is strongly recommended for severe over-pronators with flexible flat feet.

Rearfoot Dynaflange

Description 
Patented, plastic flange riveted to a plastic, thermoplastic shell.
Uses
Exclusive use on the DynaFlange
Contraindication
none
Notes
Only use zero degree intrinsically posted shell. Use reinforced arch when necessary after confirming with customers based on patient foot size and weight. Deep heel cup available on request.