Good morning, Rich. A quick question – regarding “cast fill” – do you generally prescribe the “normal” cast fill on the Root Lab form and find that leads to good patient outcomes? My experience with other labs has been that their standard cast fill, seeking to make the device more “tolerable,” is so much that it significantly compromises the effectiveness of the device for people with excessive pronation issues. That is far and away the most common problem I see with my PT patients who are referred to me because of other injuries, but for which excessive pronation is really the root cause -- e.g., runner’s knee. I often prescribed “minimal” cast fill with other labs and I just wonder what your experience has been with Root lab with whom our practice is now working.
Dr. Blake's comment: Yes, that is a big problem. Root Lab is truer to the arch than some labs for sure. You do want to have a grinder since some plantar fascial bowstringing requires a groove when the arch is true. If you are using vertical cast correction, how much change (transition modification at the first metatarsal head) will you ask them to do to a 5 degree vs 10-degree forefoot varus? I have found you have to go to a 25 degree inverted cast correction if the forefoot varus is over 5 degrees and you want great support (or at least modified forefoot correction for comfort but ask them to use a 2-3 mm Kirby skive and some extra medial column support (minimal fill proximally in the arch not distally). I will send this to Jeff Root to see if he responds. I hope this helps. Rich
Dr. Blake's comment: Yes, that is a big problem. Root Lab is truer to the arch than some labs for sure. You do want to have a grinder since some plantar fascial bowstringing requires a groove when the arch is true. If you are using vertical cast correction, how much change (transition modification at the first metatarsal head) will you ask them to do to a 5 degree vs 10-degree forefoot varus? I have found you have to go to a 25 degree inverted cast correction if the forefoot varus is over 5 degrees and you want great support (or at least modified forefoot correction for comfort but ask them to use a 2-3 mm Kirby skive and some extra medial column support (minimal fill proximally in the arch not distally). I will send this to Jeff Root to see if he responds. I hope this helps. Rich
Any experience you can impart would be very much appreciated.
Thank you.
