Positive Casts showing Forefoot Deformities needing different Orthotic Design

Podiatrists will start with a cast of the foot and some examination findings (both static and dynamic) to design complex foot inserts which change function and better patient's lives. It typically starts with an impression cast of the patient's foot. This image shows 3 left feet, all taken with the same cast technique, showing 3 different foot types. The cast on the right is fairly stable and neutral positioned. The middle cast shows a foot that easily rolls to the outside and needs stabilization for supination. This demonstrates forefoot valgus. The left side cast shows a foot that easily rolls inward producing over pronation. This is called forefoot varus, and there are various corrections for this based on degree of deformity. 

Forefoot Varus Orthotic Corrections: Based on Degrees of Deformity

Top 100 Biomechanical Guidelines #36: Root Balancing Key to Correct Forefoot Abnormalities

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Happy New Year from Dr Rich Blake!!

 Podiatrists, and many physical therapists, make orthotic devices and other biomechanical decisions based on balancing the patient's forefoot abnormalities. When the primary function of the orthotic device is to support structural problems in the foot, the orthotic devices is called a balanced orthotic device or Root balanced orthotic device. Dr Mert Root, the founder of modern day orthotic devices, first published and lectured extensively on this subject in the 1960s and 1970s. It is still to many health care providers the only way to treat patients. The next few weeks I will be discussing the biomechanical guidelines surrounding this type of approach.

     It was the 1980s that the next explosion in biomechanics occurred with the development of Corrective orthotic devices with Biaxial sectioning, Inverted technique (my invention), Kirby Skive, and other modifications. Here the foot was modified to correct the forces of pronation more than could be accomplished by Root balancing or modified Root balancing. Here will be many posts on these sections.

Ah Chihuly!!

 This is the typical appearence of the outside or lateral arch in a Root Balanced orthotic device. The foot is suspended off the ground along the lateral side of the foot. This is crucial in supporting feet with many injuries including metatarsal fractures, neuromas, ankle sprains with instablility, etc.

Now see the mold below. The lateral arch is filled in. This is more like an OTC orthotic device now and loses its effectiveness for many injuries. 

Below is the orthotic device designed around Root Balancing. See the great lateral and medial archs. With this type of orthotic device, there are times when you can not tell which is the inside arch and which is the outside arch. Root balancing is classic podiatry and since it can be more harder to get used to, it is commonly lowered labs whom want to make a comfort orthotic device. Unfortunately, the effectiveness of the orthotic device may be greatly sacrificed. This the the common look of an orthotic device for a forefoot abnormality called forefoot valgus or plantarflexed first ray.