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Hello Everyone!

I am studying to become an Orthotist in Canada and currently working for the summer. It is my understanding that there are many opinions on casting position of different orthoses (Foot Orthotics, IMOs, SMOs, AFOs, etc.) . I am curious about how practicing clinicians approach this dilemma, if the aim is for Subtalar Neutral, maintaining the calcaneus perpendicular to the ground in order to reduce Moments, a marriage between the two, or if there is a better way to determine casting position. I've read a number of articles on the topic and spoken to many clinicians, but I would like to open it up to the forum to see what everyone thinks.

Thanks for your time!

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The only time that I do a neutral STJ cast is when I demonstrate it! I have not done it for a patient for a long time. I tend to cast more often more inverted that neutral.

You should cast the foot in the most appropriate position so that the foot orthotic can have the design features to deliver the prescription variables needed for that patient. That is going to vary from patient to patient and maybe sometimes that is STJ neutral.

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There is a range of orthotic shapes that will help the patient. One casting method can get you closer to an ideal shape than another casting method. However, if you know the shape you want, you could start with a block of wood and get the shape of positive cast and orthotic that you want. It is important to know what you want the orthotic to look like and this comes from the prescription.

Eric

For what it is worth, about 90% of my orthosis casting is done in subtalar joint neutral position with 10% done pronated from neutral and 0% done supinated from neutral position. However, I do manipulate the forefoot to rearfoot relationship by adding dorsal or plantar pressure to the medial column during casting in about 50% of my orthosis castings.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
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Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

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Kevin:
very interesting.

How do you decide when to use which?

Dennis