Foot & Ankle Center in Seattle

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Foot Orthotic Casting Seattle

Custom Foot Orthotics Seattle

Foot Orthotics Seattle

Custom Orthotic Casting

How Should Your Foot Be Casted for Custom Orthotics?
There are several methods that can be used to obtain an image of the foot to make custom foot orthotics. The reality is that some work much better than others.
Unfortunately not all practitioners use the methods that have been shown to be most effective. This may be because they are not familiar with the literature, because they want a cheaper way to take the image of the foot, or because they were sold a “pressure mat” system that looks impressive but does not work particularly well. The most important criteria is the experience and skill of the medical practitioner, but regardless, there are some techniques that have been shown to be much more effective than others.
The only method that has been shown in the medical literature to be effective in producing a quality functional custom foot orthotics is a three-dimensional non-weight-bearing laser scan or cast of the foot. In this technique the foot is held in a precise position – essentially the position in which it should function. The image of the foot can be taken using a laser scan, plaster or fiberglass. All of these techniques can provide the same quality image as long as the foot is held in the correct position while the image is taken.

laser scanning for orthotic 
 Laser Scan
fiberglass casting for orthotic
  Fiberglass Cast
plaster scanning for orthotic 
  Plaster Cast

Who Should Take the Cast?
Casting position is absolutely critical to orthotic outcome. Thus, it is our opinion that only the doctor, and not a staff member, should take the scan or cast of your foot. Before making an appointment to have orthotics made, the first question you should ask is “who will take the cast of my foot – the doctor or an assistant?” If the answer is anyone other than the doctor, go somewhere else.

Are There Other Methods to Take a Cast of the Foot for Orthotics?
There are 3 other methods used for making custom orthotics, but they have been shown to be ineffective for making orthotics that improve function of the foot (although they can be used to make simple arch supports). The three techniques are:

  1. Plaster or foam box casting where the patient sits and the foot is placed down on the floor to produce the cast.
  2. Walking across a force plate
  3. Standing on a digital imager of the foot.

Several studies have shown all of these methods to be less effective at producing well-functioning orthotics.

A 1989 Northern Arizona University study showed that having any weight on the foot during the casting or imaging process resulted in an orthotic shape that has been shown to cause pain in the big toe joint and tension on the plantar fascia.1, 2

A 2002 study from the Joiner Center for Sports Medicine at the University of Delaware showed that weight-bearing casting resulted in abnormal force under the big toe joint.3 This has been shown to result in the production of an orthotic that does not work well at reducing the forces that lead to common foot problems such as bunions, big toe joint pain, heel pain, arch pain, plantar fasciitis and other conditions.1 Non-weightbearing casting was recommended as the most reliable and valid method for making custom foot orthotics.3 .

    Summary of Information about Casting for Custom Foot Orthotics

  1. Only a non-weightbearing laser scan or cast should be used (see figures above)

  2. Weight-bearing casts and images of the foot have been shown in the medical literature to be ineffective methods for producing functional foot orthotics.
  3. Whether you are sitting or standing does not matter. If your foot is on the floor during the casting process, you are not likely to get an orthotic that provides optimum function.
    The medical literature indicates that walking across a pressure mat cannot provide enough information to make a quality functional orthotic.
  4. The doctor, and not an assistant, should take the cast of your foot.

    1 Forefoot to Rearfoot Angle – A Comparison of Orthotic Casting Techniques. McPoil, TG; Schmit, D. Phys Ther. 1989 Jun;69(6):448-52
    2 Position of the First ray and Motion of the First MTP. Roukis, et. al 1996 JAPMA. Vol. 86:11
    3 A comparison of four methods of obtaining a negative impression of the foot. McClay-Davis I, Laughton C, Williams, DS. J Am Podiatr Med Assoc. 2002 May;92(5):261-8


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All pages on this website © 2005-2013
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
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