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Casting question - supine OR prone and why?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Berms, Nov 27, 2007.

  1. Berms

    Berms Active Member

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    I was only taught to cast the patient in the prone position, and have never had much success in my few and far between attempts at supine casting.... and I cant figure out why you have to grasp the 4/5th toes in supine casting - why can't you just load the 4/5th met heads as you do in prone casting? (apologies for my ignorance).

    What do others prefer, and why? TIA
  2. Craig Payne

    Craig Payne Moderator

    I have ALWAYS casted supine and ALWAYS taught people to cast supine.

    I visted a lot of labs and casting is generally badly done. The number one mistake during casting is letting the anterior tibial muscle contract and dorsiflex the first ray --- its obvious to see in all the casts.

    The easy way to avoid this mistake is to observe the anterior tibial tendon during casting to make sure it does not contract --> you have to do it supine.

    Supine is more comfortable for the patient.

    When patient is supine, you can have a more polite conversation with them while casting than you can prone.

    Most do load the fourth and fifth met heads when casting supine --- but you also have the option of grasping the digits while plantarflexing them to get a different position, if you want it.

    I can not think of a reason as to why anyone would want to cast prone. :bang:
  3. markjohconley

    markjohconley Well-Known Member

    Berms, I (this was an "i" but I thought KK might be perusing the posts) was taught the "prone" technique, however I apply a plantarflexory force on the proximal phalanges of 2-5 with more force applied to the lateral end than to the medial end >> thereby applying a dorsiflexory force on mets 2-5 with more force applied laterally. I use the the thumb and 1st finger of the usual hand to apply these forces.
    Question, in the Glasner? foam box technique why bother to apply a plantarflexory force to the digits after the inverted rearfoot, lateral forefoot and plantarflexed 1st ray have given a profile which I thought would not be altered by the final digit manouvre?
    Apologies Berms, will watch with interest the replies of the pundits, Mark C
  4. Admin2

    Admin2 Administrator Staff Member

  5. Boots n all

    Boots n all Well-Known Member

    Now see all of your questions could have been answered for you had you attended "Boot camp #4":D, where Major Payne showed everyone how to use a foam impression boxes(no plaster required near the client), the client is then seated looking at you.
    just thought l would confuse the thread alittle
    Last edited: Nov 27, 2007
  6. Berms

    Berms Active Member

    Thanks for the reply Craig.

    As far as reasons to cast prone go... I "assumed" that by looking down the foot from the back of the calc to the plantar metatarsal area I got a better view of the f/f to r/f relationship?? Probably not much truth in that though, and I am keen to give the supine method a go.
  7. Craig Payne

    Craig Payne Moderator

    Why do you need to visualise that during casting?
  8. Mark Egan

    Mark Egan Active Member

    I agree with Berms I like to see the foot in relationship RF to FF it makes sense to me.

    I do prone as I could never get comfee in the supine and felt I was twisting the foot. In the prone I like to correct the foot in the cast, i.e plantar flex the 1st and or invert the RF which is dependent on what I think the patient can tolerate. Ultimately each person will prefer one method over the other dependent on what they are taught.

    Craig with regards to the use of foam boxes, at the boot camp, as mentioned above is this using a technique as suggested by sole supports? as I noticed another discussion re MTJ talking about the gib test which also comes from this group. If so is anyone else using this technique or the orthotics themselves here in Australia?
  9. Craig Payne

    Craig Payne Moderator

    I would not necessarily say I am advocate of the technique, but I use it, think it has its indications and we demonstrated it as an option to those at the Boot Camp and everyone got a practice with it. I was surprised how useful everyone found that particular session. I think the technique is most useful for those narrow feet with large (ie >30-40 degrees) of forefoot supinatus. I do not know who else is using it, but guess after the Boot Camp, a lot will be!
    Last edited: Nov 28, 2007

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