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First ray cut-outs in orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, May 23, 2009.

  1. Admin2

    Admin2 Administrator Staff Member

  2. Simon:

    Don't have a clue. As far as I know, neither Root, Weed, Sgarlato, Valmassy, Blake, Chris Smith, or any of the other CCPM biomechanics professors used such a thing as a first ray cut out. I think this technique could have started somewhere on the east coast of the States (maybe Langer labs?), where forefoot varus still is the predominant "foot deformity" found in the patients of the podiatrists in these areas.:rolleyes:
  3. delpod

    delpod Active Member

    whilst were on the topic of 1st ray cut outs...what are people's opinions? I'm a big fan of them however i've found they really do anything unless you couple them with a reverse morton's extension or something else to load up the lateral FF.
  4. This is from Ray Anthony's Prescription Writing for Functional Foot Orthoses from the web. The site says

    First published 1990
    Revised 1995
    Revised 2000

    I don't know if this was included in the original or was one of the later revisions
    Orthosis shell width
    Shell widths can be quantified by describing the position of the medial border of the shell in relation to the shaft of the first metatarsal. When manufacturing the width of the distal aspect of the shell, the medial balance platform (which represents the size of the first metatarsal head) is marked from it’s most lateral border as either 0%, 25%, 50%, 75% or 100%. This has been called shell “creep” where 100% creep is a “full width shell” (Fig. 15) and a 0% creep is known as a “first ray cut-out”.

    Kevin, I don't have a copy of Ray's book, could you check this is in there and the year of publication please. He also wrote a paper in the British Journal of Podiatric Medicine on this- I can't seem to find the ref - but I have the paper at work.
  5. Here's what I said in the "Orthotic Posting and the Triple Interface" thread about the subject of first ray cut outs.

  6. Simon:

    Here is the reference for Ray's book....from my autographed copy in my library....

    Anthony, Raymond J: The Manufacture and Use of the Functional Foot Orthosis. Karger, Basel, 1991.

    Here is what Ray said in his book about first ray cut-outs (pp. 169-170): "It is essential that a deep medial addition, that creates a channel in the orthosis shell, is added to the positive cast of a full width orthosis shell. Failing to apply this addition may cause the 1st metatarsal to be abnormally dorsiflexed, despite the provision of adequate forefoot control. In the author's experience, a 'first ray cut-out' that may be prescribed on a full width orthosis shell is ineffective and may cause discomfort if a deep medial addition is not applied. If the proximal-plantar aspect of the shaft of the 1st metatarsal is being supported by the orthosis shell, the metatarsal head will be unable to drop into the space provided by the 'cut-out'."
  7. pgcarter

    pgcarter Well-Known Member

    From ten years of making orthoses I have never prescribed a first ray cut out. I see it as a bit of "muddy thinking". If the angle of descent of the orthosis shell from the navicular area to the ground just proximal to the 1st met head is steep enough, cutting some shell away is not necessary, if this angle is not steep enough cutting some shell away won't really help. If you do cut the anterior medial corner off a device, it potentially collapses even further medially allowing an even greater loss of height under the navicular, compounding your lack of control issues.
    regards Phill
  8. drsha

    drsha Banned


    I'm surprised that you roll your eyes at the East Coasters. It's not like you to totally reject anything that is not related to your theories and findings (LOL).

    I have no claim on inventing the 1st ray cutout or documenting it. For me, Howard Dananberg DPM is the father of the 1st ray cutout and historically is the Father of East Coast Biomechanics.

    His work is better evidenced, authenticated and his legend, I believe matches that of any West Coaster including Dr. Root:rolleyes:

    I lay no claim to invention or publishing but would just like to give some historical pointers to this thread. I will only take some credit for spreading the gospel of the 1st ray cutout to the East Coasters a long time ago.

    I attached as much as I could to Western Biomechanics as it was (and probably still is overall) held in higher esteem than the East Coast version in the 70-'s and 80's. I took preceptees with CCPM degrees (I have Josh Gerberts class notes of Dr Roots courses). I attended the Super Seminars in Vegas as one of the few East Coasters for years. I read the western bio literature. I used west coast labs on and off.

    I accepted the fact that the East Coasters were finding it difficult to envision Dr Roots Rohadur deformed medial column corrections instead of true posts and was searching for an alternative that worked clinically to bring home.

    I asked during one of the think tanks as an "East Coaster" at a Super Seminar if the group felt that clinically, a 1st ray cutout with and extrinsic 2-5 ff post would have a similar effect on the forefoot as Dr Roots "medial ff plantarflexed" plastic. There was a hush of about 5 minutes and the consensus was "don't see why not!"

    I've been 1st ray cutout-ing ever since, long after Dr Roots techniques have been dropped by all labs, even The Root Lab.

    I have personally dispensed 10,000 devices with 1st ray cutouts in practice.

    For me, they are indispensable to a biomechanics practice when treating forefoot pathology as a primary entity.


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