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Help, I need a good book on how to make/prescribe orthoses

Discussion in 'Podiatry and Related Books' started by quiltypie, May 18, 2014.

  1. quiltypie

    quiltypie Member

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    Dear fellow pods,
    I am a new graduate wishing to improve my skills in orthotic manufacture and prescription. Are there any good books to help me? Basically I would like an atlas of orthoses showing which orthoses to prescribe for which foot type/ condition. Please don't say Root there was not even a copy of this at my university library. the most up to date book in our library was the 1991 edition of the manufacture and use of the functional foot orthoses by Anthony. I have bought Dr Thomas Michaud's latest book but I would really like more information on what to use when, preferably with pictures. I am astounded that our profession has such little consensus on the matter. How can any study questioning whether sham versus custom orthoses be relevant if every podiatrist makes something different for each condition?
    Any ideas on clinically useful books would be most welcome.
  2. Craig Payne

    Craig Payne Moderator

    The only two books that cover manufacturing in any great details are:
    Ray Anthonys: Manufacture and Use of the Functional Foot Orthoses
    Jim Philps: The Functional Foot Orthosis
  3. quiltypie

    quiltypie Member

    Dear Craig, thank you for your prompt response. I think this is a real problem for new podiatrists as both these books are out of print. Where are we to go for help? I don't want to just leave all the decisions up to a lab. I want to improve but I need a good base to start from. If we are to grow and improve as a profession and have standardised practice we need some up to date practical advise from some talented and experienced podiatrists.
  4. Craig Payne

    Craig Payne Moderator

    I did try and start a consensus type thingy going a few yrs back - its was an epic fail before it started; its was obvious from the start that a consensus was not going to happen .... as bad as that is for the profession.

    I do have something else in the works, so for now its watch this space.
  5. Griff

    Griff Moderator

    Hi Quiltypie

    And herein is the problem - even if there were an "atlas of orthoses showing which orthoses to prescribe for which foot type/condition" (which there isn't) would all individuals with a given "foot type" or pathology respond in the same way to the same device or prescription? (Research tells us not). Would they all result in clinical success?

    Some would argue that going to a recipe book of orthoses for answers is not that different to leaving decisions up to a lab (something which I personally don't believe should even be an option or service offered). What is reasonably clear is that there will not be just one device/prescription/solution to a given problem - there will be an envelope of success; we often have a bigger target to aim for than just a bullseye.

    I think the good base for all of us to work from is an understanding of functional anatomy, an understanding of the physics which underpin movement and an understanding of how introducing a new interface at foot level [e.g. orthoses] will potentially alter kinematics +/- kinetics in a given individual/pathology. How we will grow as a profession is by showing we understand these concepts far better than any other profession, not by relying on recipe books (in my opinion).

    Make sure you read this paper on foot orthoses: http://www.sportspodiatryinfo.co.uk/wp-content/uploads/2013/09/orthoses2012.pdf

    Followed by this paper on person to person variation: http://www.sportspodiatryinfo.co.uk/wp-content/uploads/2013/09/nester09.pdf

    Followed by this narrative on applying a 'tissue stress' approach to injury: http://www.sportspodiatryinfo.co.uk/wp-content/uploads/2013/09/hunt1995.pdf

    Then buy Kevins 4 books: http://www.dpmlab.com/html/bookreview.html

    And attend the Biomechanics summer school next month (where the theme will be foot orthoses): http://langergrp.com/biomechanics-summer-school/
  6. Lab Guy

    Lab Guy Well-Known Member

    Ian G gave great advice. You are a new graduate so you have the opportunity to start off on the right path if you so choose.

    Read all the past posts pertaining to biomechanics as there are so many gems in there as well as information regarding orthotic prescriptions. Below are just a few of the papers and books that I think will provide an excellent understanding of biomechanics.

    Clinical experience along with a lot of reading will help you to come far in your knowledge of applied biomechanics. It will take you a lot of time and effort but it is worth the investment as this is your chosen profession and you have the obligation to your patients to be the best that you can.


    Volumes I, II, III, & IV: Kirby KA (ed): Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona,

    Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987.

    Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91(9):465-488, 2001.

    Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989.

    Perry J. Gait analysis: normal and pathological function 1992. New Jersey, SLACK Inc. Terminology of Human Walking From North American Society for Gait and Human Movement 1993 and AAOP Gait Society 1994

    Ozkaya, Nihat: Fundamentals of Biomechanics: Equilibrium, Motion and Deformation

    Dananberg HJ. Sagittal Plane Biomechanics. JAPMA 90(1): 47-50, 2000.

    Dananberg HJ. Gait Style as an Etiology to Chronic Postural Pain, Part 1. Functional Hallux Limitus, JAPMA 83(8): 433-441,1993

    Dananberg HJ. Gait Style as an Etiology to Chronic Postural Pain, Part 2, Postural Compensatory Process, JAPMA 83(11):615-624,1993

    Fuller, E.A. “The Windlass Mechanism Of The Foot: A Mechanical Model To Explain Pathology. J Am Podiatric Med Assoc 2000 Jan; 90(1) p 35-46.

    Fuller, E.A. “Center of Pressure and its Theoretical Relationship to Foot Pathology.” J Am Podiatric Med Assoc. 1999 Jun;89(6):278-91.

    McPoil TG, HuntGC, Evaluation and management of foot and ankle disorders: Present problems and future directions. Journal of Orthopaedic and Sports Physical Therapy1995; 21(6): 381-388.

    Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989.

    Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.

    Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992.

    Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000.
    Roukis TS, Kirby KA: A simple intraoperative technique to accurately align the rearfoot complex. JAPMA, 95:505-507, 2005.

    Piazza SJ: Mechanics of the subtalar joint and its function during walking. Foot Ankle Clin N Am, 10:425-442, 2005.

    Spooner SK, Kirby KA: The subtalar joint axis locator: A preliminary report. JAPMA, 96:212-219, 2006.

    Lewis GS, Kirby KA, Piazza SJ: Determination of subtalar joint axis location by restriction of talocrural joint motion. Gait and Posture. 25:63-69, 2007.

    Lewis GS, Cohen TL, Seisler AR, Kirby KA, Sheehan FT, Piazza SJ: In vivo tests of an improved method for functional location of the subtalar joint axis. Journal of Biomechanics, 42:146-151, 2009.

    Kirby KA: “Evolution of Foot Orthoses in Sports”, in Werd MB and Knight EL (eds), Athletic Footwear and Orthoses in Sports Medicine. Springer, New York, 2010.

    Fuller EA, Kirby KA: Subtalar joint equilibrium and tissue stress approach to biomechanical therapy of the foot and lower extremity. In Albert SF, Curran SA (eds): Biomechanics of the Lower Extremity: Theory and Practice, Volume 1. Bipedmed, LLC, Denver, 2013, pp. 205-264.

    Payne CB, Dananberg HJ: Sagittal pplane facilitation of the foot. Australasian Journal of Podiatric Medicine: Volume 31. Number 1, 1997
  7. Petcu Daniel

    Petcu Daniel Active Member

    Hi Quiltypie,

    My first book about manufacturing of FFO, which I bought after 1 year of efforts, was Dr. Anthony's book and I was so happy ! After that I've bought Dr. Kirby's books and I passed from the comfort of a very well detailed methodology to the panic of thinking ! After a while with the help of Dr. Kirby's books and many threads from Podiatry Arena I understood much better many things from the first book !

    My personal experience tells me that you don't need a "good book on how to make/prescribe orthotics" but you've need a lot of literature about how "to think" an orthotic solution to a foot pathomechanics. And all the literature from this thread is a "must read" and Podiatry Arena is an invaluable resource for learning not necessarily how "to make" but for sure how "to think" about foot pathomechanics and foot orthotics. How "to make" will follow !

    Good luck !

  8. quiltypie

    quiltypie Member

    Dear Daniel,
    thank you for your reply. While I am grateful for the replies above and have indeed read many of the articles suggested, (I am working my way through them) the main point is that the Anthony book recommended is now out of print. So while previous pods have had the benefit of Root and Anthony and Phillips, the point I am making is that there are no up to date text books for podiatry students on how to cast and make orthoses and I think that is a real problem. While I understand that every foot has it's own unique set of biomechanical challenges and solutions we need a practical base from which to start. You cannot bake a cake based on the theory that it should taste sweet, crumble in the mouth and be served well on a plate. You need a recipe to begin with. Similarly podiatry students need good quality textbooks. With all due respect how no amount of reading about the subtalar joint axis is going to explain the actual casting and manufacturing process (although it is very useful in terms of understanding biomechanical issues). I would even request reprinting Anthony except it suggests using products such as methyl methacrylate which is no longer used due to it's carcinogenic properties. I hope Craig Payne or other experienced podiatrists are willing to share their knowledge and put it in book form for the good of our profession.
  9. Quiltypie:

    I would suggest you go spend some time with another practitioner who makes their own orthoses, or, better yet, go spend some time at an orthotic lab. Honestly, this would be much more educational for you than reading any book (and I have both Anthony's and Phelps' books). There are many ways to make foot orthoses, not just one best way. You only need to learn one way, not all the ways. In addition, I haven't made an orthosis myself in nearly 30 years but rather have an orthotic lab do that work for me. In addition, since most orthotic labs are going to computer milling of orthoses versus making positive casts, you may want to learn about that process also, which is not covered at all in Antony's and Phelps' books.

    I have to agree with the others that it is better to understand foot and lower extremity biomechanics, foot orthosis biomechanics and shoe biomechanics than it is to understand how to make plaster additions to a positive cast or vacuum press an orthosis. We aren't cooks baking cakes here. We are physicians making devices that alter the magnitudes, plantar locations and temporal patterns of ground reaction forces on the feet of our patients that may positively change their lives or cause them further pain. It is much more important to understand the biomechanics of foot orthoses, than to know how to make foot orthoses.

    If you still think you really need to read Anthony's and Phelps' books, why don't you put a request up here on Podiatry Arena to see if anyone would sell their copies? That would probably work.

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