Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Off the shelf Orthotic

Discussion in 'Biomechanics, Sports and Foot orthoses' started by bigtoe, Sep 21, 2010.

  1. bigtoe

    bigtoe Active Member

    Members do not see these Ads. Sign Up.
    Hi All

    If someone suggested you could only have 2/3 off the self Orthotics to use in your clinic and had no access to casted devices or a lab to modify what would your picks be and why???


  2. Peter

    Peter Well-Known Member

    Interpods; offer great control, easily accommodated into most sensible FW, gives me very good results
    Pedipods; suitable paediatric device in sensible shoes
    X-Lines; same as pedipods, gentle control esp for the aged foot
  3. I'd go slimflex Kinetic, Slimflex kinetic and Duosoft

    And I can still modify the first two in clinic with a heat gun and a packet of pre form components. So there.
  4. Graham

    Graham RIP

    Vasily Howard Dananberg

    Vasily Armstrong

    Kiddi Orthotics from Paris Orthotics
  5. Vasyli Dananberg- shank dependent
    Interpod control tech- shank independent
    kiddithotic- paediatric option

    Like Robert, if you give me some 3mm EVA sheeting, some sticky wedge, a handful of prefab components and some carpet tape / adhesive I can usually provide something therapeutic without a lab or a prefab.
  6. Graham

    Graham RIP

    When we ran our Diabetic clinics in Trinidad and Tobago, Carpet Tape was the key component for on the spot orthotic manufacturing!
  7. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    Have you tried the products from Peak Performance Products. We use this company currently for most of our NHS production.

    They have introduced a range of 'off the shelf' products that can be modified in the clinic. Pre-cut finished wedge is available, EVA shells both at 3/4 and full length, Different material densities. I have seen a new product they are due to launch quite soon which is a carbon fibre shell device (off the shelf / semi-custom device).

    There pricing is very competitive.
    I also tend to favour the interpod range due to the fit and control you can achieve from the device.

    It is rare that we cast for a custom made product in the NHS now. I think with our current financial climate we were almost driven to find an alternative.
  8. Have you noted any difference in your outcomes since you stopped using so many custom devices?
  9. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    Due to the format of our clinical set up. Patients are not routinely booked for follow up treatment. They are given an estimated period of time to try the devices supplied and if problems arise they are given the opportunity to book in for a review appointment.

    'Success', would appear to be related to those patients who have had experience of casted / bespoke devices before who are more reluctant to try the alternatives. For those who are new to our service, it would appear from the feedback we have had that most are happy with the outcome from the semi-custom product. This appears to be linked with symptom resolution or improvement and the accomodation in more footwear means a higher compliance rate.

    Our bespoke EVA products were sometimes a challenge to accomodate in footwear.

    The rare occasion a custom device is prescribed is only if the semi-custom route has been exhausted or their presenting foot shape / pathology requires this as a first phase treatment option.
  10. RobinP

    RobinP Well-Known Member

    Vasyli Howard Danenberg
    Interpod flex
    Kiddiethotics - seldom use anything else for kids now - brilliant prefab

    Does anyoone know where one can get the adult version PROLABS P3 in the UK(with the posting - I know Rx do the unposted ones)
  11. Anyone used the Quadrastep devices yet?
  12. Simon and Robert:

    You are following in some great footsteps. Mert Root often told the story about how he corrected an intoed gait pattern in a "grand rounds" (i.e. with orthopedic surgeons and pediatricians also consulting on the patient) pediatric patient, when none of the other doctors could determine the cause of the intoeing, by going into the bathroom to get some toilet paper and putting the tissue inside the child's shoe. Maybe Jeff can provide some more specific details of this story I heard Dr. Root tell a few times at the seminars he gave.
  13. ackers

    ackers Member

    Just a quick expansion,
    who manufacture the kiddiethotic?
  14. RobinP

    RobinP Well-Known Member

  15. Peter

    Peter Well-Known Member

    Coincidentally, my manager reviewed a pt yesterday who was precribed a pair, found it worked very well, controlled the rearfoot frontal plane position, and pt was asymptomatic (P.Brevis overuse). I'm fitting a pair next week.
  16. bigtoe

    bigtoe Active Member

    Thanks for the replies

    At present my main choice has been the interpod flex and slimflex plastic.

    There is much discussion around the interpod flex within our department at present with regards to a lack of modification i.e. first ray cut outs and being able to apply postings (we use double sided tape at present due to health and safety issue around glue use) and issues around the quality of the cover.

    We are looking for something that will give us the benefits (functional control) of an interpod but with the ability to make a chair side first ray cut outs and modifications.

    The question that I am struggling with is- Should we dismiss the interpod due to this and use something with less control but is more easily modified??


  17. Phil Wells

    Phil Wells Active Member

    Bit of a sales pitch but we have a new OTC insole being launched at this years SoCaP conference. (You may have seen the patent application on this site a year ago).
    I would love to know people thoughts on the concept -

    -Low profile homopolymer polyprop shell with interchangeable rearfoot posts
    -Full lenth PU top cover.
    The main USP is that it has three different density PU(soft foam) medial arch inserts and one for the lateral arch/cuboid. These inserts fit in between the Poly and PU pieces.
    There are 2 main proposed benefits depending on your perspective - the different densities can be used to apply varying levels of supinatory forces or you can change the comfort level for the individual patient.

    Would love to know any thoughts.

    Phil (Salts Techstep)
  18. If it is the same one that Allana (?) brought to the Devon SCP study day a while back, I liked it a lot! Nice hybrid, nice concept.
  19. Craig Payne

    Craig Payne Moderator

    You should have a range of devices in the 'library' as it would be rare for any one device to be appropriate. You should have a big enough library to be able to deliver the range of design features so that all different prescription variables for the range of patient's you see can be delivered.
  20. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    Peak Performance products have a poly-prop shell device with interchangeable clip wedge additions ranging from neutral, 2degree and 4 degree. The degree's of posting can be used both as medial or lateral wedge. The shell can be modified easierly in clinic for first ray cut outs etc. I tend to use a large burr to reduce any rough edges.

    the product name is EZ-post (competitively priced). just another item we have in our library of devices available as a semi custom device for patients.
  21. Agreed. I was talking to Greg Quinn about this last week. The problem for the manufacturers is that the retailers don't want to carry all the stock. Which is where Phil's idea comes in. It's a good idea, in my opinion, Phil. But you already know that.

    Craig's point raises the question, how many different devices do you need for a population? Suppose the animated .gif attached shows the relationship between the number of devices (n) and the "width" of the population pathologies that each device has to be efficacious for...

    Attached Files:

  22. Griff

    Griff Moderator

    Are you on commission Charlotte? ;)
  23. bigtoe

    bigtoe Active Member

    Totally agree Craig, and at the moment I have no limitations on what I can order however in these current times within the NHS we are having to consider limiting the choice so a better financial arrangement can be made.

  24. Phil Wells

    Phil Wells Active Member


    Yes it is the same insole Alana showed you. (Will be able to send you a sample soon)

    Re the Ez insole, I have to admit (wish I had come up with the idea for the rearfoot posting they use on the EZ) that it is a cracking product - simple and effective.

  25. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    :DNo, but the extra money wouldn't go a miss.

    We have found the products they supply meet the needs of most our patients whilst remaining competitively priced.
  26. Yes please. That ez-post just looks like the vector orthotic idea, which has a really secure rearfoot plug in, but the forefoot posts attachment is shocking.
  27. I found almost everything about the Vectothotic to be shocking myself. They're not even any good as door stops. But each to their own I guess.
  28. Griff

    Griff Moderator

    Kept my Mrs' nephews occupied for a while - I told them it was Lego
  29. LOL, Ok I stand corrected. There IS a use for them

    Craig's post has given me a nudge to get around to something I've meant to do for ages.

    I've just rummaged through my cupboard and found 7 different types of pre fab which I had in size 10. There were others but they were either different sizes or too expensive to play with. I then ran them through the band saw, cutting in the frontal plane, 10.5 cms from the heel (which in most cases was around the peak of the arch). I have them lined up on the desk in front of me.

    When I get home I'll put them end down on the scanner and scan the cross sections. There really is a big variety.

    The highest has a medial flange at 40mm, the lowest is 23 mm.

    The widest on the superior surface is 85mm, the narrowest 73mm

    The widest on the posterior side (the shank side) is 74 mm, the narrowest is 40 mm

    Some are basically tilted platforms with a lip at either edge, others are curved along their whole length

    Some are homogenous, others are laminated, with a soft layer on top of a harder. One is even medium density on top, low in the middle and high underneath.

    They really are immensely different. It makes a nonsense of the "pre fabs are as good as customs" argument. They have so little in common!
    Last edited: Sep 22, 2010
  30. Photos not great, as I say i'll scan the X section later.

    But you get some idea...


  31. But they may achieve the same results............. removing the skin of a cat and all that. ;)
  32. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    the shell shape is different to the vect orthotic. In profile it would appear they EZ-post has 'more' talo-navicular support (arch profile is more pronounced than the vect orthotic).

    I have previously tried the vecto - orthotic privately and the control obtained with the Ez-post appears to be better.
  33. Horseraddish:eek:;).

    Assuming that we are all subscribing to the "orthotics work by modifying GRF acting on the foot" model (rather than the "voodoo" model), the amount and type of modification of the GRF will vary depending on the surface geometry and load deformation characteristics of the device. That's something the research does show us!

    The surface geometry is visibly different. The load deformation characteristics are different. Therefore it is reasonable to assume that they will create different mechanical effects. Therefore it is also reasonable to assume that outcomes will vary.

    Besides which, whilst the interpod rigid prefabs are pretty good for removing the skin of a cat, the low density eva freelan types shown there are rubbish. You try trying to scrape the fat off the pelts with a duosoft and see how long it takes. :butcher: Bloody ages!
  34. But you said
    and now your compairing prefabs - to prefabs

    my comment was re custom to prefab
  35. Oh I see. Sorry, I meant in they have so little in common with each other, not so little in common with customs.

    The point I was making is that comparing "custom" to "pre fabs" is like comparing a Yamaha YZF-R1 990cc to a "car". It's a nonsense because "car" like "pre fab" covers such a big range. You may find a car with similar performance, some with better and some not so good.

    My bad :eek:
  36. Well said, It´s a bit like papers which compair custom to prefab but only use 1 type of device for the custom say a root device - It´s just not custom in my book and misleading.

    say we take Plantar fasciitis

    If we compair custom to a prefab device and N = 30 there would be 30 different divices all attempting to reduce the load on plantarfascia. Some might be similar but each would be built for the individual.

    What would be a great paper would be to have 10 -15 different prefabs and try and match the best prefab to the persons foot and compair this to a real custom group ( as discribed above)

    then we may have a real world answer to the prefab - custom arguement re plantarfasciitis.
  37. Nice!

    Even more plausible, try this. Take a scan of a foot and sent it to a lab for a "standard" device. Then go through the selection of pre fabs and try to find one which is more like the foot than the custom device (you could derive a CG positive image based on the orthotic as a negative and compare it to the actual positive)
  38. cpoc103

    cpoc103 Active Member

    Hi Scott,

    When I worked for Portsmouth city PCT we had the same issue, funds for casting were being limited more and more and so our biomech team had to try and come up with alternatives to othoses Rx.

    I introduced a system there from a company called Sidas/ conform able, it uses a vacum pack silicone air bag so you can mould a foot, we sourced different blanks from what Sidas offered as we found them too soft. But as an alternative this worked very well and is still being used today to great effect, and I'm pretty sure they did an audit to see how it compared and it was good.

    We also had a range of off the shelf soles too, that we could add rear/ forefoot corrections to. You should also have a look at Paul Harradine's range of OTS soles they come with wedges already attached and you grind off what you dont need, have used them and they were good. He runs the Podiatry and chiropody centre in portsmouth.
    Hope some of this helps.

  39. Geoff Hull Footman

    Geoff Hull Footman Active Member

    I am a non Scp/degree pod of 18 yrs pp:wacko:.My biomec ability is limited.I did 2 DH courses and learned to do casting etc but without measuring roms and ordering post to cast options . I have had all satisfied customers for my devices and follow ups have always been positive.However I do feel totally inadequate when listening to some of the subjects discussed on here.I do not expect dumbed-down posts .I try to learn from you bigjobs. So having said that ,People shy at paying £100 plus.I have supplied vasyli orthoheels to a lot of people also ,but,now they are under the Scholl brand and do not seem as good . I have had negative comments from regular buyers. I am doing my own revision of these otc insoles and wonder if more can be acheived with the heat molded styles- that several makes have - as opposed to adding bits and pieces.?
    I want to stock a better range as suggested but which way to jump?
    Ideas please

  40. Geoff, I've dispensed thousands of custom, semi-custom and off the shelf devices over the years. Unlike you my follow ups have not always been positive. So either I've dispensed a lot more devices than you, or you have the magic touch;). I'm not a massive fan of heat molding, I use it when necessary to push a device away from a foot that is causing irritation. If you want a range of devices that you don't have to add bits to, why not look at something like the quadrastep range. Alternatively, familiarise yourself with as many different off the shelf devices as possible and try and choose the right device for the right patient. Or you could just use one of the Vasyli medical devices which matches the geometry and stiffness of the old orthaheel before scholl tinkered with it. It sounds to me though, that you should be giving me (and I'm sure many others) advice on how to prescribe given your success rate.:drinks

Share This Page