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Portuguese style orthotics my take on it !

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Jul 27, 2011.

  1. Members do not see these Ads. Sign Up.
    So Ive been thinking and experimenting - collective groan from the audience .

    November 2010 Spooner and Isaacs went to Portugal to do some lectures etc.

    and mentioned a form of orthotic manufacture - which I term Portuguese style and I have been playing around with, and have amazing feedback from.


    So 1st The casting technique has become the most important section of the process.

    No photos - But foot manipulation into the desired position is very important.

    I tend to set the parameters at in 3 sections.


    Heel -Ive noted that by attempting to have the heel parallel to all 3 body planes works best - ie frontal transverse and sagittal - now clearly this is a guess or close approximation

    MLA - manipulate the MLA height through plantar/dorsi flexion of the hallux and Plantar/dorsi flexion of the head of the 1st Metatarsal.

    Forefoot - after determining if the patient needs a FF varus or Valgus post and approximation of how much in MM manipulate the Forefoot in the appropriate direction and amount again an approximation.

    Right so after cast set - remove very important here not to remove the cast until fully hard - it will bend and not fully capture the plantar couture shape of the foot.

    After your happy with the cast - Fill.

    If this patient does not require any further cast modifications ie heel skive or further FF posting - more plaster bandage is used - I´ve been using 3 layers. The slab of wet plaster is placed flat on the plantar surface of the cast over the double layer of plaster of the original cast. It is important here to make sure the extra plaster bandage covers where the plastic/EVA will be pressed.

    Leave dry and then press the plastic and grind as normal.

    If the patient requires further cast modification then remove plaster bandage, remove plaster as in heel skive technique and/or remove material from the FF Varus or Valgus etc. Add Plaster to the MLA

    The next stage it to add plaster bandage to the positive cast - I´ve been using 5 layers here.

    But re added plaster bandage you could measure the heel expansion required on the patient and add the amount of plaster needed -

    Again after the cast is dry press and grind as normal.

    Here is some pictures of the process and how it looks.

    Attached Files:

  2. So a lot of the work is done during casting, but intrinsic modifications can also be done.

    By using this technique the contours, lumps and bumps of the foot are captured and then appear in the plastic - while it may not look as a normal finished device the comfort level has increased dramatically as has patient feedback.

    I´ll leave it there and let the 1st stones be cast.

    Attached Files:

  3. CraigT

    CraigT Well-Known Member

    I am a big believer of the importance of the orthotic capturing 'lumps and bumps'- I like the orthotic to have a very organic shape rather than trying to look like an orthotic. I believe it does make a difference to comfort and efficacy (which are closely linked)
    Good on you for experimenting with techniques... can't do that when you only ever use a lab!
  4. I agree 100% with this statement.
  5. Gordon@pier.com

    Gordon@pier.com Welcome New Poster

    Would you still not be better off using a laser scanner with a permanant digital record of the patient?
  6. Probably only work with a cast scan -My hands get in the way.

    Feet change so after a few years re-scan/cast anyway - but the cast modification maybe.

    But this is way cheaper - and not the only way to skin a cat, just throwing it out there as a discussion point.
  7. CraigT

    CraigT Well-Known Member

    Yes... if you can then manipulate the cast/scan as you want to. This is the important part.
    I am not interested in any scanner and software combination which only allows you to do certain modifications or uses the scan simply to size the resultant orthosis.
  8. I'm really rather impressed with your vacuumless vacuum former!

    Home made?
  9. Yep with a little help from a confused Swede who could weld.
  10. Nice. Very nice. Might have to have a go at that myself.
  11. Got the idea from a Book by Jim Phelps (old New Zealand Pod lecturer ) Book on orthotic design.

    Some more pictures to help with design for you Robert.

    Attached Files:

  12. They are hand presses, you youngsters don't know y' born. Cue the 4 Yorkshire men. Used to find them a bit of a pain trying to do very deep heel-cups, but otherwise they were pretty good. And a very green option too.

    P.S. vacuum formers are pretty easy to make too. I've done a few now. I run mine with a vacuum pump out of an old vacuum autoclave, but I've made some perfectly functional ones using vacuum cleaners.

    P.P.S. Your lab is far too clean, Mike. You want to get some work done in there (or invite me and Isaacs over for a weekend).

    P.P.P.S. Gloves are for girls.

    P.P.P.P.S. For Gods sake, get yourself a radio and a page 3 "stunnaz" calendar for the wall, how you ever expect to make decent orthoses without these vital pieces of equipment in your lab is beyond me.
  13. Deep heel cups are a pain.

    and thanks for the other tips :drinks
  14. gnitram900

    gnitram900 Active Member

    Hi Mike and colleagues,

    I was very interested to read this thread. I am working in a Barcelona clinic, initially I was taken aback and skeptical, when I saw the orthosis manufacture process ´a la española´, however I have swum with the flow and found that is a valuable technique to have acquired. I believe that the technique could also combine well with Kirby skives. I am going to experiment on my own feet with this one in the coming weeks!

    So, I have a brief summary of the steps which we follow. In the use of resins, the patients commonly have a very quick adaptation period to the orthosis, because it does very slightly deform with time.


    1. Cut a layer of plaster, 4 times the size of the foot, plus some, to account for the anterior and posterior folds. (For a size 11 foot, you are normally going to need about 1 complete roll).
    2. Soak the entire roll then stretch it out and smooth the surfaces of the layers, with your fingers, so that they become one almost homogenous smooth sheet, with the four borders also smoothed.
    3. Cast foot in supine with heel aligned perpendicularly to the frontal plane of the knee, and the forefoot perpendicular to the heel.
    4. Cast the foot from the toes, then stretch it down to cover the heel and quickly massage in and stretch the sides around the MLA and cuboids, to get impression here. Then wet your fingers and clean your gloves, return to the foot and with your fingers rub the plaster lightly to smooth out any uneven threads or grains of plaster.
    5. With your fingers, press the removed cast, right side up into a hard bench to lightly flatten the main points of weightbearing. (heel and MPJs)
    6. Fill cast with plaster.
    7. Allow plaster to cool, and wrap it completely in cling film.
    8. You are now ready to cut your materials, heat them and mould them directly to the foot model.
    9. To mould a polypropylene device, you to need to wrap a foot length cotton hosiery over the model or the plastic film will stick. Most of our orthoses are made from a acombination of synthetic resins, such as
      podiaflex 1,9 [URL="http://sidas.eurowintuecommerce.com/articulo/FLEX1.9-podiaflexazul19.html"]http://sidas.eurowintuecommerce.com/articulo/FLEX1.9-podiaflexazul19.html[/URL]
      , its benefit being that it malleable at a low temperature.
    10. Whichever material is to be used, it is cut to measure, according to a pattern drawn on the ink imprint of the foot.
    11. You then heat the material and position it on the plaster model and vacuum press it for about 1-2 minutes. Remove it whilst it is still slightly warm, so that you can make final shape adjustments, using your fingers and a hammer.
    12. (If you are making a poly – then you will need gloves and a towel to not burn your fingers!)
    13. Grind, polish, glue on any pads as required and then 98% of orthoses we place a full length cover, unless it is a poly device.
    For casting, my personal preference is suspension casting, but the clinical outlay and logistics do not facilitate this presently.

    Compared with positive model additions, the anecdotal benefits which I have observed are:
    Dramatic reduction in lab time.
    Use of resins allows for easier reheating with a heat gun to “touch up” the orthosis if necessary.
    An orthosis with a better fit to the unique foot shape, which improves comfort.

    The negatives have been:
    More difficult to achieve desired shape of orthosis, with poly devices, due to the higher heat needed.
    An initial period of trial and error, whilst you acquire the techniques of quickly forumulating the orthotic shape with your fingers and the hammer, whilst the orthosis is still warm.

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