So Ive been thinking and experimenting - collective groan from the audience .
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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.
Right,
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
MLA
Forefoot.
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.
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