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I would like advice on writing prescriptions for orthotics for children who have flexible pes planus foot type and hypermobility.
I use RX Labs but often find the medial arch of the orthotic is too low and there is soft tissue overhang of navicular and medial arch area. I request 100% shell width and kirby Skive, but what else can I request on the prescription form to obtain a better orthotic.
Many thanks
Bonnie

 

Hi Bonnie

I'm sure you will get some useful advice here but the best people to talk to would be the lab itself- they're the ones making them!

If they prove unhelpful or are unable to provide the type of device you are after find someone else who is (or do it yourself)

If you are finding that you get this because there is a large transverse plane movement/navicular drift you might want to try a device with a high medial wrap/UCBL type?

 

:good:

All labs will have a default setting for orthotic shells and if you do not specify, they will work to the default.

As Ian said, you must speak to the lab and perhaps arrange a visit in order to get a handle on how they interpret your prescription, how they modify your cast and how they manufacture the device.

The important element, however, is that you should be able to prescibe everything about the device from the arch height to shell width to the thickness of the material at certain points in the shell. These factors are your responsibility.

In the "foot type" described in your original post, depending on a multitude of different factors, not least the diagnosis, you could have infinite prescription variations.

Of course, experience teaches us that certain pathologies necessitate certain prescription variables in the orthoses. However, it may not be the case 100% of the time.

On a personal note, one of the best things I did for learning about prescription variables and being responsible for every element of the prescription was to look into CADCAM orthotic production. You can virtually specify anything you want. You can be accurate about the fact that you want a 15.5mm heel seat depth, that you want the plastic to be thicker in the medial arch for greater rigidity or that you need a 42 mm medial flange.

I've made a few horrendous errors along the way but it has all contributed to knowing better how to design an orthosis. As many will tell you on here, manufacturing your own devices is the best way to understand the reasons for certain manufacture techniques and for being 100 % in charge of what is being manufactured.

Staying within the same company, you have access to CADCAM manufacture and good technical/clinical support and they are usaully very open to having visitors so make use of it. If they are not, there are others that will be who are members on this forum.

BTW - before I turn this into a CAD vs conventional arguement, I use about 50/50 so I have no preference - horses for courses.

Hope this helps

Robin

 

Request less pr no arch fill (or whatever terminology they use)

There is no such thing. You request the design features in the foot orthotic based on what prescription variables each individual patient needs.

 

Hi

Can I suggest using the International Children's Orthotic Lab in Queensland.

It is my experience with the foot you described that a high calcaneal inclination angle built into the device.

Regards
A

 

My labs that I have worked with... Dont want to give that advice they are very vague... may be legal reasons etc... I mean they always say your the podiatrist :p

But yes first try the lab :D

 

RX devices are renowned for having a particularly low arch profile.

Why not try Langer or TM Custom devices (both of which you can also use if you have an RX account) and see if they give you the shell dimensions/topography that you are after.

 

Also try asking them to pour the cast, rather than direct milling it. I know Langer do this (Langer now own both Rx labs and TM).

:drinks

 

Bonnie:

If the medial arch of the orthosis is too low, then have the lab use minimal medial expansion plaster on the positive cast and have the cast inverted 3-5 degrees. In addition, when you are negative casting the child for orthoses, plantarflex the first ray/medial column during casting.

Here is something I wrote 12 years ago on this subject which may be of help.

 

I have been working in asia and this foot type is common (Kids and adults) My best results have come with a modified blake, heel lift, first ray cut out and fascial groove. I can see good nueromuscular fascilitation over the first few months. NB. Check the length (too long is not good even for a kid and labs sometimes make kids devices way too long) also add some eccentric calf work if appropriate.
Be patient and you will see some great changes.

 

Greetings

I may be regarded as the Devil's Advocate but no one seems to have suggested using or modifying a prefabricated device. There is a plethora of of "blank" paediatric foot orthoses out there which can be used as is (one never knows until it is tried) or modified according to need. A more affordable place to start.

 

I work full-time in paeds and it concerns me that you describe flexible pes planus as if it is a pathology, which it is not. so I don't see why you would prescribe for them anyway. Now if the patients you see have a pathology and you feel that they would benefit from a device, you need to prescribe based on the presenting pathology and the patient you see, therefore each prescription will be unique to the individual.

But if they just need a bit, I agree with the last poster, I use a pre-fab, play with the posting before I decide on a custom device. Of course, then all the posts above apply. However, I am fortunate enough to have my own lab, where I can personally go in to make my trick Rx's, who you can tell really at the casting stage. I could show you in plaster how to avoid the problems you speak of, but on the whole if you ask for a steeper calcaneal inclination angle it will help, and I max out on the skives too, they are awesome. Paeds Rx are totally different to adults.