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The history of casting techniques

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Feb 22, 2011.

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    I'm doing some background research for one of my presentations at Biomechanics Summer School 2011. I'm interested in the history of casting techniques. Prior to Root, what position was the foot cast in? I used to own a copy of Roots book regarding neutral casting, but a student didn't return it :mad:. So, what was Root's rationale for casting the foot in neutral position?
  2. blinda

    blinda MVP

    I think you should name and shame said student....but that doesn`t really help, does it. I`ll ask my contacts.
  3. They know who they are. :hammer:

    If anyone has a copy of Mike Burns paper: Burns MJ: Non-weightbeaing cast impressions for the construction of orthotic devices. JAPA, 67(11): 1977. I should really appreciate a copy.
  4. davidh

    davidh Podiatry Arena Veteran

    At Glasgow, in 1970, we were taught non-weightbearing casting.

    It made no sense then either:confused:.
    I only ever did one outside of College. The insole did not work.
  5. Simon:

    I have the book by Root et al you speak of, but there is little in it regarding the history of casting techniques. All that I can tell you is that prior to Mert Root's neutral suspension casting method, the predominant casting for Levy Mold orthoses at CCPM was the semi-weightbearing plaster puddle cast with the STJ in the "corrected position". I do have some ancient podiatric textbooks that I can look through on this subject for you when I have some more free time.

    This would be a good question for Barry Block's "PMNews" where there are many older podiatrists who sometimes contribute and may remember how the foot was casted for orthoses prior to 1960.
  6. Jeff Root

    Jeff Root Well-Known Member


    The rationale was to capture the foot in an uncompensated position (all joints) so that GRF from the shape of the resulting shell would resist compensatory changes of the foot during weightbearing activity. Neutral position was chosen via trial and error. I believe that most casts prior to that time were done in a semi or full weightbearing manner.

  7. davidh

    davidh Podiatry Arena Veteran

    After thinking about this last night I now remember how the casting was done.
    The cast was weightbearing. A few strips of plaster were applied from heel to toe and the cast-shape was the familiar slipper. But the patient was weightbearing, so weightbearing rather than non-weightbearing.

    "It made no sense......" still applies.

    I think we can be fairly safe in assuming that this was an old technique which had not changed over the years. Certainly I saw my father take a cast in around 1962 or thereabouts (he qualified in 1952), and it was the same technique.
  8. Cameron

    Cameron Well-Known Member


    The history of foot casting can be traced back to the introduction of plaster bandage (see the old text books and plaster journals) . I can concurr with Dave we were taught in Glasgow circa 1970, slipper casting (non weightbearing), then with a heel lift and hand rail support the patient stood with weight evenly distributed. Apart from the obvious health and safety risks the vasts were often driend before the banadage could be manipulated to the weightbearing foot. Made it all a bit of a waste of time. Putty casting and Oasis casting were also used - always weight bearing.

    Prior to the intorduction of Roots casting techniques in the 80s weightbearing methods prevailed. Once the stj neutral casting technique was introduced to the schools of podiaty (circa 1981) the weight bearing casting technique became less common. Langer took the initiative and ran a two day seminar for the chiropody teachers in London, which was very well attended and from that gradually the Root theories were intigrated into the UK schools curriculum. It was a slow process and not without considerable resistance in places. Manchester (Salford) were perhaps the most thorough with their intellectual appraisal of the new paradigms and from their early papers published in the professional journal slowly the schools' curriculum was changed. Langers casting charts were everywhere and were certainly influencial in bringing Roots work to UK practitioners.

    Mid 80s I used to get my students in Edinburgh to consider the differences between a weight bearing foot and a non weightbearing foot using popular casting techniques. We developed an anthropodmetric measurement technique pin pointing centres of 1st and 5th MPJs; then using the bisection of the heel curve Measured the linear distance between the points as well as the angle. Using this data we could estimate weightbearing changes. It was that long ago we were using Sinclair computers to do the number crunching but came up with reasonable data to indicate a universal value which represented change due to weightbearing. One of my students at the time was a young Jim Woodburn, and Colin Thompson did the computations on the computer and George Rendall worked the stats . Later still I used the same techniques to compare footprints .

    Tea time - must off
  9. davidh

    davidh Podiatry Arena Veteran

    Hi TS,

    I corrected myself a little later down the thread. I remember weightbearing casting, but not non-weightbearing, although I may well have seen this.

    I should explain that TS and I were a year apart at Glasgow, and as I remember we were also split into groups for "appliances". It is entirely possible that we were taught in a different way to another group or year since casting was a very small part of appliance-making.

    For the uninitiated, applinace-making included fabricating simple insoles, contralateral wedging, latex HV shields, and all manner of leather-covered pads which were held in place with lastinet. For our year and the preceeding yearly intakes at Glasgow dental silicone putty and disposable scalpel blades were truly cutting edge - to be used once we had qualified, but not before.

    That Langer casting chart, and the rationale for casting in that way, was a revelation.
  10. Cameron

    Cameron Well-Known Member


    Beef Olives for tea smashing.

    As an after thought one of the crtical things to come from the Manchester evaluation of podiatric biomechanics during the 80s was an article by Bob Kidd (published in the Chiropodist). I think he lurks on the pod arena and certainly would be worth contacting since he was one of the influencial 'angry young men' who intelllectually appraised the stjn paradigm. Bob's seminal work/obserations set the discourse for much of the current debate on podiatric foot biomechanics as documented of the podiatry listserve and Podiatry Arena over the last decade.

    Prior to the intro of Podiatric biomechanics in the UK casted foot orthoses in the were more arch supports than what would came after. There was little appreciation of forefoot rearfoot relationships back in the 70s in the UK. The preferred medium was cork/latex butter (gunge) which was slapped onto the positive cast pre- prepared with coverings of gas meter reject of chamois, then coated in layers of latex. Once dried the hedgehog was ground off to set the cast flat to the ground. The test used was to place the orthoses in position under the cast and place a finger over the the middle of the cast (approx to the keystone of the arch) - provided it was stable and did not rock from side to side, then that was it.

    In actual fact very few chiros made casted foot orthoses - there were some of course but only a small percentage of the total population . There were literally no prescription labs as we understand them at that time.

    Two other things happened in the 80s in the UK schools. Just as podiatric biomechnics was being introduced from the US there was a major push for degree status and a radical reappraisal of core syllabus was undertaken. Only one major survey* was completed to estimate the actual use of foot orthoses in chirpodial practice and the findings indicated it was less than 10% of the worked hours. The foot orthotic component in traditional chiropody syllabus accounted for 33% of the course. As a reslt of this survey the taught syllabus for foot orthoses was slashed across the board and most but not all centres adopted a new model with classrroom biomechanics (theory - very degree) combined with workshop labs for practical training in the first and second year only (of the three year program).

    This suited the new degree programs with emphasis on theory and less on practical training. By this time also there were new schools starting and the reduced need for consumables for over long foot orthotics programs was welcomed by managment. Other areas of the syllabus were being developed which took up the money saved from foot orthoses programs ie surgical facilities.

    By the ned of the 80s students made a much smaller portfolio of foot orthoses for assessment. Senior students were encouraged to use prescription services now instead of making their own.

    * the author of the survey was ostrosised by her her colleagues after her paper was published.

  11. Simon not sure if this helps ..... http://www.podiatrym.com/cme/Sep02cme.pdf

  12. Thanks all,

    I have a vague recollection of these from my student days- does anyone have a copy of one?

    I checked my antique books today and found some descriptions of casting from the 1950's and 60's. In fact one of them described the Letterman method which Mike linked to.

    Once again, many thanks to all who have responded.
  13. Jeff Root

    Jeff Root Well-Known Member


    This is from the introduction of Neutral Position Casting Techniques:
    The purpose of this casting technique is to provide a reproduction of the foot from which a functional orthosis can be made. A functional orthotic is a device which controls motion and position of the foot during locomotion. It re-establishes normal function within the physical limits of the patient.

    A normal foot pronates at heel strike becoming a mobile adapter to variances of terrain and body position. It must then supinate, during propulsion, to become a rigid lever which is stable and bears weight without hypermobility. The orthotic should influence the calcaneus to create normal subtalar joint pronation and supination during locomotion. It should also influence the forefoot to create a fully pronated (locked) position of the midtarsal joint during the last half of the stance phase of gait. While allowing for normal motion of the foot, the orthotic should prevent:
    1. Excessive motion of the foot
    2. Inappropriate direction of motion of the foot for each phase of gait

    Simon, I underlined an important point in the first paragraph. So the objective is to cast and support the foot in a position that encourages a healthy osseous relationship (i.e. resist pathological forces as best possible).

  14. Cameron

    Cameron Well-Known Member


    Whilst casting techniques were around in various guises from before the Second World War it took until the development of plaster impregnated bandages before casting techniques were used by chiropodists. Even then it was a rarified occupation practised by only a very few. Franklin Charlesworth's Theory of Chiropody highlighights the more common practices of the time and much of this reflects the preoccupation of the 30s and 40s for traction.

    Back inthe 70s small post graduate grousp such as the Croydon Post Graduate Group were instrumental in bringing American procedures like nail wedge resection into the scope of chiropody practice. The main problem was acceptance by the medical fraternity that chiropodist could safely administer local anaesthetics. Foot surgery (mostly amputations) had been practised by chiropodists well before the war but again this was not a general rule. At first there was a swell of interest in the UK especially around the Midlands and South of England to engage in post graduate training. The schools remained aloff, preferring the development to come at post graduate level. This allowed them to contiune with a standard undergraduate curriculum set by the Society. Very slowly things began to change and once the politics to accept local anaesthics was passed in the early 70s the schools gradualy embraced local anaesthetics into the undergraduate curriculum.

    From the initial fevor for post graduate education there was a major hiatus as the legislation to practice open surgery on the foot began to slow things down. The Americans were obviously keen to promote anything that would keep the UK market interested and promoted (very much as an afterthought) closed surgery techniques using the 'new' Californian biomechanics based on the works of Root et al.

    Enter the functional foot orthosis made to a custom cast. At first there was very little interest principally because the majority of pods in the UK worked in the NHS and private practice was not that well geared to charge for custom foot appliances. Californian biomechanics was generally not understood and a radical departure from podology as taught in the UK and Australia & NZ). The contiuned success of the Californian post grad program was due in no small part to the interest of pods in the UK and Australia etc., wanting to learn more. Eager but still a very small number it took for Langer Orthotics in the US, keen to increase their market share and encourage the Brits, and Australians to use their functional foot orthoses, to premote Californian biomechanics in the actual countries. So it was really Sheldon Langer et al that established Roots work firmly in the UK and Aussie psyche.

    In the school I worked in, Root et al volumes were locked away in the boss's office and it took until the mid 70s before they appeared in the library. My school was not alone.

    Langer UK continues and may well now be the biggest prescription lab in the country. In Australia the Aussies picked up the Californian Biomechanics from Langer but were very quick to set up their own lab services.
  15. Thanks Cameron for the great historical review.

    And I believe that it was Langer that taught that STJ neutral could be found by palpating for "talo-navicular congruency" (I remember this on one of Langer's posters from the early 1980's), whereas I don't believe that Mert Root or John Weed ever taught talo-navicular congruency as a valid method of determining STJ neutral. John Weed even specifically taught in his biomechanics classes that this TN joint palpation method could not be reliably used to determine STJ neutral.

    Maybe Jeff can confirm where this idea of talo-navicular congruency for determining STJ neutral originated from.
  16. Jeff Root

    Jeff Root Well-Known Member


    I think my father may have mentioned talo-navicular congruency as an possible indicator of stj neutral somewhere in one of his books. However, he did not use it as a clinical tool to find or verify the stj neutral position. If anyone believes that my father recommended talo-navicular congruency as a tool to locate stj neutral, they are probably taking his statement or position out of context. I know my father did discussed palpating the margins of the talus and the calcaneus in his casting manual.

    The talo-navicular joint, like the 1st mpj, seems to be one of the more adaptive joints in the foot. As a result, the more “abnormal” the stj, the more likely the possibility that adaptive changes have occurred at the talo-navicular joint. In feet that function significantly pronated, the navicular can adapt an abducted attitude and the talo-navicular joint feels congruent in some of these individuals. I’m not sure who popularized this technique, but I find it unnecessary.

  17. Thanks Jeff. John Weed also mentioned in his lectures to us that the degree of metatarsus adductus/forefoot adductus of the foot would change the congruency of the talo-navicular joint so that TN joint palpation was not a reliable method of determining STJ neutral position. As for myself, I have never found it easy or reliable to palpate the margins of the talo-calcaneal joint, as your father and John Weed mentioned. My experience hast been that in most feet there is too much adipose/soft tissue covering the osseous margins talo-calcaneal joint to assess for "talo-calcaneal congruency". In addition, I am not even sure if the talo-calcaneal margins correlate to the anatomical variances seen in the articular geometry of the talo-calcaneal joint.

    Good discussion.:drinks
  18. Rick K.

    Rick K. Active Member

    My uncle Louie (who worked the Campisi family in North Jersey) was using concrete for foot casting way before Root et al. He never had any subsequent complaints of foot pain in anyone he casted. The fishes also liked him a lot.
  19. So, from my reading, we had boxes filled with plaster, then plaster bandage... who introduced foam box casting and when? I don't recall these being used when I trained in the late 80's... And can't really remember seeing them used much before the mid 90's.
  20. Don't forget the grease box - a tin box (of Jacobs Cream Cracker variety) filled with heavy grade engine grease covered in cling film or muslin. Weightbearing obviously and a favourite of every domestic cleaner.....
  21. Yep, got that in one of my books.
  22. Jeff Root

    Jeff Root Well-Known Member

    And don’t forget “Some Practical Points in the Anatomy of the Foot” by Lovett and Cotton in the Boston Medical and Surgical Journal, (see page 315) published August 4, 1898: “The apparatus is made of strips of spring steel, eighteen or twenty gauge, riveted together as shown, made to fit a cut-out plaster cast, which is taken in the corrected position.”

    Very interesting!

    Attached Files:

  23. Ransart

    Ransart Welcome New Poster

    Casting has been used since a long time for the treatment of diabetic foot ulcers. It derives from the devices used in leprosy in those old days and make with plaster of Paris.
  24. Cameron

    Cameron Well-Known Member


    Oasis foam was developed in the mid fities for flower arrangment.

    Later by the sixties oasis blocks were introduced. The procedure was weightbearing and despite the absence of water did carry real health and safety risks. To stand any chance of getting a reasonable impression it was necessary to educate the subject to use the oasis box and that usually involved using several boxes which increased costs. Inaviably the impression sat deeper at the heel than the rearfoot and the final casting was weak across the mid tarsal joints. When vacuum forming the plastic shell, the plaster cast cracked. This meant the one off casting procedure was far more expensive than more conventional plaster bandage slipper cast technique. Hence it came and went. Some pods preferred the technique because of ease and it continues to have a limited market.

    When I taught these things and Adam was a lad, I used it with the students to compare anthropometric values between weightbearing and non weightbearing casting techniques. Even with measured rotation of the knee and plantar pressure over the first metatarsal head, invariably the oasis cast caught a supinated foot position. Hence the measurements from an oasis cast were smaller than a subtalar neutral cast of the same foot.

  25. blinda

    blinda MVP

    It`s on its way......snail mail :rolleyes:

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