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Casting for Functional Orthoses

Achieving the Best Outcomes


ProLab Casting Standard

  • Use a nonweightbearing, neutral suspension casting technique for functional orthoses

This standard is based on two significant studies:

  • A 1989 Northern Arizona University study showed that having any weight on the foot during the casting or imaging process resulted in an orthotic shape that has been shown to cause pain in the big toe joint and to increase tension on the plantar fascia.1, 2
  • A 2002 study from the Joiner Center for Sports Medicine at the University of Delaware showed that weightbearing casting resulted in abnormal force under the big toe joint.3  This has been shown to result in the production of an orthotic that does not work well at reducing the forces that lead to common foot problems such as bunions, big toe joint pain, heel pain, arch pain, plantar fasciitis and other conditions.1  Nonweightbearing casting was recommended as the most reliable and valid method for making custom foot orthotics.3

Step-by-step functional casting instructions are available on video or you can refer to the guide below.

Functional AFO Casting—Follow all steps. Functional Foot Orthoses Casting—Omit steps 1, 2, and 5

1 AFO Only
• Outline the lateral malleolus
• Place a dot in the center of outline
2 AFO Only
• Outline the medial malleolus
• Place a dot in the center of outline
3 • Mark the 5th MPJ   • Mark the 1st MPJ
4 • Position the foot 90° to the leg 
• Apply 2 strips of plaster
5 AFO Only
• Apply a 3rd strip of plaster above the malleolus
6 • Lift foot holding the 4th and 5th toes
• Position the foot in neutral at the STJ
• Ensure that the MTJ is fully pronated and locked
7 • Press down lightly on 1st metatarsal or dorsiflex the hallux to plantarflex the 1st ray
8

• Remove cast

References

1.  McPoil, TG; Schmit, D. Comparison of three methods used to obtain a neutral plaster foot impression. Phys Ther. 69(6):448-52, 1989

2.  Roukis TS, Scherer PR, Anderson CF. Position of the first ray and motion of the first metatarsophalangeal joint.  J Am Podiatr Med Assoc. 86(11):538-46, 1996

3.  McClay-Davis I, Laughton C, Williams, DS. Comparison of four methods of obtaining a negative impression of the foot. J Am Podiatr Med Assoc. 92(5):261-8, 2002

 

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