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Mar 15

Written by: Larry Huppin, DPM
3/15/2010 1:00 PM

In part 1 of this series, we discussed the first two of our Five Rules of Negative Casting:

It turns out that casting with a plantarflexed first ray may have other benefits. A cadaveric study by Kogler in 1999 found that valgus forefoot wedging decreased strain on the plantar fascia under experimental weightbearing conditions, while varus wedging increased strain.(6) This study showed unequivocally that the most effective way to decrease strain on the plantar fascia is to evert the forefoot.

To provide the force needed to evert the forefoot, a valgus wedge can be added to the orthosis, but valgus should also be captured within the orthotic plate itself. To do so, as much valgus as possible should be captured during the casting process. To accomplish this, the subtalar joint should be held in neutral, the midtarsal joint maximally pronated and the first ray should be plantarflexed during casting.

So this gives us Casting Rule #3:
To produce an orthosis that decreases strain on the plantar fascia, cast out any soft tissue varus to enhance forefoot valgus in the negative cast.

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