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Nov 24

Written by: Cherri Choate, DPM
11/24/2010

A common confusion on the ProLab prescription form involves the terminology of cast fill, arch pad and arch fill.  Each of these is distinctly different and should be used for distinct patient symptoms.

The cast fill is part of the construction of the shape of the positive image prior to the plate being created.  A maximum cast fill will lead to a lower arch and minimum cast fill will lead to a higher arch.  These options are based on the foot of each individual, so the end result will be custom for that patient's foot.  Sometimes  a minimal cast fill is termed as more "aggressive" as it will lead to a higher arch in the orthotic itself and ultimately more pronation control.

The arch pad is placed between the orthotic plate and the topcover.  It is usually a softer type of material, such as poron.  It can be used to add height to the arch that is not firm.  It is an option to "raise" the arch, without making the plate higher.  Some practitioners use it as a softer transition in more sensitive or elderly feet so that the firmness of the orthotic plate will not bother the patient. 

The arch fill is used on the plantar surface of the orthotic plate in the medial arch.  It is used to add firmness or rigidity to a more flexible plate.  Many practitioners use the arch fill to improve the ability to adjust the orthotics in their office, without needing to return them to the lab.  Since the arch fill adds rigidity to the arch area of the plate, as it is removed (ground down), the arch becomes more flexible.  In very heavy patients the arch fill is necessary to obtain the plate rigidity that is ordered by the physician.  Additionally, in situations where there is a heel lift of more than 10 mm, arch fill is often added to stabilize the plate and avoid the stressors that occur in the medial arch area with a high heel lift.  Lastly, some practioners prefer a device that "fills the shoe" and helps avoid orthotic movement in the shoe during ambulation.

Awareness of these modifications allows the practitioner to order more effective and successful orthotics and braces.

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