Post on 13-Oct-2020
Custom Prescription Guide
POWERED BY
Bespoke range of foot ortho�csCustom
Powered by
CUSTOM
02 www.dolaorthotics.com
7
4
www.talarmadecustom.com
:: ::
Bespoke range of Custom
Powered by
Custom and Semi-custom orthotics available now at TalarMade Custom. • Customised orthotics for your patients• Simple and easy 5 step process to order• Delivered within 10 working days• Cost effective orthotics solution
For more information:Contact us on 01246 268 456 or visit www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 03
HOW TO ORDER 05
TALARMADE CUSTOM OPTIONS 06
SHELL MATERIALS 08
DIGITAL CORRECTIONS 11
Shape 11
Pour 12
MLA Fill
MLA Profi le 13
MLA Highpoint
Heel Cup Height
Heel Cup Width 14
Shell Width
Lateral Arch 15
Heel Skives
Shell Modifi cati ons
POSTINGS Rearfoot 17
Elevati on
Forefoot
ADDITIONS Rearfoot 18
Midfoot
Forefoot 19
Specialty 20
TOP COVERS 21
ORTHOTIC CONSIDERATIONS 25
CLINICAL TESTS 29
GLOSSARY 30
CONTENTS
TalarMade Custom Powered By
HOW TO ORDER
TALARMADE CUSTOM OPTIONS
SHELL MATERIALS
DIGITAL CORRECTIONS Shape 11
Pour 12
MLA Fill
MLA Profi le 13
MLA Highpoint
Heel Cup Height
Heel Cup Width 14
Shell Width
Lateral Arch 15
Heel Skives
Shell Modifi cati ons
POSTINGS Rearfoot 17
Elevati on
Forefoot
ADDITIONS Rearfoot 18
Midfoot
Forefoot 19
Specialty 20
TOP COVERS
ORTHOTIC CONSIDERATIONS
CLINICAL TESTS
GLOSSARY
WE ARE OPEN SOURCE, BYO SCANNER AND USE OUR FREE APP
KEY FEATURES:Free App
Scanning + Clinical Photos + Prescripti on Form + Instant OrderWatch how to scan video on
www.youtube.com/user/DigitalOrthoti csAus
iPAD SCANNER
Bespoke range of foot ortho�csCustom
Powered by
DOLA Orthoti cs Custom Soluti ons 05
STEP 1
STEP 2
STEP 3
STEP 4
CASTS / SCANS / SCRIPT
COMPUTERISED ORTHOTIC DESIGN
COMPUTERISED ORTHOTIC MANUFACTURING
DELIVERY SERVICE
Cast or Foam BoxSend cast/foam box and prescripti on form to us
3D Printi ng and 100% Direct Milled
By our team of CAD designers, Podiatrists & Biomechanists
Your orthoti cs are dispatched within 10 working days
iPad Scanner & FREE AppScan, clinical photos, In-built prescripti on, direct
order through the app
By our team of CAD designers, Podiatrists & Biomechanists
iPad Scanner & FREE App
CASTS / SCANS / SCRIPT
4 STEPS - HOW TO ORDER
TalarMade Custom Powered By
06 www.dolaorthoti cs.com
TALARMADE CUSTOM OPTIONS
INDEPENDENT DESIGN POSSIBILITIESDo what you want at the...Do what you want at the...
Met DomeMet BarForefoot ExtensionGait PlatesCustom PaddingToewalker
Forefoot Valgus ExtensionForefoot Valgus PostReverse Mortons Extension
1st Met CutoutForefoot Varus Extension
Forefoot Varus PostShell Width
Mortons ExtensionCluff y Wedge
pg. 21
pg. 21
pg. 22
pg. 17
pg. 22
pg. 17
pg. 21
pg. 19
pg. 21
pg. 16
pg. 22
pg. 17
pg. 20
Lateral ArchCuboid Pad/Notch
Lateral FlangeLateral Plantar Fill
REARFOOT
MIDFOOT
FOREFOOT
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 07
TALARMADE CUSTOM OPTIONS
1st Met CutoutForefoot Varus Extension
Forefoot Varus PostShell Width
Mortons ExtensionCluff y Wedge
pg. 16
pg. 21
pg. 19
pg. 15
pg. 17+21
pg. 22
pg. 13
pg. 13-14
pg. 14
pg. 14
pg. 20
pg. 17
pg. 12
pg. 16
pg. 20
pg. 12
pg. 19
pg. 16
pg. 14
pg. 15
pg. 20
pg. 19
pg. 20
pg. 20
pg. 20
pg. 16
pg. 22
pg. 17
pg. 20
PourArch Fill
Arch Profi leArch Highpoint Positi on
Arch PadPlantar Fascial Groove
Medial Flare/Taper Medial Flange
Medial Plantar FillShell Shape
Rearfoot Valgus PostLateral Heel Skive
Rearfoot Varus PostMedial Heel Skive
Heel Cup HeightHeel Cup Width
Heel RaiseElevati onHeel Pad
Heel ApertureHorse Shoe Pad
pg. 19
pg. 16
TalarMade Custom Powered By
1st Met Cutout1st Met CutoutForefoot Varus Extension
Forefoot Varus PostShell Width
Mortons ExtensionCluff y Wedge
pg. 16pg. 16
pg. 21
pg. 19
pg. 15
pg. 17+21
pg. 22
Rearfoot Valgus Post
08 www.dolaorthoti cs.com
SHELL MATERIALS
SHELL TYPE What is it? What is it used for?
POLYPROPYLENE
EVA
Polypropylene Ultra
EVA 3/4 Length
EVA Full Length
EVA Soft (Density 220, A35)
Polypropylene Semi
Polypropylene Standard
Polypropylene Firm
Polypropylene Extra Firm
Direct Milled from the fi nest sheets of custom German polypropylene.
It is stronger than the same thickness of vacuum formed poly. This allows our devices to be up to 30% thinner for the same control.
Our thicknesses diff er by fracti ons of a millimetre giving you the ulti mate control over fl exibility and support whilst reducing unnecessary bulk.
Direct Milled from the highest quality and most consistent EVA sheets.
Control with maximum fl ex
Shell extends to proximal metatarsal heads
Shell extends to the full length of the footwear
Maximum cushioning
Control with moderate fl ex
Control with standard fl ex
Control and reduced fl ex
Control and minimal fl ex
- Shank independent material- Hardwearing- Long lasti ng- Easy footwear fi t- Customisable thicknesses- Variable fl exibility- Heat moldable- Grindable
- Shank dependent material- Easily adjusted- Heat moldable- Grindable- Cushioning, deformati on & lifespan are density dependant
- Mild to moderate control- Low BMI- Hard to fi t footwear- Low to moderate MSRT
Footwear fi t dependant- Reduced forefoot space required- Lower bulk
To replace removeable insole
- Mild to moderate control- Low BMI- Low to moderate MSRT- Increased cushioning
- Mild to moderate control- Low BMI- Low to moderate MSRT
- Moderate control- Standard BMI- Low to moderate MSRT- Standard Footwear
- Moderate to high control- Moderate to high BMI- Moderate to high MSRT
- Moderate to high control- Moderate to high BMI- Standard to deep / wide footwear- Moderate to high MSRT
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 09
SHELL MATERIALS
SHELL TYPE What is it? What is it used for?
EVA Medium (Density 350. A50)
EVA Hard (Density 400, A65)
3D PRINTED
3D Printed Ultra
3D Printed Semi
3D Printed Standard
3D Printed Firm
Standard cushioning & control
Maximum control
Change what is possible with 3D Printed Orthoti cs. Work with our 3D design team to create a custom corporate design for your practi ce.
Control with maximum fl ex
Control with moderate fl ex
Control with standard fl ex
Control and reduced fl ex
- Moderate control- Standard BMI- Low to moderate MSRT
- Moderate to high control- Moderate to high BMI- Standard to wide footwear- Moderate to high MSRT
- Shank independent material- Easy footwear fi t- Customisable thicknesses- Variable fl exibility
- Mild to moderate control- Low BMI- Low to moderate MSRT
- Mild to moderate control- Low BMI- Low to moderate MSRT
- Moderate control- Standard BMI- Low to moderate MSRT
- Moderate to high control- Moderate to high BMI- Moderate to high MSRT
LEARN MORE ATwww.talarmadecustom.com
TalarMade Custom Powered By
SHELL TYPE
EVA Medium (Density 350. A50)
EVA Hard (Density 400, A65)
3D PRINTED
3D Printed Ultra
3D Printed Semi
3D Printed Standard
3D Printed Firm
10 www.dolaorthotics.com
SHELL MATERIALS
SHELL Type 0-40kg 40-70kg 70-100kg 100-130kg 130+kg
Direct MilledPolypropylene &3D Printed
Ultra
Semi
Standard
Firm
Extra Firm
Direct Milled EVA Soft
Medium
Hard
LAB GUIDE
When to make more flexible?AGE: Older people often prefer more flexible devicesCOMFORT: When patient comfort and compliance is a priorityFOOT TYPE: Rigid feet, cavus feet when pressure distribution is a prioritySUPINATION RESISTANCE: Low MSRT score
When to make less flexible?SUPPORT: When more support or correction is required BODY WEIGHT: In patients with high BMISUPINATION RESISTANCE: High MSRT score
Ultra
Sem
i
Stan
dard
Firm
Extra
Firm
Shell FlexibilityMany factors influence the relative flexibility or rigidity of an orthotic device including shell thickness, material properties, patient body weight, activity type and orthotic design variables including arch height, rearfoot posting etc.
We offer 5 levels of material flexibility. This material thickness profile is maintained across your prescriptions providing you with consistency of design and consistency of results.
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 11
DIGITAL CORRECTIONS
SHAPE What is it? What is it used for?
Standard
Dress
Medial Taper
Medial Flare
Traditi onal orthoti c shaped device
Lower profi le device with tapered sides, lower heel cup, reduced calcaneal inclinati on angle
Decrease in the width of the medial border of the orthoti c shell by 5% or 10% from standard orthoti c shape
Increase in the width of the medial border of the orthoti c by 5%, 10% or 15% from standard orthoti c shape
- To fi t the majority of standard footwear applicati ons
- Aid footwear fi t- Hard to fi t footwear types
- Aid footwear fi t- Hard to fi t footwear types
- Increasing surface area contact- Pressure redistributi on- Talonavicular bulging- Orthoti c Reacti on Force (ORF) medial to STJ axis- Medially deviated STJ- Accessory navicular- Signifi cant navicular drift in RCSP and gait
LAB TIP Beware footwear fi t implicati ons
ISOMETRIC MEDIAL ANTERIORDORSAL LATERAL POSTERIOR
ISOMETRIC MEDIAL ANTERIORDORSAL LATERAL POSTERIOR
STANDARD
STANDARD
+5% MEDIAL FLARE
-5% MEDIAL TAPER
+10% MEDIAL FLARE
-10% MEDIAL TAPER
+15% MEDIAL FLARE
TalarMade Custom Powered By
12 www.dolaorthotics.com
DIGITAL CORRECTIONS
LEARN MORE ATwww.talarmadecustom.com
No Fill
Very Minimal
Minimum
Standard
No Fill 25mm
Very minimal fill 23.75mm
Minimal fill 22.5mm
Standard fill 20mm
Maximal fill 17.5mm
Very maximal fill 12.5mm
FIG. 01 - MLA EXAMPLEMLA FILLThe amount of fill applied to the MLA (medial longitudinal arch) captured in the scan/cast. This influences the medial arch height of the device. We use a set percentage of the arch captured in the scan, cast or impression box after desired balancing is applied for consistency.
ExampleA cast balanced forefoot to rearfoot with a 25mm arch height would result in the following device heights shown in figure 01 on the right.PLEASE NOTE: IF A REARFOOT POST ANGLE IS APPLIED THE FINAL ARCH HEIGHT WILL BE HIGHER FOR VARUS POSTS AND LOWER FOR VALGUS POSTS.
No fill appliedOrthotic shell will contour to arch captured in scan/cast with smoothing only
5% of arch captured in cast/scan is filled inDevice is 95% of arch captured
10% of arch captured in cast/scan is filled inDevice is 90% of arch captured
20% of arch captured in cast/scan is filled inDevice is 80% of arch captured
- Max control- Max contact- Very high arch contour
- High control- High contact- High arch contour
- Moderate to high control- Moderate to high contact- Moderate to high arch contour
- Moderate control- Moderate contact- Moderate to arch contour
Maximum 30% of arch captured in cast/scan is filled inDevice is 70% of arch captured
- Mild to moderate control- Mild to moderate contact- Mild to moderate arch contour
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 13
DIGITAL CORRECTIONS
MLA FILL
MLA PROFILE
HEEL CUP HEIGHT
MLA HIGHPOINT
What is it? What is it used for?
Very Maximal
Standard
Low
Specify
Comfort
Standard
High
Specify
50% of arch captured in cast/scan is fi lled inDevice is 50% of arch captured
Traditi onal arch profi le and calcaneal inclinati on, metatarsal declinati on angle
Low Heelcup <10mmCreates a low profi le device
The verti cal distance between the heel contact point and the heel cup line of the device
The positi on of the medial arch apex or high point:
STANDARDTalar-navicular
ANTERIORNavicular-cuneiform
POSTERIORSustentaculum tali
Practi ti oner specifi ed arch height. Rearfoot correcti on is applied aft er this so it may result in an increased/decreased fi nal arch height.
Increased concave arch profi le with lower calcaneal inclinati on angle
Standard Heelcup 12-14mmProvides a balance of control and shoe fi t
High Heelcup >16mmProvides increased stability and shell rigidity
Practi ti oner specifi ed heel cup height
- Mild control- Mild contact- Mild contour
- Balance of support and comfort
Minimal to standard rearfoot controlHard to fi t footwear:Dress shoesCasual shoesSlip ons
Boots (football, soccer, ski)Cycling cleats
- Rearfoot control- Rearfoot stability- Footwear fi t
- Infl uences calcaneal inclinati on and metatarsal declinati on angle of the device- Modify force applicati on points- Support specifi c regions- Alter pati ent device tolerance
- Specifi c arch height requirements
- Increase comfort- Increase tolerance- Reduce arch irritati on
- Standard to severe rearfoot control- Increased stability- Standard shoe types
- Increased rearfoot control- Increased rearfoot stability- Severe over-pronators - Instability / hypermobility / ligament laxity- Used in UCBL devices
- Specifi c heel cup height requirements
POSTERIOR
STANDARD
ANTERIOR
LAB TIP: Beware footwear fi t implicati ons
LAB TIP: Height before rearfoot post applied. If required as fi nal height please advise.
TalarMade Custom Powered By
14 www.dolaorthoti cs.com
DIGITAL CORRECTIONS
HEEL CUP WIDTH What is it? What is it used for?
Narrow
Standard
Wide
Specify
Width of heel cup from medial to lateral border
3mm added to heel captured in cast/scan
5mm added to heel captured in cast/scan
8mm added to heel captured in cast/scan
Practi ti oner specifi ed heel cup width
Allows for:- Fat pad expansion- Top cover thickness- Footwear fi t
- Hard to fi t footwear- Minimal fat pad expansion- Narrow heel size- Thin covering materials
- Standard footwear- Standard fat pad expansion- Standard heel size- Standard covering materials
-Wide footwear- Wide heel size- Large fat pad expansion- Thick covering material
- Specifi c heel cup width requirements
LAB TIP: Consider cast/scan type used eg. NWB/SWB/WB
NARROWSTANDARDWIDE
LAB TIP Beware footwear fi t implicati ons
SHELL WIDTH
Narrow
Standard
Wide
Lateral border of the foot to lateral sesamoid
Lateral border of the foot to bisecti on of 1st metatarsal head
Lateral border of the foot to medial sesamoid
Width of anterior shell (behind metatarsal heads) from lateral to medial
- Narrow footwear- Hard to fi t footwear- Standard / narrow forefoot size- No forefoot deformity (HAV / tailors bunions)
- Mild to standard control- Decreased orthoti c area
- Standard footwear- Standard forefoot size- Mild forefoot deformity (HAV / tailors bunions)- Standard control- Standard orthoti c area
- Wide footwear- Wide forefoot size- Forefoot deformity (HAV / tailors bunions)- Increased control- Increased orthoti c area
Based on foot morphology and footwear fi t
Specify Practi ti oner specifi ed shell width - Specifi c shell width requirements
LAB TIP: Beware footwear fi t implicati ons
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 15TalarMade Custom Powered By
DIGITAL CORRECTIONS
LATERAL ARCH What is it? What is it used for?
Contour of the lateral border of the orthoti c shell following the lateral column / arch- Standard: Minimal lateral arch- +3mm lateral arch- +5mm lateral arch- Specify lateral arch
- Support lateral column- ORF lateral to STJ axis- Lateral ankle instability- Peroneal pathologies
LAB TIP 2mm = mild control | 4mm = moderate control | 6+ mm = maximum control
LAB TIP Consider in combinati on with a forefoot valgus extension
LAB TIP Beware pati ent tolerance and footwear fi t implicati ons
STANDARD
+5mm
HEEL SKIVE
SHELL MODIFICATIONS
Medial
1st Met Head Cutout
Medial Flange
Lateral
Dorsal intrinsic varus wedge in the medial heel area of the device. The lab standard of 15degrees (modifi ed on request) is applied to the depth altering the aggression of the modifi cati on.
The distal-medial corner of the orthoti c is removed from the 1st intermetatarsal space and extending proximally.
Increase in height of the medial border of the orthoti c as a conti nuati on of the medial heel cup.
Dorsal intrinsic valgus wedge in the lateral heel area of the device. The lab standard of 15degrees (modifi ed on request) is applied to the depth altering the aggression of the modifi cati on.
- Increased varus rearfoot control- ORF medial to STJ axis- Pronated foot types
- Improve 1st MPJ range of moti on- Functi onal hallux limitus- Improve propulsion- Windlass mechanism- Rigid plantar fl exed 1st ray
- Severely pronated foot types- Transverse plane control- MTJ and STJ support- Part of UCBL design
- Increased valgus rearfoot control- ORF lateral to STJ axis- Lateral instability- Flexible supinated foot types
1mm
2mm
3mm
4mm
1mm
2mm
3mm
4mm
16 www.dolaorthoti cs.com
DIGITAL CORRECTIONS
SHELL MODIFICATIONS What is it? What is it used for?
Lateral Flange
Gait Plate In-toeing
Gait Plate Out-toeing
Plantar Fascial Groove
Mortons Extension
Toewalker
Increase in height of the lateral border of the orthoti c as a conti nuati on of the lateral heel cup.- Short to cuboid- Long to 5th metatarsal
An extension of the anterior border of the orthoti c shell, angled laterally towards the 5th.Mild: SulcusModerate: IPJSevere: Apex
An extension of the anterior border of the orthoti c shell, angled medially towards the 1st.Mild: SulcusModerate: IPJSevere: Apex
A groove placed on the dorsal surface of theorthoti c.
Extension of the poly orthoti c shell or thickening of full length EVA shell forward under the 1st metatarsal.Short: to sulcusLong: to apex of hallux
An extension of the anterior border of the orthoti c shell past the metatarsal heads Length of extension to sulcus as standard or defi ned by prescriber.
- Lateral instability- Supinated foot types- Transverse plane control- MTJ and STJ support- Part of UCBL design
In-toeing rotati onal presentati ons
Out-toeing rotati onal presentati ons
- Prominent plantar fascia/FHL/aponeurosis- High fascial cord tension- Blistering- Fibroma
- Restrict 1st MPJ movement- Hallux rigidus- Primus elevatus- Rigid dorsifl exed 1st ray- Acute Turf toe- Post surgery immobilisati on
Infl uence habitual toewalking
LAB TIP Beware footwear fi t implicati ons
LAB TIP Use with cauti on, treatment directed testi ng recommended
LAB TIP Use with cauti on, treatment directed testi ng recommended. Flares medially to follow 1st met head shape.
LAB TIP Use with cauti on, treatment directed testi ng recommended
LAB TIP Consider using comfort MLA profi le
DORSALISOMETRICCROSS-SECTION
LONG
LONG
SHORT
SHORT
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 17
POSTINGS
REARFOOT What is it? What is it used for?
Rearfoot wedge thicker medially than laterally - ORF medial to STJ axis creati ng a supinatory force- Pes planus/pronated foot type
LAB TIP Increases orthoti c bulk and sti ff ness
LAB TIP Consider Varus/Valgus Forefoot extension for support extending under metatarsal heads (SEE P.21)
Rearfoot Varus
Rearfoot Valgus
Intrinsic
Extrinsic
Rearfoot wedge thicker laterally than medially
Low profi le rearfoot postDigitally balanced to increase stabilityDirecti on opti ons: varus/valgusAngle opti ons:Mild : 0 - 2degModerate: 4degSevere: 6+deg
Standard profi le rearfoot postExtrinsic polypropylene (built in) or EVA is added to create a larger surface areaDirecti on opti ons: varus/valgusAngle opti ons:Mild : 0 - 2degModerate: 4degSevere: 6+deg
- ORF lateral to the STJ axis creati ng a pronatory force- Flexible supinated foot type- Flexible pes cavus- Lateral ankle instability
- Low bulk- Low profi le- Easier footwear fi t- Mild to moderate rearfoot control
- Increases rearfoot stability- Increases rearfoot control- Used for mild to severe rearfoot posti ng angles- Requires appropriate footwear
REARFOOT VARUS (LEFT FOOT)
4˚
REARFOOT VALGUS (LEFT FOOT)
4˚
ELEVATION
FOREFOOTBalance FFT – RFT
Intrinsic/Extrinsic
Plane of forefoot balanced intrinsically to plane of rearfoot
Alters the heel to forefoot pitch of the device in shell
Practi ti oner specifi ed correcti on for forefoot varus and valgus alignment.Intrinsic: Correcti on is within the shell
Flexible forefoot deformiti es
Positi ve pitch footwear
Forefoot deformiti es
INTRINSIC (LATERAL)
STANDARD INTRINSIC VALGUS 4˚
EXTRINSIC (LATERAL)
INTRINSIC (PLANTAR)
EXTRINSIC (PLANTAR)
0mm 4mm2mm 6mm
TalarMade Custom Powered By
18 www.dolaorthoti cs.com
ADDITIONS
REARFOOT What is it? What is it used for?
Aperture in the posterior heel area of the orthoti c.
A curved poron pad supporti ng the borders of the heel with central recess
- Low profi le device- Localised cushioning
- Fat pad syndrome- Calcaneal bursiti s- Offl oad central plantar calcaneus
Heel Aperture with poron fi ll
Horse Shoe Pad
Heel pad/cushion
Heel Raise
Poron cushioning layer in the heel region between the orthoti c and top cover
Alters the heel to forefoot pitch of thedevice with extrinsic additi on
- Increased heel cushioning- Fat pad syndrome- CPHP/Pl fasciiti s- Heel spur
- Sagitt al plane facilitati on- Appropriate leg length discrepancy- Ankle equinus- Achilles tendonopathies- Calcaneal apophysiti s (severs)
LAB TIP 1. Avoid using with heel skives and high rearfoot post angles. 2. Consider using heel pad for cushioning, CPHP, pl fasc, Fat pad syndrome
MIDFOOT
Arch Pad
Plantar Fill
Poron additi on on the top surface of themedial arch area
Additi on of EVA or poron fi ll under a poly orthoti c shell.
- MLA (medial longitudinal arch/column),- LLA (lateral longitudinal arch/column) or- Total fi ll: Enti re plantar area
- Increase arch height- Pes cavus (high arch)- Increased arch cushioning- Increased arch contour
- Reduce fl ex / increase sti ff ness of orthoti c shell - Allow spot reducti on of fi ll create hybrid shell / shank independent properti es
MLA FILL LLA FILL TOTAL FILL
LAB TIP Direct milled poly shells are available in fracti on of mm increments so fi lls are not normally required
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 19
ADDITIONS
The positi on of the apex of the metatarsaldome as the met head or intermetatarsal space.
Example:- 3: 3rd met head- 3&4: 3rd and 4th met head space.
Met DomePositi on
Met Bar
Forefoot ValgusExtension
Forefoot VarusExtension
MortonsExtension
Reverse MortonsExtension
Plantar metatarsal pad extending underall or defi ned metatarsals
A forefoot wedge under the metatarsalheads that is thicker laterally and tapersunti l there is no material under the 1stmetatarsal head.
Sulcus or Full length
A forefoot wedge under the metatarsal heads that is thicker medially and tapers unti l there is no material under the 5th metatarsal head.
Material extending from the anterior shell across the fi rst metatarsophalangeal joint.
Additi on extending under metatarsal heads 2-5 to sulcus length and is a uniform thickness.
- Alter forefoot pressures- Metatarsalgia- Neuroma- Neuriti s- Capsuliti s- Fat pad atrophy
- Pronatory force on forefoot- Provide Orthoti c Reacti on Force(ORF) lateral to MTJ/STJ- Rigid forefoot valgus- Improve propulsion- Plantar Fasciiti s
- Rigid forefoot varus- Stabilise 1st ray- Restrict 1st MPJ- Provide Orthoti c Reacti on Force (ORF) medial to MTJ/STJ
- Limit fi rst metatarsophalangeal range of moti on or support the metatarsal.- Dorsi-fl exed fi rst ray- Turf toe- Hallux rigidus- Short 1st metatarsal
- Plantarfl exes fi rst ray to increase 1st MPJ range of moti on.- Functi onal hallux limitus- Improve propulsion- Windlass mechanism- Rigid plantarfl exed 1st ray
FOREFOOT What is it? What is it used for?
Tear shaped pad added to the top of theorthoti c under a topcover. Standard positi on begins at midshaft of themetatarsals to just proximal to themetatarsal heads. It is highest in the centre and tapers at the edges.
- Alter forefoot pressures- Metatarsalgia- Neuroma- Neuriti s- Capsuliti s- Bursiti s
Met DomeSize
LAB TIP Reduced height met domes are also available on request
LAB TIP Use with cauti on, treatment directed testi ng recommended. Flares medially to follow 1st met head shape.
1 2 3 4 5
CROSS SECTION
CROSS SECTION
CROSS SECTION
TalarMade Custom Powered By
20 www.dolaorthoti cs.com
ADDITIONS
FOREFOOT What is it? What is it used for?
Forefoot additi on extending under themetatarsal heads through to the fulllength of the device.Multi ple materials available
- Increased comfort and cushioning- Reduced fat pad- Anterior shift fat pad- Bony protrusions- Corns and Callus- Replaces space of insole removed- Apertures for exostosis, corns, ulcers, verrucae
ForefootExtension
SPECIALTY
Forefoot with 1st Met Cutout
Cluff y
Cuboid Pad/Notch
Custom Padding
A forefoot extension with 1st metatarsal cut out.
Wedge extending from the MPJ under the proximal and distal phalanx, thicker distally.
An increase in either shell height (notch) or additi on of poron or EVA pad under the cuboid on the lateral border of the orthoti c.
A range of materials and opti ons are available.
- Functi onal hallux limitus- Improve propulsion- Windlass mechanism- Rigid plantar fl exed 1st ray- Sesamoiditi s (with poron fi ll)
- Delayed windlass mechanism- Aid propulsion
- Cuboid syndrome- Support lateral column- Lateral ankle instability- Peroneal pathologies
- Pressure defl ecti on/cushioning- Fat pad atrophy- Sesamoiditi s (under 1st MPJ)
LAB TIP Please supply diagram or detailed informati on when ordering.
www.talarmadecustom.com
TOP COVERS
Available at www.talarmadecustom.com
Available on all custom and prefab opti ons from DOLA, also available as mini-roll from orthoti csupplies.com.au
:: ::
Bespoke range of Custom
Powered by
Custom and Semi-custom orthotics available now at TalarMade Custom. • Customised orthotics for your patients• Simple and easy 5 step process to order• Delivered within 10 working days• Cost effective orthotics solution
For more information:Contact us on 01246 268 456 or visit www.talarmadecustom.com
22 www.dolaorthoti cs.com
TOP COVERS
NO COVERNo cover supplied, for self covering.
SHELL LENGTHCover extends to the length of the
device only.
SULCUS LENGTHCover length to the sulcus of
the foot.
FULL LENGTHCover length to footwear size.
Supplied oversize to allow trimming.
Black (Smooth)
Black (Semi Perf.)
Marine / Navy (Semi Perf.)
Bronze (Smooth)
Blue (Semi Perf.)
Orange (Semi Perf.)
Cocoa (Smooth)
Camel (Semi Perf.)
Silver (Semi Perf.)
Skin (Smooth)
Cream (Semi Perf.)
Skin (Semi Perf.)
Anthracite (Semi Perf.)
Lime (Semi Perf.)
Stone (Semi Perf.)
Beige (Semi Perf.)
Magenta (Semi Perf.)
Durafi t™
Durafi t™ is a luxurious premium quality 100% breathable microfi bre with the appearance of genuine leather. It is 15x more durable than leather and 2x more tear resistant.
Durafi t™ is available in more than 17 colours and fi nishes including the popular semi perforated which has a completely sealed colour matched backing.
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 23TalarMade Custom Powered By
TOP COVERS
nora® Lunatec moti on 10Nora® Diabeti c Anti Shear - Extremely soft , shock absorbing top cover with excellent shear force absorpti on. Used for pressure relief in pati ents with Diabetes and joint diseases like rheumatoid arthriti s.
Nora® Lunalasti k - Excellent cushioning properti es, restorati on capabiliti es and tear resistance.
PoronPoron provides outstanding cushioning and is highly durable. It can be added to the enti re orthoti c or just the front to minimise the space required in the shoe.
• High performance cushioning layer• Requires extra cover for top surface (recommended EVA or Durafi t™)• 2 types: medical (blue) and slow release/rebound (red)• Cushioning increases with thickness: 3.2mm is more cushioned than 1.6mm, but the trade off is it takes
up more space• Used for full length cushioning layer / heel pads / forefoot extension etc.• Ensure space is available in footwear
Medical 1.6mm / 3.2mm Slow Release 3.2mm
Diabeti cAnti Shear Stone Grey
Lunalasti k Flesh Lunalasti k Sky Blue
Black Blue Red Lime Green Black/Grey Blue Swirl
Natural Yellow Purple Pink Lime Swirl Pink Swirl
EVACombining the perfect blend of cushioning, comfort and performance. This thin, high performance material is available in 12 colours and is suitable for almost all applicati ons.
• Light weight high performance popular orthoti c cover
• Resilient and hard wearing for sports
• Cushioning increases with thickness: 3mm is more cushioned than 2mm, but the trade off is it takes more space
• Protects device and underlying additi ons, poron cushioning layers etc.
• Aestheti cally pleasing and provides a professional fi nish
• Multi ple colour opti ons are popular with kids
24 www.dolaorthoti cs.com
TOP COVERS
Plastazote• Light weight polyethylene foam• Commonly used for diabeti c, arthriti c & high risk pati ents due to it being highly conformable
ANTI SHEAR NORA® LUNATEC MOTION 10New type of EVA material absorbs shearing forces and has extremely soft cushioning properti es.
Flesh 3mm/6mm
ANTI SHEAR NORA® LUNATEC MOTION 10New type of EVA material absorbs shearing forces and has extremely
Available on all custom and prefab opti ons from DOLAAlso available in sheets from www.talarmadecustom.com
:: ::
Bespoke range of Custom
Powered by
Custom and Semi-custom orthotics available now at TalarMade Custom. • Customised orthotics for your patients• Simple and easy 5 step process to order• Delivered within 10 working days• Cost effective orthotics solution
For more information:Contact us on 01246 268 456 or visit www.talarmadecustom.com
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 25TalarMade Custom Powered By
ORTHOTIC CONSIDERATIONS
1st Met CutoutCluff y Wedge
ORTHOTIC CONSIDERATIONS TO INCREASE MEDIAL ORTHOTIC REACTION FORCE (ORF)
ORTHOTIC CONSIDERATIONS FOR SAGITTAL PLANE FACILITATION
Increase Rearfoot Varus PostExtrinsic Rearfoot Post Type
Medial Heel Skive
Rearfoot Varus PostMedial Heel Skive
Inverted Pour
Heel Raise
Thicker polypropyleneHigher density EVA
Forefoot Valgus ExtensionReverse Mortons Extension
Increase Rearfoot Varus PostExtrinsic Rearfoot Post Type
Thicker polypropyleneHigher density EVA
Lateral Arch FillCuboid Pad/Notch
Arch FillArch Profi le
Arch Highpoint Positi onArch Pad
Plantar Fascial Groove
Decrease Arch FillIncrease Arch Height
Standard Profi leArch Pad
Medial Flare Medial Flange
26 www.dolaorthoti cs.com
ORTHOTIC CONSIDERATIONS
Heel Pad- CPHP
- Fat pad syndrome
Heel Raise- Achilles Path
Forefoot Valgus Extension - Plantar Fasciiti s- Windlass- Propulsion
Reverse Mortons Extension- Functi onal Hallux Limitus
Met Dome/Bar- Capsuliti s/Bursiti s/ Neuroma/Neuriti s- Metatarsalgia
Poron Forefoot Extension- Metatarsalgia- Comfort- Cushioning- Reduced Fat pad
ORTHOTIC CONSIDERATIONS TO INCREASE LATERALORTHOTIC REACTION FORCE (ORF)
ORTHOTIC ADDITION CONSIDERATIONS FOR TISSUE STRESS PATHOLOGY
Everted Pour
Forefoot Valgus ExtensionReverse Mortons Extension
Lateral Arch FillCuboid Pad/NotchLateral FlareLateral Flange
Cuboid Pad- Cuboid syn- Lat ankle instability- Peroneal path
Increased Rearfoot Valgus PostLateral Heel Skive
ORTHOTIC REACTION FORCE (ORF)
Forefoot Valgus ExtensionReverse Mortons Extension
Lateral Arch FillCuboid Pad/Notch
Forefoot Valgus Extension - Plantar
Reverse Mortons Extension
Poron Forefoot Extension
Cuboid Pad- Cuboid syn- Lat ankle instability
Custom Cutouts/defl ecti ons/apertures- Exostosis - Ulcers - VP, cal, corns
Increase Arch FillLower Arch Height
Comfort MLA Profi leMedial Taper
Reduce Medial ORF
Arch Tolerence / Comfort- Comfort Profi le
- Arch Pad- Plantar Fascial Groove
1st Met Cutout/Cluff y- Functi onal Hallux Limitus
- Windlass- Propulsion
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 27TalarMade Custom Powered By
ORTHOTIC CONSIDERATIONS
ORTHOTIC CONSIDERATIONS FOR AT RISK/COMPLEX FOOT
ORTHOTIC CONSIDERATIONS FOR COMFORT
Heel Pad
Heel Pad
Full length cushion mid-layer
- Poron- Poron SR
Full length cushion mid-layer
- Poron- Poron SR
Shell Material- EVA Soft
Specialty covers- Nora Diabeti c Anti -Shear- Plastazote
Cushioning Topcover Combinati ons- Durafi t + Poron mid-layer- 2mm EVA + Poron mid-layer- Nora Lunalasti k- Nora Diabeti c Anti shear
Full length cushion mid-
Full length cushion mid-
- 2mm EVA + Poron mid-layer
Follow Foot Shape- Medial fl are 5 or 10%- Comfort MLA profi le
- Arch pad
Arch Comfort/Tolerance- Comfort MLA profi le
- Increase MLA fi ll (lower arch height)- Arch pad
Forefoot Extensions- Cutouts
- Defl ecti ons- Poron forefoot extensions
Poron forefoot extension
Custom cut outs / Defl ecti ons / Divots for Exostosis, Ulcers, Nodules etc.
Shell Material- Poly: Ultra/Semi Flexible- EVA: Soft
28 www.dolaorthoti cs.com
ORTHOTIC CONSIDERATIONS
UCBLDeep heel cup
Heel Raise (Severs)
Specialty Extensions- Gait plate (in-toeing)- Gait plate (out-toeing)- Toewalker
Kids Topcovers- Colourful lunasoft - Colourful EVA- Colourful Durafi t
ORTHOTIC ADDITION CONSIDERATIONS FOR PAEDIATRICS
Intrinsic rearfoot postLower rearfoot post
angles
Cover length- Shell- Sulcus Shell Material
- Polypropylene (shank independent)
Elevati on to match footwear
Arch Tolerence / Comfort- Comfort MLA profi le
- Arch pad
Low heelcup height
Low bulk top covers- Durafi t- 2mm EVA
ORTHOTIC CONSIDERATIONS FOR HARD TO FIT FOOTWEAR
Shell Material- Polypropylene (shank independent)
Narrow shell widthLow bulk additi ons only
Dress Shape5% Medial Taper
10% Medial Taper
- Age- Acti viti es
- Footwear- Body weight
- Foot type & Functi on- Additi ons for pathology
- Additi ons for ti ssue stressOVERALL CONSIDERATIONS
www.talarmadecustom.com
DOLA Orthoti cs Custom Soluti ons 29TalarMade Custom Powered By
CLINICAL TESTS
ANKLE JOINT
SUBTALAR JOINT (STJ)
MIDTARSAL JOINT (MTJ)
1ST METATARSOPHALANGEAL JOINT
Test & Normal Values Functi onal Importance
TESTSAnkle joint dorsifl exion and plantar fl exion• Performed with knee both fl exed and extended• Assess ROM, QOM and SOM
NORMAL VALUES• Approx 50° total ROM through plantarfl exion and
dorsifl exion• Depends on muscle fl exibility, osseus confi gurati on,
ligamentous stability & age• 10° of dorsifl exion is traditi onally considered
normal, if not available = sagitt al plane block, however required ROM diff ers between individuals
TESTS• STJ pronati on (calcaneal eversion)• STJ supinati on (calcaneal inversion)
NORMAL VALUES• Approx 30° total ROM through inversion and
eversion (highly variable)• 2:1 rati o of inversion to eversion 20:10 is considered
normal (highly variable)• Depends on muscle fl exibility, osseus confi gurati on,
ligamentous stability and age
TESTS• MTJ Inversion and Eversion • MTJ Adducti on & Abducti on• MTJ Dorsifl exion & Plantarfl exion
NORMAL VALUES• Mobile• Restricted• STJ positi on can infl uence ROM available at MTJ
TESTS• 1st MPJ dorsifl exion and plantarfl exion
NORMAL VALUES• Normal > 65° dorsifl exion and 20° plantarfl exion• Limitus < normal ROM• Rigidus : no range of movement
• Dorsifl exion:– Enables foot clearance during swing phase– Enables the ti bia to move over the
supporti ng foot during stance phase (acts as a sagitt al plane ‘pivot’)
– If range not available = sagitt al plane block and compensati on may occur in gait
• Plantarfl exion– Generates power for acti ve propulsion
• Important for adapti ng to various terrain and changes in posture
• Simplifi cati on:– pronati on makes the foot a compliant
adaptor & assists in shock absorpti on– supinati on makes the foot a more rigid
structure and assists in propulsion– If range not available = sagitt al plane
block and compensati on may occur in gait• The subtalar joint can also compensate for
abnormal ankle or midfoot positi ons and it infl uences the mid tarsal joint ROM
• Important for adapti ng to various terrain and changes in posture
1st MPJ ROM is required for propulsive phase of gait and windlass mechanism. Lack of 1st MPJ ROM can result in compensatory mechanics and gait changes.
Non Weight Bearing Joint AssessmentRange of moti on (ROM): Assess joint in its planes of moti on and compare to normal valuesQuality of moti on (QOM): Assess the feel of the joint. Normal, restricted (crepitus) or hypermobility (laxity)Symmetry of moti on (SOM): Bilateral comparison, identi fy any asymmetry
30 www.dolaorthotics.com
CLINICAL TESTS / GLOSSARY
1st: 1st Metatarsal1st MPJ: 1st Metatarsophalangeal JointBMI: Body Mass IndexCPHP: Chronic Plantar Heel PainEv: EvertedExt: ExtensionDF: DorsiflexionFFT: ForefootFHL: Flexor Hallucis Longus or Functional Hallux LimitusHAV: Hallux Abducto ValgusIPJ: Interphalangeal JointInv: Inverted
Lat: LateralLLA: Lateral Longitudinal ArchMed: MedialMet: MetatarsalMLA: Medial Longitudinal ArchMPJ: Metatarsophalangeal JointMSRT: Manual Supination Resistance TestMTJ: Midtarsal JointNCSP: Neutral Calcaneal Stance PositionNWB: Non-Weight BearingORF: Orthotic Reaction ForcePF: Plantarflexion
Pl fasc: Plantar FasciitisQOM: Quality of MotionRCSP: Relaxed Calcaneal Stance PositionRFT: RearfootROM: Range of MotionSOM: Symmetry of MotionSTJ: Subtalar JointSWB: Semi-Weight BearingVL: ValgusVR: VarusWB: Weight Bearing
RCSP (RELAXED CALCANEAL STANCE POSITION)
MANUAL SUPINATION RESISTANCE TEST (MSRT)
LUNGE TEST
JACKS TEST
MEDIAL ARCH HEIGHT
The position of the calcaneus relative to the ground in normal stance
OPTIONS:- Vertical- Valgus (everted/pronated)- Varus (inverted/supinated)
Manually determine the level of supinatory orthotic reaction force (ORF) required to be applied to the foot to have an effect.Scale 1-5: 1 = easy or low force 5 = hard or more force
Functional assessment of sagittal plane function, ankle joint dorsiflexion ROM in stance. Range of motion available before the heel raises.
NORMAL VALUES- Distance greater than 10cm- Angle less than 35 degrees
Assessment of sagittal plane function of the 1st MPJ in stance compared to non-weight bearing ROM
ASSESS- Dorsiflexion range until force is felt and arch raise is seen- Force required- Delay in initiation
The height of the medial longitudinal arch relative to the ground in normal stance.
OPTIONS:- Low (planus)- Normal- High (cavus)
Foot Posture Observations
Glossary
Functional Tests
Pronated (+2) Right Foot Neutral Right Foot Supinated (-2) Right Foot
Low Arch Normal Arch High Arch
Watch Clinical Tests -Visit our Youtube Channel
www.talarmadecustom.com
FootcareEdition 2.2
Made with clinical excellence in mind
FOR ALL OF YOUR ORTHOTIC NEEDS...
Prefabs.TalarMade Custom Orthoti cs
PlusAdditi onsTop CoversScanners
Bespoke range of foot ortho�csCustom
Powered by
Bespoke range of foot ortho�csCustom
Powered by
www.talarmadecustom.com
TalarMade Ltd.Springwood House, Foxwood Way, Foxwood Industrial Park, Chesterfi eld, Derbyshire, United Kingdom S41 9RN
Tel: +44 (0)1246 268 456 | Fax: +44 (0)1246 268 648www.talarmade.com
DISCLAIMER: The informati on and recommendati ons provided in this manual are general in nature and do not replace the need for professional assessment. Including thorough history, physical examinati on, clinical diagnosis and other treatment modaliti es. The results of treatment directed testi ng including strapping and padding; and the results of applicable tests can be used to determine if your pati ent could benefi t from orthoti c therapy and to guide the design features of your custom orthoti c.
Bespoke range of foot ortho�csCustom
Powered by