Logic & the Foot Orthoses

LOGIC and the FOOT ORTHOSES

Logic and the foot = orthoses is why we=20 chose our company name =E2=80=9CFoot Logic=E2=80=9D. We strongly = believe that if you=20 approach all problems = logically, with a complete and thorough understanding of their = nature,=20 most can undoubtedly be resolved. So what exactly will we need = from you to=20 commence a logical approach to your patient=E2=80=99s foot orthoses = needs? Let=E2=80=99s=20 begin with the . . .

THE NEGATIVE=20 IMPRESSION

The=20 first and perhaps the most important ingredient to a good orthoses is = the=20 negative impression. At Foot Logic, Inc. we prefer the foam = impression=20 which gives you a smooth, clear, plantar impression. It is also = cleaner=20 and less time consuming for both you and your patient. With either = method,=20 slipper casting or foam, the most common error that we have seen over = the years=20 is =E2=80=9Cover correction=E2=80=9D.

One common example = of =E2=80=9Cover=20 correcting=E2=80=9D involves a collapsed Midfoot If you = =E2=80=9Cover correct=E2=80=9D the foot=20 you will undoubtedly create an abnormally high longitudinal and cuboid = arch, in=20 return you=E2=80=99ve also shortened the heel to ball length with the = results being as=20 follows:

- The overall length = with be=20 short.

-=20 There will be an intolerable arch height.

- You will = have an=20 incorrect placement of both the metatarsal arch and any metatarsal = relief=E2=80=99s=20 indicated.
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Another common=20 problem is with forefoot varus and valgus. Most shoes, even orthopedic = styles,=20 will only accommodate no more than =C2=BC=E2=80=9D inch of forefoot = posting. Presenting=20 more than that in your negative impression can create potential problems = during=20 the modification of the positive impression.

Getting onto the = negative=20 impression let us begin with your patient seated comfortably in a chair = with the=20 patient=E2=80=99s hip, knee, and ankle at 90=C2=B0 (if possible). = Evaluate the subtalar=20 position for any forefoot to hind foot mal alignment (forefoot and/or = hind foot=20 valgus or varus). Once a subtalar position is established through = passive=20 manipulation, evaluate the plantar surface of the foot for any callusing = or=20 plantar prominence's, and mark these areas with lipstick. =

Next, position=20 the foot on the foam impression box with the heel about 1=E2=80=9D inch = from the back=20 edge, align it in the center as much as possible. Once again, = determine=20 the subtalar neutral position by palpating the medial and lateral = borders of the=20 talus to establish neutral.

Position the knee=20 relative to the patient=E2=80=99s tibial valgum or varum with one hand = and use the other=20 hand to position the foot at neutral. With both hands in place, = push on=20 the foot and knee simultaneously, sinking the entire foot into the foam = all at=20 once.

Do not push in=20 the heel and then the forefoot as this will cause and abnormally high = arch to=20 form. Once the foot is completely pushed into the foam so that the = heel=20 and the forefoot is bottomed out, gently push down the toes so that they = are=20 parallel to the forefoot.

Note: When a = higher trim=20 lines are desired for any product (Examples: Over the distal end of a = partial=20 foot - TMA or Chopart or for UCBL trims) a slipper cast(s) is the = preferred=20 method in obtaining the negative impression.

YOUR=20 COMPLETED LAB ORDER

Because we cannot=20 be there to actually help you diagnose, and resolve your = patient=E2=80=99s problems,=20 it is very important=20 for you to complete your Foot Logic, Inc. Lab Order with as much = information as=20 possible. Otherwise we have no insight of what must be corrected and = what must=20 be left alone.

What are we looking for and why is it so = important? Beginning with your = patient=E2=80=99s=20 height, weight, activity level, type of shoe wear and shoe size, we are = also=20 looking for the other important factors, such as diagnosis and past = history.=20 These are all needed to help you make the correct decision = as to the=20 materials and design for your patient=E2=80=99s completed foot orthoses. =

Though all the above = factors are=20 important in making such a decision, the diagnosis is of course the most = important, and is usually provided by the patient=E2=80=99s physician.=20 However, we rely heavily on your = evaluation,=20 as it is equally important. This is = where you=20 must be certain that you completely understand the diagnosis. = There can be=20 in every case many common bio mechanical characteristics associated to = your=20 patients problems that the physician may or may not have noted on the=20 prescription.

For example, with post tibial endpoints you will = commonly find=20 that the patient has pronounced forefoot varus that if left unaddressed = will=20 inhibit you in relieving their discomfort. And while the diagnosis = of=20 metatarsalgia is more of a generalization of any forefoot pain, it may = be left=20 up to you to determine the actual cause and location of that pain, not = the=20 physician.

There are many good books on the subject, however, we = have found=20 that Ian J. Alexander=E2=80=99s book =E2=80=9CThe Foot, Examination and = Diagnosis=E2=80=9D, to be the=20 most helpful in understanding both the common and complex foot disorders = encountered.

Another important=20 factor is shoe wear.=20 This can prove to be a touchy subject, especially with your female = patients, and diabetic patients. It is however an important part = of your=20 patient=E2=80=99s recovery and it is very important for them to be aware = of that.=20 Within reason=20 you should try to work with what the patient will feel most comfortable = wearing,=20 however, when being realistic even the best foot orthoses will fail if = the shoe=20 is not equally as supportive.

We have also found that = sometimes a=20 simple shoe modification may be necessary in achieving the goal of = comfort, or=20 for example, in healing an ulcer on your diabetic patient. It is = after all=20 logical = that only so=20 much relief can be fit inside a shoe. If you approach your patient = with a=20 honest and up front explanation of their medical necessities, you may = find them=20 more receptive to the idea that a different shoe type or external = modifications=20 may be required, and possibly even necessary for them to achieve comfort = and=20 recovery.

With time you will find = yourself=20 systematically examining each patient and determining the type of = treatment you=20 provide to them as a foot orthoses or shoe modification to become = easier.=20 Of course there will always be that =E2=80=9Cdifficult = case=E2=80=9D, and sometimes two=20 heads are better than one, so feel free to call us if you feel = discussing a=20 patient is necessary or would be helpful.

As always, remember the = important key=20 of communication between us, and you is the Foot Logic, Inc. Lab Order; = its sole=20 purpose is to avoid any possible mistakes in your completed products, so = always=20 call on us if you need assistance.

The IMPORTANT ROLE of = MODIFICATIONS=20 When Completing Your LAB ORDER
3Dmods.jpg=20

When reviewing your lab = order for=20 relevant and important patient information, the section entitled = MODIFICATIONS will = ultimately=20 become our foot bible in regard to each particular patient, and it will=20 undoubtedly become our safety hook to providing your patient with the = correct=20 type of product to help in their healing. It is very important to = your=20 patient that you fill this section out accurately, and with as much = information=20 as possible, and if at anytime you are unsure of what modifications will = help=20 your patient please call on us. Again, because we have not = evaluated=20 your patient, we will rely heavily on your decision of how corrective = the=20 finished product needs to be.

Please keep in mind that the actual impression of the = foot is=20 going to change the appearance of the modifications. For example, = a strong=20 metatarsal arch on a foot that is as =E2=80=9Cflat as a board=E2=80=9D = is going to appear much=20 shallower than on a foot that already possesses a natural metatarsal = arch.=20

Unfortunately, there aren=E2=80=99t any set rules to = follow when=20 deciding on how much support your patient will tolerate. For those = of you=20 who have easy access to grinding equipment, more support is usually = better=20 because it=E2=80=99s easier to reduce the support, rather than add to = it. For=20 anyone who does not have grinding equipment to adjust the finished = product we=20 highly recommend that you go with a more conservative approach and = adjust your=20 orthoses by adding met pads or arch cookies. Of course you can = always=20 return the finished product to us, providing you have the = patient=E2=80=99s original=20 cast(s), and we will be happy to perform any adjustment you deem = necessary.=20

Also keep in=20 mind that before making any initial cuts to your patient=E2=80=99s = positive=20 impression(s) we look at several areas of information. Again, = referring to=20 your completed lab order, the patient=E2=80=99s overall size is a = definite deciding=20 factor. For example, a large robust male is likely to tolerate = more=20 support than a small petite female. Also, is the foot flexible and = pliable, or is it bony and rigid? Even the materials you are = working with=20 should be considered when modifying your positive impression. For = example,=20 the softer the materials used in the completed product, the more = aggressive you=20 can be with your choice of modifications.

Relief = areas should always be clearly marked on your lab order, = even if=20 you=E2=80=99ve taken the time to mark them on your negative impression, = as the lab order=20 gives us a written record of what you actually wanted = relieved.

When do you want a = relief?=20 Any bony prominence or callused areas should be relieved. = For=20 example, does your patient have site specific metatarsal pain? If = so, mark=20 the painful metatarsal head so that we will relieve that area. = Also, a=20 patient diagnosed with a Charcot foot, should always be carefully marked = for mid=20 foot relief.

When ordering a=20 toe crest = remember=20 that this particular modification can always be a little tricky. = If you=20 are asking for this particular modification, we strongly suggest a = weight=20 bearing, or semi weight bearing impression. For a toe crest to be accurate and effective it must = be=20 correctly placed, and if you have not allowed the foot to elongate = naturally, we=20 may miss our target.

Toe = relief=E2=80=99s can be added when=20 a patient presents with hammer toes, claw toes, or mallet toes and the = distal=20 tip is either painful or perhaps ulcerated. Please keep in mind = that with=20 any forefoot relief a shoe with a roomy toe box is essential. We = suggest=20 that you prepare your patient for this reality before delivery of the = finished=20 product.

In this next section we = will discuss=20 material descriptions another important factor in completing your Foot = Logic,=20 Inc. Lab Order.

MATERIALS used at FOOT = LOGIC,=20 INC.

Let=E2=80=99s begin by reviewing and choosing the = materials that will be=20 used to fabricate our foot orthoses. Understanding the materials = used in=20 fabrication is an important step to choosing the correct foot orthoses = to=20 compliment your patient=E2=80=99s needs. The following are brief = descriptions of=20 many of the materials we use at Foot Logic, Inc. Please note that most = of the=20 material descriptions have been taken directly from the = supplier=E2=80=99s catalog.=20 If you prefer to use a material that is not mentioned below, = please=20 contact us and we will do our best to provide this material, or match it = to what=20 we have in stock. Please keep in mind that if we are unable to meet your = material needs, do not become disappointed, we may be able to suggest=20 alternative designs that are of equal or better quality. =

Also keep in mind = that if we=20 are unable to supply you with the material your accustomed to, it = is=20 nothing to reflect against you, but because it is not always financially = feasible for us to keep every single material choice known on hand. = As=20 with any fabrication company, we fabricate with what we feel are the = most=20 beneficial, and economical material choices.=20

Also remember that when = making=20 material choices, it is feasible to mix and match any materials you feel = will=20 give you the result you are looking for, but most importantly choices = your=20 patient will be satisfied with and benefit from. Occasionally, you = may=20 choose materials that our staff feels would be inadequate for your = patient,=20 usually due to their diagnosis, weight, activity level, etc. When = we are=20 faced with this particular situation we will attempt to contact you = before=20 fabrication to discuss other options. Please be reminded that = although we=20 are here to satisfy a need for you and your patient(s), our knowledge of = the=20 materials we use is very extensive, and it may sometimes be beneficial = to=20 discuss a change.

Begin Material=20 Descriptions

Blue Standard Trilam = Unique triple=20 combination of Poron laminated between (2) layers of Microcell Puff.=20 Excellent shock absorption. Very durable. Molds and = cleans=20 easily.

Multi Color Trilam = Unique triple=20 combination of Poron laminated between (2) layers of multicolored or = speckled=20 Microcell Puff. Excellent shock absorption. Very durable.=20 Molds and cleans easily.

Cork Lightweight and semi firm. Can be spot modified. = Heat=20 moldable. Grindable. Washable. 1/8=E2=80=9D, = =C2=BC=E2=80=9D, =C2=BD=E2=80=9D Thicknesses.=20

Pink=20 Plastazote Light weight, closed cell foam = that is=20 non-allergenic and can be used directly against the skin. = Good choice=20 for diabetic and/or arthritic patients. Heat moldable, grindable,=20 washable.

P-Cell Trilam 1/16=E2=80=9D Poron or = PPT Unique triple combination of 1/16=E2=80=9D Poron = laminated between (1)=20 layer of P-Cell and (1) layer of Microcell Puff. Soft, = resilient,=20 great for many uses other than Diabetic. =

Plastazote Trilam = 1/16=E2=80=9D Poron=20 or PPT Unique triple combination of = 1/16=E2=80=9D Poron=20 laminated between (1) layer of Pink Plastazote and (1) layer of = Microcell Puff.=20

Plastazote Trilam 1/8=E2=80=9D Poron or = PPT Unique triple combination of 1/8=E2=80=9D Poron = laminated between (1)=20 layer of Pink Plastazote and (1) layer of Microcell Puff.   No = history=20 of delaminating. (Downside: = Can cause=20 an orthoses to become very bulky if not combined with the correct = supportive=20 materials).

Poron or PPT = Available in 1/16=E2=80=9D, 1/8=E2=80=9D and = =C2=BC=E2=80=9D. This=20 is an open cell foam that will not =E2=80=9Cbottom out=E2=80=9D = permanently. Absorbs more=20 energy than sponge rubber and almost twice the energy of latex foam.=20 Porous enough to help the skin remain dry, cool, and comfortable.=20 Poron is non-sensitizing, washable and odor free. = (Downside: If not ordered in the correct = thickness when=20 added to an existing manufactured orthoses can cause over=20 bulkiness).

Puff Lite = Trilam Unique triple combination of 1/16=E2=80=9D Poron = laminated between (1)=20 layer of Light Microcell Puff and (1) layer of Microcell Puff.=20

Vinair=20 Unique blend of coagulated urethane that breathes. Very thin and = durable.=20 Can be washed. Stays cool next to skin, even under the most=20 strenuous of activities. A synthetic leather. Available in = brown=20 only. (Downside: Will not = mold into=20 deep heel cups without creasing and wrinkles).

Gel = (Silopos) Provides extra padding and cushion to specific areas = of relief=20 or in need of special protection.

1/8=E2=80=9D or = 3/16=E2=80=9D Plastic=20 (Copoly) Copolymer=20 with a corrugated under surface for structural integrity. Allows = for some=20 natural flex to take place. Heat moldable. Grindable. Washable. = Semi=20 rigid and rigid applications available.

Subortholene Thermoplastic = material.=20 Excellent deep-drawing properties. For use in semi to = rigid=20 applications.

Best Foam = Durable and thermo-moldable polyethylene foam = that provides=20 excellent support and shock absorbing protection. Available in = multi=20 colors only. Great for use in children=E2=80=99s products. =

Bocklite Shock absorbing and durable EVA that provides = excellent support=20 with flexibility. Available in Caucasian only.

Dynalite Closed cell, lightweight, low density PE foam. = Available=20 in perforated tan, red, blue and non-perforated black. Great = for use=20 in low profile orthotics.

Firm EVA This medium-firm EVA material is resilient, very = durable=20 and thermo-moldable making it ideal for firm orthotics and AFO = posting or=20 shoe buildups. Spot adjustable with heat gun. Available in = sand,=20 brown, black.

ORM=20 (Available in black only) 1/8=E2=80=9D = and =C2=BC=E2=80=9D thicknesses.=20 Orthotic=20 Reinforcement=20 Material = is a very=20 dense, heat moldable material that provides excellent support and = control under=20 heavy stress applications. Ideal for foot orthotics, posting, = wedging and=20 similar applications. Spot adjustable with heat gun. =

Polypro=20 Translucent polypropylene that is ideal for a broad variety of orthotic = and=20 prosthetic applications. Very flexible. Available in clear, = black,=20 natural.

Superfoam A = polyethylene material=20 that provides excellent support and shock absorption. Can be used = for top=20 cover or padding. Available in several different multi colors. = Great=20 for use on children=E2=80=99s products.

Carbon Foot Plates (Flat, Contour, = Morton=E2=80=99s) Thin, durable carbon = plates used=20 to limit toe extension when used with a foot orthoses. Adds = rigidity to a=20 partial foot prosthesis while allowing minimal toe break. Can be = ordered=20 in varied rigidity specifications.

Cloud Ultra = Lite A unique, very soft and lightweight, = moldable EVA=20 that provides long lasting shock absorbing protection. Can be used = against=20 the skin as a top cover or padding. Excellent choice for diabetic = and=20 arthritic patients. Available in blue only.

Cloud EVA = (Crepe) A durable, thermo moldable, medium density EVA that = provides=20 exceptional support and shock absorption. We currently use blue=20 only.

THK1=20 (Celastic) Fibrous Thermoplastic. = Heat=20 activated adhesive on one side. Provides extra support and = integrity to an=20 already firm material. Great for use in athletic products. = Comes=20 standard in our style of Soft UCBL.

Thermoflex Similar to the THK1 (Celastic). Heat activated = adhesive=20 on one side. Provides extra support and integrity when applied to=20 particular products. Not as rigid as THK1 (Celastic).=20

Cowhide or Soft Leather = (Cream Cow)=20 (Self descriptive) Great wear and looks clean and sleek. (Downside: Promotes bacteria when not = properly=20 cleaned on a regular basis.

P-Cell or Plastazote Replacement = Material Light weight, closed = cell foam=20 that is non-allergenic and can be used directly against the skin.=20 Good choice for diabetic and/or arthritic patients. Much softer = and better=20 resilience then Pink Plastazote. Heat moldable, grindable, = washable.=20

Now=20 that we are more familiar with the material choices that Foot Logic, = Inc. has to=20 offer, let=E2=80=99s decide which material choices, or designs would = best suit your=20 patient=E2=80=99s needs.

MATERIALS & THEIR=20 PREFERRED/RECOMMENDED APPLICATIONS

In=20 the following sections we will review the many different uses of = materials and=20 how they will interact with your patient=E2=80=99s needs. For a = more individual=20 description of each material we ask that refer back to the preceding = section=20 =E2=80=9CMaterial Descriptions=E2=80=9D.

TRILAM=E2=80=99S =

or Sometimes = Referred to by=20 Our Long Time Customer=E2=80=99s as ORIGINAL STYLE MATERIAL CHOICES are = as=20 follows:

BLUE=20 STANDARD TRILAM
MULTI COLOR TRILAM
PUFF LITE = TRILAM
PLASTAZOTE = 1/16=E2=80=9D TRILAM=20
PLASTAZOTE=20 1/8=E2=80=9D TRILAM
P-CELL TRILAM 1/16=E2=80=9D

In=20 reviewing the overall description of Trilam we find that it is durable,=20 available in firm or soft densities, and it provides excellent shock = absorption.=20 In other words you might say that there is a Trilam ideal for = nearly all=20 foot disorders. We also know it can be cleaned preferably with a = soft=20 cloth and alcohol. Your Blue Standard and Multi Color = Trilam=E2=80=99s are your=20 most firm. Puff Lite, Plastazote, and P-Cell Trilam=E2=80=99s = are your soft=20 versions. Though your Plastazote Trilam is less durable than your = other=20 Trilam=E2=80=99s it is a better choice for your diabetic and arthritic=20 patients.

Special Note about=20 Tri-laminates

Although we feel the tri-laminate products to be = an=20 excellent choice for shock absorption and cushioning =E2=80=93 = WE CANNOT AND WILL NOT WARRANTY THEM IN REGARD TO DELAMINATING. We have = experienced=20 delaminating of certain prelaminated materials in the past, before and = after=20 fabrication, and we now do our best to monitor and prevent use of = delaminating=20 materials in any of our products. However, since we do not = manufacture the=20 tri-laminate materials ourselves, we = cannot=20 extend a warranty that is also not offered to ourselves by the supplier = when we=20 purchase tri-laminates to use in fabricating.=20

COMMON SUPPORTIVE = MATERIALS FOR=20 TRILAMS

Cloud EVA (Crepe) by = itself is=20 soft and supportive=20 and ideal for low to moderate activity levels. Easily = adjusted.

Firm EVA (1/4=E2=80=9D_ by itself is=20 firm and = ideal for=20 moderate to high activity levels. Improves integrity of the = orthoses and=20 increases its life span. Easily adjusted.

Cork = (1/4=E2=80=9D) by itself is moderately=20 firm and ideal for low to moderate = activity levels.=20 Also supportive with a softer effect but not as soft as Cloud EVA = (Crepe).=20 Easily adjusted.

ORM (Black) (1/4=E2=80=9D) by itself is very = firm and ideal for high activity levels or larger = patients.=20 Improves integrity of the orthoses and increases its life span.=20 Easily adjusted.

Cork & ORM (1/8=E2=80=9D) together are=20 firm and = ideal for=20 moderate to high activity levels. ORM improves the integrity of = the=20 orthoses and increases its life span. Easily = adjusted.

Ucolene 60 (Blue) = (1/4=E2=80=9D) by itself is extremely firm and = ideal for very=20 high activity levels, larger patients, and sports related activities.=20 Improves integrity of the orthoses and increases its life span. = Can=20 be finish ground to be less bulky without losing its integrity. = Easily=20 adjusted.

ORM=20 (1/8=E2=80=9D) and Ucolene 60 (1/4=E2=80=9D) together are extremely=20 firm and ideal for very high activity = levels,=20 larger patients, and sports related activities. Improves integrity = of=20 orthoses and increases its life span. Easily = adjusted.

Copoly (Standard) = or=20 Subortholene (to behind the Met. Heads - Standard) (3/32=E2=80=9D, = 1/8=E2=80=9D,=20 3/16=E2=80=9D) is=20 semi rigid or firmest=20 while allowing for a =E2=80=9Cspringboard=E2=80=9D effect to occur = during full weight bearing.=20 Is ideal for very high activity levels, larger patients, and = sports=20 related activities. Improves integrity of orthoses and increases = its life=20 span. To increase the = rigidity in this Trilam product consider the use of Subortholene in = place of the=20 copoly. Please keep in mind that any Copoly/Subortholene Trilam = combo=20 product is slightly more difficult to adjust because when combined with = Trilam=20 you have two completely different types of materials.   The = Copoly=20 must be heated carefully during adjustments in order not to overheat the = Trilam.=20 Sometimes it is suggested to carefully separate the two materials = before=20 adjusting then glue them back to each other.

Copoly (Full) or = Subortholene=20 (to end of toes) (3/32=E2=80=9D, 1/8=E2=80=9D, = 3/16=E2=80=9D) is semi rigid or = firmest=20 though is more commonly used when limited = toe=20 extension is required. To increase = the=20 rigidity in this Trilam product consider = the=20 use of Subortholene in=20 place of the copoly. Some great uses for this particular material = when=20 combined with Trilam are Hallux Rigidus, Sesimoiditis, or Flexor = Tenosynovitis.=20 Results will be less bulky then if you were to add a Copoly foot = plate to=20 an already standard design. Slightly more difficult to adjust = because when=20 combined with Trilam you have two completely different types of = materials.=20   The Copoly must be heated carefully during adjustments in = order not=20 to overheat the Trilam. Sometimes it is suggested to carefully = separate=20 the two materials before adjusting then apply glue them back to each=20 other.

THK1=20 (Celastic) when=20 incorporated into or combined with other supportive materials choices=20 (excluding Copoly or = Subortholene) adds semi rigidity = while=20 remaining flexible. Once heated and = in place=20 cannot be adjusted without reheating the entire finished product or = grinding the=20 material clean from the area of placement. Cannot be used as a = stand alone=20 material.

Thermoflex = (Similar to THK1)=20 when incorporated into or combined = with other=20 supportive materials choices (excluding = Copoly or=20 Subortholene) adds=20 semi rigidity while remaining flexible. = Once=20 heated and in place cannot be adjusted without reheating the entire = finished=20 product or grinding the material clean from the area of placement. = Cannot=20 be used as a stand alone material.=20

MATERIAL CHOICES IN = RELATIONSHIP TO=20 A PARTIAL FOOT PROSTHESES

At Foot Logic, Inc. = you have a choice of = what types of=20 materials you wish to use for a partial foot prostheses. Again, = please=20 refer to =E2=80=9CMaterial Descriptions=E2=80=9D for a more accurate = definition of a particular=20 material, and always remember your final decision should be determined = by the=20 diagnosis, activity level, and weight of your patient even in the case = of=20 partial foot prostheses. Using a = less=20 expensive material combination for your partial foot prostheses will not = lower=20 the price of your finished product at Foot Logic, Inc. = The final costs of all our partial feet are based on = the amount=20 of time and work involved to make each individual product and not the = materials=20 involved.

What=20 will however lower the cost of your partial foot prostheses in how = specific you=20 are when completing your lab order. For example, the partial foot=20 prostheses with no toe breaks and no carbon foot plate will be = considerably less=20 expensive than one with for example, two (2) toe breaks and includes a = carbon=20 foot plate.

Another important factor = to the=20 proper function of the partial foot prosthesis is to add or not to add a = foot=20 plate. Active patients who have one or more toe breaks will = generally=20 benefit from the use of a carbon foot plate that will provide excellent = toe=20 spring or leverage at toe off. Again, the patient=E2=80=99s = activity level and=20 size or weight, will play a large role in choosing the correct rigidity = and type=20 of foot plate. To reduce costs even farther, low level activity = patients=20 can most likely be managed using a simple 1/8=E2=80=9D Copoly (plastic) = foot plate.=20 If you decide not to use a foot plate, you might also consider = adding a=20 rigid rocker bottom to the patient=E2=80=99s shoe, as this works well = and reduces wear=20 on the shoe.

MATERIAL CHOICES in = RELATIONSHIP to=20 Dress (3/4=E2=80=9D), Sulcus, Semi Rigid, Rigid and UCBL Style Foot=20 Orthotics

Dress (3/4=E2=80=9D), = sulcus, semi rigid or=20 rigid (Copoly or Subortholene), and UCBL style foot orthotics are = available in=20 semi firm, firm, and extremely firm (semi rigid and rigid) materials. = They=20 are generally =C2=BE=E2=80=9D to sulcus length. Again, pleaser = refer to =E2=80=9CMaterial=20 Descriptions=E2=80=9D for a more accurate definition of each individual = material choice.=20

Cork by itself with a = thin Vinair=20 or soft leather top cover is moderately=20 firm and is ideal as a supplement to a = full length=20 design. Trim lines are kept low and the heel is kept thin so not = to=20 promote heel pistoning. Easy to clean. Easy to=20 adjust.

Cork=20 and ORM combined with a thin Vinair or = soft leather=20 top cover are much firmer than cork alone and is another ideal supplement to a = full=20 length design. ORM will increase integrity and life span of the = orthoses.=20 Trim lines are kept low and the heel is kept thin so not to = promote heel=20 pistoning. Easy to clean. Easy to adjust.

Firm EVA by itself with a thin Vinair or soft leather top = cover is=20 very firm = and is ideal=20 as a supplement to a full length design. Trim lines are kept low = and the=20 heel is kept thin so not to promote heel pistoning. Easy to clean. = Easy to adjust.

Copoly (3/32=E2=80=9D, 1/8=E2=80=9D, 3/16=E2=80=9D) = by=20 itself or with your choice of a top cover is very=20 firm, semi rigid, or rigid and is ideal = for high to=20 extremely high activity levels requiring stronger support. Allows = for some=20 flexing to occur to naturally pronate while preventing over pronation.=20 Ending at the metatarsal heads without a top cover allows for = intrinsic=20 forefoot posting only. While adding a full length top cover for = additional=20 comfort is fine this will however limit use with a sleeker style shoe = wear.=20 Top covers must also be replaced periodically due to wear. = Left=20 uncovered can be used in multiple pairs of shoes by slipping them in and = out.=20 Easily maintained and cleaned. Has an indefinite life span.=20

Subortholene (3/32=E2=80=9D, = 1/8=E2=80=9D) by=20 itself or with your choice of a top cover is extremely firm = or rigid and not easily = tolerated.=20 Trim lines are best kept low. Ending at the metatarsal heads = without=20 a top cover allows for intrinsic forefoot posting only. While = adding a=20 full length top cover for additional comfort is fine this will however = limit use=20 with a sleeker style shoe wear. Top covers must also be replaced=20 periodically due to wear. Left uncovered can be used in multiple = pairs of=20 shoes by slipping them in and out. Easily maintained and cleaned.=20 Has an indefinite life span.

Our Soft UCBL (Non = Perforated=20 Dynalite Top Cover, THK1 and ORM Supportive Body) by itself offers soft = but firm=20 control. We designed to Soft UCBL = to=20 accommodate the patient who requires superior control but cannot = tolerate the=20 semi rigid or rigidity of the Copoly or Subortholene UCBL. Can be = ordered=20 in a standard sulcus length or with a full length toe box. For a = softer=20 affect we recommend replacing the Non Perforated Dynalite cover with the = P-Cell material. As with the standard semi rigid or rigid = Copoly or=20 Subortholene UCBL we recommend a slipper or plaster cast to achieve a = deep heel=20 seat and high trim lines. Slightly more difficult to adjust than = your=20 regular standard foot orthoses and may require cast modification, = reheating and=20 reforming to assure total contact maintenance. Easy to clean.=20 Indefinite life span (growth may be main deciding factor).=20

Semi Rigid=20 (1/8=E2=80=9D Copoly) or Rigid UCBL (3/16=E2=80=9D Copoly or = Subortholene (With Optional=20 Removable, Pre-ground Interface) by = itself is=20 very firm or extremely firm and is ideal when total control is required for your = patient.=20 As with the Soft UCBL, it may be necessary to use a slipper = or=20 plaster impression to obtain very high trim lines. We recommend = your=20 choice of Trilam, Soft EVA (Crepe), or P-Cell if you plan to use a=20 removable, pre-ground interface, all of which can be extended to a = full=20 length toe box when requested (comes sulcus length if not indicated).=20 Difficult to adjust without the proper equipment. May = require cast=20 modification, spot reheating and reforming to assure total contact = maintenance.=20 Easy to clean. Indefinite life span (growth may be main deciding=20 factor).

Now that we are more familiar with Trilam material = choices and=20 their uses, including the supportive materials used at Foot Logic, = Inc. to=20 accompany them, let=E2=80=99s move on to further materials and = designs used in our=20 product lines. The following are not prefab products, but rather=20 pre-designed product lines, and we hope you will find them=20 useful.

MATERIALS and PRODUCT = DESIGNS USED in=20 Foot Logic, Inc.=E2=80=99s ECONOMY, PEDIATRIC, L-CODE, AND SADMERC = approved Product=20 LINES of
Foot Orthoses

The following materials = are used in=20 the product lines below (See =E2=80=9CMaterial Descriptions=E2=80=9D for = better definitions of=20 each material):

BOCKLITE
CLOUD EVA (CREPE)
COPOLY (PLASTIC)
CORK
DYNALITE = (PERFORATED/NON-PERFORATED)
FIRM = EVA
ORM (ORTHOTIC = REINFORCEMENT=20 MATERIAL)
P-CELL
PLASTAZOTE
SUPER FOAM OR MULTI PUFF
THK1 = (CELASTIC)
THERMOFLEX
ULTRA CLOUD BLUE

PEDIATRIC

* THK1 OR = Thermoflex can be=20 added to improve integrity

1. Pediatric Soft Support = Super Foam with Cloud EVA=20 (Crepe) and are ideal for low to moderate = activity=20 levels. Mild support. Easily = adjusted.=20 *

2. Pediatric Firm Support = Super Foam with Firm = EVA and are ideal for = moderate to=20 high activity levels. Mild support. Easily adjusted.=20 *

3. Pediatric X-Firm Support=20 Super Foam and ORM and are ideal for = high activity=20 levels. Strong support. Easily adjusted. *

4. Pediatric Gait Plate=20 Semi Rigid Copoly and are ideal for total control when ordered with high = trim=20 lines (not to be confused with a UCBL). Interface optional.=20

TEEN=20 & ADULT ECONOMY LINE
3Dpp0a341216.jpg=20

* THK1 OR = Thermoflex can be=20 added to improve integrity

P-Cell can be used as optional soft top cover on any = of the=20 below products!

1. Cloud Combo=20 Blue Ultra Cloud Top Cover, = Cloud EVA=20 (Crepe), 1/8=E2=80=9D Cork Supportive Body and are ideal=20 for low to moderate activity levels. Supportive with softer = affect. Easily=20 adjusted. *

2. Soft Support=20 Dynalite Top Cover, Cloud EVA = (Crepe),=20 ORM Supportive Body and are ideal for low = to=20 moderate activity levels. Supportive with softer affect. Easily = adjusted.=20 *

3. Firm Support = Dynalite Top Cover, Firm EVA, and ORM Supportive Body=20 and are ideal for moderate to high = activity levels.=20 Firm EVA and ORM improve the integrity of the orthoses and = increase its=20 life span. Easily adjusted. *

4. Firm Slim Line = Full Length Firm EVA with Firm EVA Supportive Body / = Optional=20 Top Cover Choice and are ideal for very = high=20 activity levels. Suggested low trim lines for low profile = footwear.=20 Easily adjusted. *

5. X-Firm Slim Line = Full Length ORM with ORM Supportive = Body /=20 Optional Top Cover Choice and are ideal = for very=20 high activity levels. Suggested low trim lines for low profile = footwear.=20 Easily adjusted. *

L-CODE, DIABETIC, = SADMERC=20

P-Cell can be used as optional soft top cover on = most of=20 the
below products!

=E2=97=8F L-3010 for Longitudinal Arch Support = Only

1. L-3010-1 = Dynalite w/Soft EVA

2. L-3010-2 = Soft EVA with Firm EVA or Cork

3. L-3010-3 = Soft EVA w/Thk1 and Firm EVA

=E2=97=8F L-3020 for Longitudinal & Metarsal Arch = Support=20 Only

1. L-3020-1 = Plastazote w/Bocklite

2. L-3020-2 = Plastazote w/Soft EVA and Cork = Midfoot

3. L-3020-3 = Dynalite w/Soft EVA

4. L-3020-4 = Soft EVA with Firm EVA or Cork

5. L-3020-5 = Soft EVA w/Thk1 and Firm EVA

=E2=97=8F L-3000 Soft Met Raise Only or = Accommodative

1. L-3000-1 = Plastazote w/Bocklite

2. L-3000-2 = Plastazote w/Soft EVA and Cork = Midfoot

Still not sure what type = of product=20 or material choices would be best suited to help your patient? The = following=20 section is a list of COMMON DIAGNOSES = COUPLED WITH=20 FOOT ORTHOSES=20 DESIGNS available at Foot Logic, Inc.=20

TO VIEW=20
COMMON DIAGNOSES COUPLED WITH = FOOT ORTHOSES = DESIGNS
ENTER THE Activity LINK BELOW

ACTIVITY LEVEL ARTHRITIS = R.A./

ACTIVITY=20 LEVEL.htm

Congratulations!

Concluding with = everything we=20 have learned, we should now have a better idea of what our materials are = capable=20 of, and how they will compliment each other when combined. We are = now=20 ready to move onto the last and final steps of completing your = fabricated foot=20 orthoses.

We have a beautiful negative impression taken on your = part, a=20 completed lab order with your new knowledge of what Foot Logic, = Inc. needs=20 from you, including your well educated and informed decision on the = materials=20 and product choices that are available and you wish to use.=20

We are=20 now ready to begin the modifying, fabrication, and grinding processes, = something=20 that will be suspended until we have a full set of instructions from = you,=20 again this takes us back to why a COMPLETED LAB ORDER is so VERY=20 IMPORTANT!

With all this in = mind, let=E2=80=99s=20 begin!

MODIFICATION of = the POSTIVE=20 IMPRESSION

The second most important = ingredient=20 to achieving a good foot orthoses is how the cast(s) is modified. = As=20 stated earlier Foot Logic prefers working with a foam impression, it is = not only=20 more efficient when taking the negative impression, but it also wins our = vote=20 for all the following reasons in regard to the positive=20 impression:

a) When taken correctly = you receive=20 a smooth, accurate=20 picture of the plantar surface;

b) Relief=E2=80=99s and = modifications can=20 accurately = be pressed=20 into the foam before filling;

c) Toe boxes for full = length designs=20 can be added before filling giving us a more accurate length for the = foot=20 orthoses.

NOTE: We use a Plaster/Zonalite mix that makes for a much = easier and=20 faster modifying process than a solid plaster fill.

There is however only one = drawback to=20 the foam impression and when it is not understood, and corrected, it can = create=20 several problems in the finished product. With your slipper cast or = plaster=20 impression the plaster is wrapped up and around the foot capturing the = medial=20 and lateral aspects. While a foam impression can be pressed in and = around=20 the foot, this is not recommended as it will create thin, weak side = walls in the=20 foam and when filled can collapse ruining your negative impression.=20 Consequently, the foam impression possesses a box like appearance = when=20 pulled and if not corrected during the modification process will produce = a=20 bulky, shapeless foot orthoses. The result can be compared to = fitting a=20 square peg into a round hole which will ultimately create a real of shoe = fitting=20 problems.

FABRICATION, GRINDING = & FINISH=20 GRINDING

Fabricating the=20 final product is a relatively simple process. It naturally = involves=20 heating your chosen materials and vacuum forming them to our final = positive=20 cast(s). It is important that before heating and fabricating the = materials=20 that you have measured out an adequate amount of each to properly assure = the=20 correct finished form. It is equally important to keep in mind = that if the=20 material is cut too large it will create a =E2=80=9Ctent=E2=80=9D affect = losing its intimacy=20 with your cast(s). Fortunately, our custom made vacuum = tables=E2=80=99 enable us=20 totally to encompass the entire cast(s), keeping the trim lines high and = heels=20 deep on request.

Another important factor when fabricating several = different=20 types of materials together is the glue. The glue = must be=20 applied thoroughly to each adjoining side and allowed to dry completely = before=20 heating and vacuum forming the subsequent layers. Not allowing = your glue=20 to dry completely cannot only cause poor adhesion and air pocketing.=20

One additional=20 step that we follow involves any areas of deep modification (Example: = Strong=20 Metatarsal Arch) and requires your materials to be slightly punctured = in=20 these areas during the heating fabrication process with small holes to = that area=20 allowing for air pockets to dissipate and forming completely into your = deep=20 modification. When using a Copoly or Subortholene vacuum formed = directly=20 over a material it is important to puncture the material itself = and not the Copoly or Subortholene as this will create very sharp areas to form in your = finished=20 product. We use something similar to an oversized safety pin to = achieve=20 this procedure. Anything larger than this will create overly large = puncture marks in your finished product. Once we have finished = fabricating=20 your finished product, we allow it to cool, and then it=E2=80=99s off to = our grinding=20 area.

Before=20 grinding we must first refer back to your completed lab = order. We look for the=20 obvious. Will the product require a = high trim=20 line or deep heels? Will posting need to be incorporated into the = forefoot=20 or hind foot? You will achieve a much nicer finished product if it = is=20 ground correctly the first time, keeping in mind what is to be = accomplished, and=20 that it must lie in the patient=E2=80=99s shoe when finished. Keep = in mind that=20 the shoe is formed and shaped to resemble, and fit, the foot. If = your=20 finished product appears too boxy and bulky it will not fit the shoe = correctly.=20 It is also important to remember that having a small amount of = extra=20 material and posting on your finished product is not always bad, as it = is much=20 easier to take away, then to add to and regrind.

Also, VERY=20 IMPORTANT, it is always good practice to=20 draw trim lines onto your unfinished = product before=20 grinding. We also stress that you = should use=20 these trim lines to cut away any excess material before moving onto = grinding.=20 A good trim line will allow you to be initially more aggressive at = the=20 grinding wheel without over grinding. What is a good trim line? = A=20 good trim line is one that can be adjusted down during the final = grinding=20 process. In other words, your trim line should always be higher = than what=20 you expect on your finished product, keeping in mind that once the = material is=20 ground away it=E2=80=99s gone forever.

Let the grinding begin! Getting the feel for the grinding wheel can be = exasperating,=20 especially when your main priority is to create a finished product with = a smooth=20 and even finish. This will require you to learn and use long, = sweeping=20 strokes, which will take many long hours of practice, practice, = practice!=20 And remember, if our finish product has left your trim lines a = little=20 high, thick or long =E2=80=93 it=E2=80=99s better to take away than to = add too!

Grinding is a = devoted process,=20 one in which you must always pay special attention to the different = layers of=20 materials as you are grinding, it comes down to too much or too little = pressure=20 applied to achieve the best results. It is not uncommon to apply = too much=20 pressure during the removal of a firm layer while grinding and slipping = through=20 to your softer layer creating a hole. When firm, but steady = pressure is=20 applied, while and allowing the wheel to do the work will achieve more = equal=20 results. If you wish to try grinding yourself we suggest you allow = for=20 hours of practice, and don=E2=80=99t get discouraged, remember practice = makes perfect!=20 We purposely keep what we like to call a =E2=80=9CGoof-Up = Pile=E2=80=9D of=20 incorrectly fabricated products especially for grinding practice and=20 techniques.=20

FITTING YOUR FINISHED=20 PRODUCT

Fitting your finished product to the foot or feet, = shoe or=20 shoes, in some cases will take more patience than others. Begin by = examining the shoe for any preexisting innersole and remove it (when = possible).=20 Also, don=E2=80=99t forget to hold onto the innersole after = removing it you=E2=80=99ll=20 have the perfect pattern to trim your toe box if necessary. We = also=20 suggest returning the removed innersole(s) to the patient just in case = they=20 should require them to use during their orthoses break-in=20 process.

Now,=20 attempt to place a foot orthoses into the patient=E2=80=99s shoe, = keeping in mind that=20 it should lie flush in the bottom of the shoe. The shoe should not = squeeze, or collapse the sides of the foot orthoses, nor should it curl = the toe=20 box are of the foot orthotic. If the shoe has been sized = correctly, and=20 the foot orthotic has been shaped correctly, little to no adjustments = should be=20 necessary. Minor adjustments to the toe box, trim lines, posting = or=20 support are sometimes unavoidable. In regard to adjusting the = amount of=20 support a patient feels, we recommend doing this slowly, and carefully.=20 There is always an initial break-in period, and this should = always be=20 followed prior to making a sudden, or drastic adjustment.=20

All in all, if we had a good negative impression, a = COMPLETED=20 lab order presenting good communication between you and ourselves = --=20 we encourage you to feel confident that you should not have any major=20 difficulties during your fitting process. However, we do recommend = that if=20 you get that hard to miss, undeniable feeling that the particular = patient you=E2=80=99re=20 seeing is going to be very difficult, please call us prior to completing = your=20 lab order so that we may assist you. We also ask that you REQUEST = the=20 modified cast(s) be returned to you just in case your undeniable feeling = was=20 correct and we need to make adjustments. Making significant = adjustments=20 without a cast to work with is time consuming and often inaccurate, so = for the=20 few extra shipping dollars, it=E2=80=99s your peace of = mind!

Thank you for = entrusting your=20 orthoses fabrication needs with

FOOT LOGIC, = INC.
Central Fabrication & Custom = Products
2824 Sweitzer Rd.
Uniontown,=20 OH 44685
Phone: (330)=20 699-0123
Fax: (330) 699-0158

Kathleen J. = Kinsey,=20 President
Larry A. Kinsey, Vice=20 President
Jennifer E. Stanton, Office = Manager/Modifying
Jeremy J. Stanton, = Grinding=20 Manager
Tracy L. Monaco, Lab/Office=20 Assistant
Steve Pfaff, Lab=20 Assistant

Happy Feet, Happy = Patients,=20 Happy Customers!