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Custom Prescription Guide

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Bespoke range of foot ortho�csCustom

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CUSTOM

02 www.dolaorthotics.com

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Bespoke range of Custom

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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


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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


06 www.dolaorthoti cs.com


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




1st Met CutoutForefoot Varus Extension



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


1st Met Cutout1st Met CutoutForefoot Varus Extension



pg. 16pg. 16

pg. 21

pg. 19

pg. 15

pg. 17+21

pg. 22

Rearfoot Valgus Post


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



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



- 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


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


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.



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



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



- 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



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.



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



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


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


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


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 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



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



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



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



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.


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

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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.



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


TOP COVERS

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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



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


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)


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




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



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



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


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


FootcareEdition 2.2

Made with clinical excellence in mind

FOR ALL OF YOUR ORTHOTIC NEEDS...

Prefabs.TalarMade Custom Orthoti cs

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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.


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