The structure of the human foot presents many variables from one individual to another, as well as variations of left versus right foot in one individual. There are numerous landmarks present, often manifested as bony or soft tissue prominences that are outwardly visible on the surface of the foot. At times, these prominences are not as visible on casts, scans and impressions of those feet but yet must be accurately accounted for when producing a high quality custom orthotic device.
Marking accommodations on scans, casts and impressions is usually a simple matter and easy to perform, yet pays great dividends in the accuracy and patient satisfaction level of the orthotics. Common accommodations include:
- Prominent Navicular- in the severely pronated, often hypermobile foot a frequent complaint is irritation at the apex of the arch of the orthotic. In the case of a discreetly prominent Accessory Navicular a “button” accommodation can be made either as extra padding with an indentation, or as dell in the orthotic plate itself.
- Prominent metatarsal head-either with or without a skin lesion,
- Hypertrophic sesamoid
- 5th metatarsal base, styloid process
- Hallux, medial plantar prominence near the interphalangeal joint
- Bowstrung or tight plantar fascia
Other less common areas of the foot may need to be accommodated from time to time. For foam box and plaster casts marking the lesion of the foot with an indelible marker, skin marker or lipstick easily transfers directly from the skin to the impression material. For digital scanning which does not distinguish based on color, applying a felt or foam pad, moleskin, or a small wad of rolled up athletic tape to the affected area will transfer the location onto the scan. Additionally a photo taken of the plantar of the foot, trying to remain perpendicular to the surface of the foot with the areas marked can also increase accuracy of the accommodations and limit the possibility of error. Lastly, indicate the desired dimensions of the accommodations, such as depth, diameter or width.
Our goal at KevinRoot Medical is 100% accuracy and 100% satisfaction of our clients and their patients. Please feel free to share your “pearls” including techniques for managing accommodations.
