These words are usually used to start a 100 yard dash. We are not using a starter's pistol, but instead we are respectfully requesting our clients adequately mark their impressions where there are bony prominences or other discrete areas on a patient's feet or ankles that are needed to be accurately accommodated with the custom foot or ankle-foot orthotic device.
The most glaring example of the need for a marked accommodation is the prominent malleoli in the manufacture of a Richie type AFO. Whether you use plaster, fiberglass or an acrylic casting sock please take the time to mark the malleoli on the impression you send to the lab. It is preferred that we have an outline of the entire malleoli, but a simple dot which denotes the high point of the prominence will suffice. Any indelible marker can be used, a pencil, a sharpie, lipstick (any color), or my personal favorite, a surgical skin scribe (usually borrowed from the surgical center), which easily transfers from the patient's skin onto the casting material. In the case of the STS sock, mark the malleoli on the outside of the sock, or you can mark the inside of the sock after you have removed the plastic liner, replace the sock and mark accordingly. It is also helpful to label the prominences or write short remarks, an “x” or arrows on the impression in nthe case of unusual anatomy such as a small bone spur on the malleoli..
Marking casts is helpful in many other situations as well. Common prominences such as a retro Calcaneal exostosis or Haglund’s deformity, the peroneal tubercle, a plantar Calcaneal tuberosity with atrophied fat pad, a prominent Navicular, or 5th metatarsal styloid process. If you want a Cuboid pad, mark the outline of the Cuboid bone. Same is true for the sesamoids and prominent metatarsal heads. If the apex of the medial arch is an issue, mark the Talo-Navicular, Naviculo-Cuneiform, and Cuneiform-metatarsal joints on the cast. Don’t forget you can indicate the width and depth of the accommodation as well as the thickness of any padding you desire. Anything that requires specialized attention, please let us know!
The team at KevinRoot Medical thanks you for helping us win the race for quality, accuracy, expediency.
