This is the part 2 of a series that should be read in order.
Key Points: What are Balanced Orthoses?
What is the Difference between B1 and B2?
What does the impression we Capture have to do with any heel correction we want?
What are Modified Root Corrections?
Goal: Have your Measurement of FF/RF Deformity within 4 Degrees of your cast/scan impression when making a B1 Device.
In +/- scale, Forefoot Varus is (-) and Forefoot Valgus is (+)
Up to how much Forefoot Balancing of Forefoot Varus is typical without blocking first ray plantarflexion using full correction?
One of the Modified Root Corrections Uses A Combination of Intrinsic and Extrinsic Varus Posting with Forefoot Varus
Review below of all orthotic types
Typical KevinRoot Balanced Orthoses
The Balanced Orthosis is designed for both balance and support to the foot and lower extremity. It is symbolized by B and divided into B1 and B2. B1 is your classic Root forefoot to rearfoot balancing. It is my Gold Standard device that I grew as a Podiatrist using. B1 requires that the casting or image collection be a non weight bearing suspension technique captured with the subtalar joint in neutral position and the midtarsal joint(s) be maximally pronated. The impression of the foot shows the forefoot deformities and not heel position to the ground. Below, I demonstrate a positive cast with either a forefoot varus or valgus deformity. Will you want to push the heel to vertical or inverted or everted to the ground in each case? If you are balancing the forefoot deformities completely, you are centering the heel to vertical. Since many patients have rearfoot deformities, or other needs, the heel may ultimately be inverted or everted. The classic Root balancing can be prescribed with FF/RF angles in varus (-) or valgus (+) degrees. I have previously discussed the maximum limits of classic Root balancing as 5 varus and 20 valgus. Some laboratories have methods to achieve more correction by some modification of the original technique. I call this Modified Root corrections. Here I must emphasize the importance of learning the Forefoot to Rearfoot Measurement, and some Podiatrists just utilize the degrees captured in the cast. Generally, there appears to be a standard 4 degree margin of error in the measurement and what is captured in the casting/imaging, but occasionally I am spot on.
Positive Casts showing Forefoot Varus (left) and Forefoot Valgus (right)
One of these Modified Root corrections with widespread usage (especially in forefoot varus feet) is typically done to achieve a 50% overall correction. Therefore, if 20 degrees of forefoot varus is captured in the cast/image, only 10 degrees will be corrected. Of these 10 degrees, 5 degrees is posted intrinsically and 5 degrees extrinsically. I have not seen over 20 degrees of forefoot varus supported with Root techniques. This allows partial correction of -6 to -20 (varus) degrees of forefoot deformity, and full correction of +20 (valgus) to -5 degrees (varus) of forefoot deformity. With me?
I will discuss B2 in the next post, not used in Forefoot to Rearfoot Balancing. B1 however really helps when we are attempting to place a foot near Subtalar Joint neutral. I have attached a post from my personal blog with more information here.
Review of Orthotic Types:
Corrective Orthotic Devices
↓
- Balancing (B): (B1 and B2)
- Pronators (P): BP, P1, P2, P3, P4, P5, and P6
- Supinators (S): BS, S1, S2, S3
- M/L Instability (M): BML, ML1, ML2, ML3, ML4, ML5, and ML6
- Shock Absorption (C): BC, C1/C2, C3/C4/C5, C6, and C7
- Sagittal Plane (H): BH, H1, H2, and H3
