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Determining Orthotic Depth | KevinRoot Medical

Determining Orthotic Depth


  • The two previous posts in this series considered orthotic width and length, now we can discuss the third dimension, depth. We often underestimate the importance of the depth of our orthotic devices, especially when considering the amount of control of frontal plane motion we need to attain in the rearfoot during the initial heel contact phase of gait. The depth of the heel cup goes hand in hand with the width of the heel cup, in other words, a deeper heel cup will often also be a wider heel cup. Adding the volume of an extrinsic rearfoot post and/or lift into the decision making process, one must weigh the amount of motion control needed versus the available space in the shoe. The depth (or height) of the device in the midfoot is also something to be considered when building an orthotic frame, and on rare occasions even forefoot control on the transverse plane may be a factor in determining depth of the device in that area. We will focus on the rearfoot for now.

     

    I would like to direct your attention to the heel cup depth page in the custom modifications section of the KevinRoot Medical website;

    Heel Cup Depth – KevinRoot Medical

    The choices in heel cup depth range from 0-30 mm incrementally, with 12 mm being considered “standard”. The standards are for medium sized feet, namely men’s size 10 and women’s size 8 and  may vary somewhat with unusually small or large feet. If you tend to order one of our pre-existing models, please review the standard heel cup depth for that particular model and adjust if necessary. Be aware of how much fat pad expansion to consider in your patient, you can customize the width of the heel cup, keeping it narrower for less fat pad expansion or wider than standard for greater fat pad expansion. Heel cup depth must also be considered when adding heel pads and skives, for example in a patient with a narrow heel and little fat pad under the Calcaneus, you may prefer to order no expansion and add a heel pad which are available in varying thicknesses.

     

    Extrinsic rearfoot posts may add minimal depth to the rearfoot of the orthotic frame;

    Varus Extrinsic Post – KevinRoot Medical

    Rearfoot Valgus Extrinsic – KevinRoot Medical

     

    Adding varus or valgus correction in the rearfoot extrinsic posts will add some height either medially or laterally to the posts. The greater the correction, the more added height, so be careful when using these posts, and adjust your heel cup depth accordingly.

     

    Another method of adding depth to the orthotic frame is the use of medial and lateral flanges:

    Medial Flange – KevinRoot Medical

    Lateral Flange – KevinRoot Medical

    Confusion exists regarding the use of flanges with functional orthotics. They will generally enhance frontal and/or transverse plane motion control when necessary, while not widening the orthotic as much as deeper heel cups tend to do. There is an excellent guide to the use of flanges by Dr Blake in the KRM webpage for the medial flange. 

     

    Should you prefer to have maximum depth to your device I would recommend using the UCBL profile device;

    UCBL Orthotics – KevinRoot Medical

    This device basically combines the use of a deep heel cup with medial and lateral flanges. The choices for customization are only limited by the practitioner’s imagination.

     

    In cases where space in the shoe is limited, several options are available for consideration. First is intrinsic rearfoot posting;

    Varus Intrinsic Post – KevinRoot Medical

    Rearfoot Valgus Intrinsic – KevinRoot Medical

    These posts are built into the orthotic frame, rather than added on, and will allow some degree of frontal plane motion control , yet allow the heel to sit deeper in the shoe.

     

    If you prefer to us extrinsic posts , yet minimize volume of orthotic, consider using device undercut modification;

    Device Undercut – KevinRoot Medical

    Greater undercut narrows the plantar surface of the posts and is sometimes a useful tool in gaining control yet taking up less space. Undercut varies from 0-30 degrees, ten degrees being standard.

     

    Finally, heel skives, both medial and lateral, can be very effective in gaining motion control in either direction on the frontal plane, with minimal space usage;

    Heel Skive – KevinRoot Medical

    Lateral Heel Skive – KevinRoot Medical

     

    Heel skives differ from intrinsic rearfoot posts, posts are built into the shape of the tilt of the heel cup of the frame, while skives are generally added separately within the concavity of the heel cup to resist motion in either direction. Skives are available from 2 to 6 mm in size.

     

    Building effective functional foot orthoses is both an art and a science. It behooves the practitioner to be aware of all the options available in their toolbox in order to maximize successful outcomes. The staff at KRM is here to gladly assist you anytime! 



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