Phalanges, literally meaning "fingers", are used both medially and laterally on a CFO to provide more support. We call them Flanges on a Root orthotic but in mechanical control I like to think of them as "fingers" supporting my patient's foot.
Here is a typical medial flange for over pronation.
Medial Flange seen from the back.
Here is an view of a lateral flange.
Here is the posterior view of the right foot with a lateral flange.
Flanges give you an incredible wall medial or lateral against the motions of pronation (medially), or supination (laterally). The exception to that general rule is that lateral flanges can be a vital part of an orthosis trying to block forefoot abduction on the rear foot in a pronator with a high axis to their mid tarsal joint. You can visualize flanges by placing your finger on the top of the medial and/or lateral sides of the orthosis running distal to the heel cup area.
I love to imagine every prescribing clinician having a solid understanding of 4 classical orthotic shapes at their disposal. You take your image (casting or scanning) and you then decide what you will order to help this patient. I will be going over and over this concept this next year. You should have your standard "Root Functional" orthotic device. This is your gold standard. "Root Functional Anti-Pronation 2" will provide more pronation control. "Root Functional Anti-Pronation 4" will be more super-charged than "Root Functional Anti-Pronation 2" in terms of pronation correction. It is "Root Functional Anti-Pronation 4" that will have some version of a medial flange, and if there is forefoot abduction that is excessive, also have a lateral flange. This could be called a low-cut UCBL. "Root Functional Anti-Supination 2" will be different from "Root Functional Anti-Pronation 2 " in terms of more lateral support for supinators. All my "Root Functional Anti-Supination 2" orthoses have a lateral flange. Therefore, lateral flanges are used more often in both supinators and some pronators. Flanges in general will fill up the room in shoes more, but athletic shoes in general with a removable insert accommodate them well.
Read more about Medial Flange on our website >
