Shell Modifications

Arch Fill
Description
  • Material applied to plantar aspect of orthotic to add extra support to the arch
Location
  • Chosen material applied to plantar aspect of device, ground flush with rear foot stabilizer, tapered on sides.
Material
  • Orthotic shell
  • Strip of specified material long enough to cover the arch (poron, p-cell, nyplex, EVA 35 or 55, rekoil, birko cork)
Indications
  • Heavy/obese cases requiring extra support/reinforcement
  • Extreme pes planus cases requiring reinforced MLA support
Contraindications
  • Flexible devices (fill with increase rigidity)
Heel Cup Depth
Description
  • Device altered to deepen or lessen the area of the heel cup
Materials
  • Same as shell
Location / Characteristics
  • Standard heel cup depth = 16 mm, heel cup depth can be lowered to 0 mm for a flat heel cup or increased to 32 mm for a very deep cup
  • A deeper heel cup will widen entire device slightly

 

Indications
  • Addition of skive to a device
  • Optimication of rear foot control
Contraindications
  • Dress orthotics generally require lower heel cup depths for fitting
  • Extra depth may cause footwear fitting problems due to the extra width or height of the device
Fascial Accommodation
Description
  • Groove incorporated into shell material in area of medial plantar for 1st met tendon. Allows met tendon to be lower in profile of orthotic.

Materials

  • In shell
Location / Characteristics
  • Groove incorporated into shell material in area of medial plantar fascial ligament/flexor hallucis brevis (as marked on casts)Contraindications

Indications

  • Anatomically tight plantar fascia especially if prominent with dorsiflexion of 1st MPJ)
Flange - Medial
Description

Extra material added above the usual profile of the orthotic to stop foot from rolling in.

Material
  • Same as shell
Location / Characteristics
  • Medial border of device extended to encompass more of MLA
  • Maximum control/contact area between foot and device
Indications
  • Excessive pronation
  • Medially deviated STJ axis
Contraindications
  • Footwear which cannot accommodate extra width need for device
Flange - Lateral
Description
  • Extra material added above the usual profile of the orthotic to stop foot from rolling out.
Material
  • Same as shell
Location / Characteristics
  • Lateral border of device extended to encompass more of the MLA
Indications
  • Supinated foot type
  • Chronic ankle instability
Contraindications
  • Footwear which cannot accommodate extra width need for device
Shell Width
Description
  • Wide and narrow shell width (in relation to foot)
Material
  • Same as shell
Location / Characteristics
  • Wide –> shell to be 3-4 mm wider than lab standard
  • Narrow –> shell to be 3-4 mm narrower than lab standard
Indications
  • Wide — > excessive pronator to maximize contact area with plantar surface
  • Narrow –> slender, narrow foot-type, low profile footwear
Contraindications
  • Wide –> low profile/narrow footwear
  • Narrow –> wide footwear, deep heel cup (>16mm)
Shell Grind
Standard

Shell is tapered to reduce bulk and edges are feathered.

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Narrow

Shell is further reduces.

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Full

Shell is left a little thicker to keep full strength of material, especially around heel cup and along MLA.

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Hourglass

Shell is narrowed bilaterally along MLA. This shape is useful for certain slim dress footwear.

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1st Ray/Met Cutout (Shell)
Description

The corner of the shell is removed

 

Material
  • Same as shell
Location / Characteristics
  • Area of 1st metatarsal joint
Indications
  • Dancer pads
  • FHL accommodation
  • Plantar flexed 1st ray
Contraindication
  • Hallux limitus/rigidus
  • 1st metatarsal pad join O/A

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Get in touch with us at 705-342-7728 or at info@soundorthotics.com to find out more about how we can work with you to help your patients achieve pain-free, active living.

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