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Orthotic Molding Process

Orthotic Casting Pillows

The A.C.T.™ Casting Pillow

Inconsistencies of casting techniques provide the greatest challenge in any fabrication lab. Modifying the casts to estimate the arch height, arch length and width of the weight bearing foot is subjective at best. Extensive discussion and debate has been ongoing over the years with no ultimate solution on how to make foot casting consistent whether using a plaster slipper cast, wax or foam impression tray. Simply “loading” the lateral column during casting does not effectively create a functional or comfortable foot model. Foam impression boxes, while allowing a load to be placed manually on the mid-foot; do not overcome the problem of inconsistency due to practitioner techniques. Common complaints of foot orthotics being intolerable or ineffective due to improper “interpretation” of the plaster model are essentially eliminated by creating a weight-bearing foot impression. Utilizing a The A.C.T.™ impression pillow provides an accurate, reproducible and consistent plantar foot topography regardless of technician technique.

The A.C.T.™ Impression Stand:

The A.C.T.™ Impression Stand is uniquely designed to simplify the molding process utilizing the A.C.T.™ pillows. Once the subtalar joint has been aligned, the knee cups hold the patient in position for hands free molding/casting. The plumb bobs identify the alignment of the knee over the metatarsals providing both a reference point and diagnostic tool.

Step 1:Have the patient step onto the pillows taking care to locate the feet in the appropriate position with the ball of the foot at the transition and the heel centered in the back.
Step 2: Loosen the knobs on the sides of the cross bar and position the bar slightly below the plane of the knees.
Step 3: Loosen the knee cup knobs and center the cups to the patient’s knees and retighten. Have the patient bend the knees so they fit securely into the knee cups. Grasp the subtalar joint with one hand and the knee cup knob with the other. Loosen the knob and slide the knee cup medially and laterally while feeling for subtalar alignment. Once alignment is achieved tighten the knee cup knob. Repeat for the other foot.
Step 4: Suspend the plumb bobs and check alignment. The plumb bob should locate between the first and third toes, normally over the second. A lack of symmetry may suggest that subtalar alignment should be rechecked or that perhaps there is a leg length discrepancy or other anomaly that needs to be explored.

Step 5: Place molding/casting medium under one foot at a time and allow to cool/cure.