1. Filling the prescription… the Pedorthic Assessment  History  Non-Weight Bearing Seated Assessment  Weight Bearing Observation  Supine Physical Assessment  Prone Physical Assessment  Weight Bearing Assessment  Gait Analysis

2. Filling the Orthotic Prescription  Detailed lower limb history Current SSx Current SSx Previous SSx Previous SSx Surgical interventions Surgical interventions Previous Injury Previous Injury Previous Treatments Previous Treatments Systemic Disease Hx Systemic Disease Hx DiabetesDiabetes ArthritisArthritis Venous insufficiencyVenous insufficiency

3. Physical Assessment Physical Assessment  Seated NWB Navicular height Navicular height Med. Long. Arch Med. Long. Arch Digital alignment Digital alignment Tibial/knee alignment Tibial/knee alignment  Weight Bearing Δ navicular height Δ navicular height Δ MLA Δ MLA Δ digital alignment Δ digital alignment Δ tibial/knee alignment Δ tibial/knee alignment

4. Physical Assessment…cont.  NWB Supine Passive ROM at Passive ROM at Subtalar jointSubtalar joint MidtarsusMidtarsus 1 st Ray position1 st Ray position Hallux dorsiflexionHallux dorsiflexion Lesser toesLesser toes Resisted Muscle Tests Resisted Muscle Tests Palpation of areas of pain Palpation of areas of pain

5. Physical Assessment…cont.  NWB Prone Subtalar ROM Subtalar ROM Symetry in medial maleoli Symetry in medial maleoli Landmarking Landmarking Biomechanical measures Biomechanical measures Rearfoot alignmentRearfoot alignment Forefoot to RearfootForefoot to Rearfoot Ankle dorsiflexionAnkle dorsiflexion  WB Posterior View Relaxed Calcaneal Stance Relaxed Calcaneal Stance Tibial Alignment Tibial Alignment

6. Gait Analysis  Barefoot Heel Strike Heel Strike Midstance Midstance Heel off Heel off Propulsion Propulsion  With Current Footwear Same as barefoot Same as barefoot

7. Fabrication  Three Dimensional Volumetric Casting  Cast Correction/Modification  Orthosis Manufacture or milling  Grinding and Finishing

8. Three Dimensional Volumetric Casting  Plaster of Paris  Casting Foam  Direct Laser Scanning  Contact Digitizing  Wax Casting Currently “Subtalar Joint Neutral” is the industry standard for casting

9. Cast Correction  Done to allow the fabrication of a device that is both functional & comfortable  Technique is based on the casting method used: CAD/CAM Software for laser scans, and contact digitization CAD/CAM Software for laser scans, and contact digitization By hand, using plaster of Paris for Plaster, Foam and wax casting By hand, using plaster of Paris for Plaster, Foam and wax casting Plaster, foam and wax can also be scanned into CAD/CAM software packages Plaster, foam and wax can also be scanned into CAD/CAM software packages

10. Orthosis Manufacture/Milling  Creation of the orthosis using the corrected 3D foot cast, or milled directly from manufacturing material  Must be made from the patients casts or scans, and made from raw materials to be truly “custom made”  No “Library Devices” or Prefabricated devices that are simply modified

11. Grinding and Finishing  Grinding of orthosis to the appropriate shape to fit in shoe; done by hand  Addition of posting, padding and topcovers are the final stages before the patient’s dispensing appointment

12. Dispensing Appointment  Booked for 15-30 minutes  Educate patient on function of devices, break-in process etc.  Fit devices to footwear  Further gait analysis to ensure device efficacy and function

13. Footwear; An entire presentation on it’s own  Patient Measures Heel to toe Heel to toe Heel to ball Heel to ball Width Width Girth Girth  Last shape  Midsole construction  Closures  Upper Design

14. The Goal

16. Thank You! On behalf of the Pedorthic Association of Canada, the College of Pedorthics of Canada, thank you for this opportunity to inform you of the practice of Pedorthics in Canada. www.pedorthic.ca