Practitioner’s Custom Orthotic Guide
Table of Contents Introduction
1
Custom-made Process
2
Orthotic Shell Materials
3
Top-cover and Midlayer Materials
5
Orthotic Types
8 Orthotic Lengths 12 12
How to Take a Foam Box Impression Top-cover Customization
12 Orthotic Accommodations 13
Introduction orthotic Energy is proud to produce the highest quality, custom-made orthotics in the industry. We take the time and care to make sure that your patients’ orthotics are made exactly to prescription. Our products are individually fabricated to control a particular person’s foot function, enhancing their athletic ability, comfort, and shock absorption.
All Orthotic Energy products will be reviewed on a continual basis throughout the fabrication process to ensure conformity with the doctor’s prescription. All non-conformity will be reviewed by trained personnel and reworked or remade to eliminate nonconformity. Orthotic Energy uses the latest technological standards in the manufacturing of our custom orthotics. Research and development is an integral part of ensuring that Orthotic Energy exceeds the standards and skill level required to manufacture quality prescription custom orthotics.
We at Orthotic Energy stand behind our processes and products and are confident that our custom-made orthotics will stand up to, and surpass any of our competitors. We are proud to say that we are 100% Canadian owned and operated and all of our orthotics are custommade onsite in Toronto, Ontario, Canada.
What is an Orthotic?
Orthotics are shoe inserts that are designed to help correct an improper or irregular gait. Orthotics are not to be confused for simply “arch supports”. A custom-made orthotic can have a large impact on improving comfort while you are walking, running, or standing. Orthotics are made from a variety of different materials. We can offer a vast combination of materials and designs for treating each patient’s individual foot ailments. Based on design, orthotics can work to alter foot function, protect an existing foot problem, or any combination of both.
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Custom-made Process:
All orthotics made by Orthotic Energy are custommade for your patient. Orthotic Energy produces orthotics by two processes: 3D scanning that is directly linked to our CAD/CAM mill; and pouring plaster into either the plaster casts or foam impressions of the patients’ feet.
3D Scanning:
Your patient’s cast is scanned using our three-dimensional scanner. It is then sent directly to our CAD/CAM mill where we mill your patient’s positive impression from high density MDF. Based on your prescription, the shell material is heated, placed over the positive foot mould, and then vacuum-formed around the mould to create the desired shape and design. The shell is then sent through a grinding process to remove excess material, leaving a finished shell. The finished shell is then processed to include the desired soft material accommodations such as heel cushions, metatarsal pads, and/or heel posts that are required to finish the fabrication of the product. The finished orthotic undergoes a rigorous quality control check and is fitted into a shoe if necessary.
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Pouring Plaster:
The foam or plaster negatives are marked to indicate any bony prominences, such as 1st metatarsal heads and 5th metatarsal heads. The calcaneus is marked for mid-line vertical, and then plaster is poured into the negative creating a positive mould. Rearfoot and forefoot corrections are made to the positive as necessary. Like the 3D scanning method, the selected shell material is then heated and vacuum-formed around the positive mould. The moulded shell is then ground to remove any excess material and then processed to select and apply soft materials and accommodations. After the finished orthotic goes through quality control it is ready to be shipped to your clinic.
Section 1
Orthotic Shell Materials:
Orthotic Energy is proud to say that we offer the widest range of shell material options in the industry. In most cases we also carry our shell types in multiple thicknesses, ensuring we have the right material to help treat all of your patients.
Carbon Flex: Thicknesses (1, 2, 3mm) Carbon flex is a semi-rigid shell material at 2mm thickness, but we also offer it in 1mm (flexible) and 3mm (rigid). Because it has a degree of flexibility patients will find it comfortable and easy to get use to. Carbon flex is the most widely used shell material in the industry. It is the standard shell type for Casual, Dress, and Sport orthotics. We suggest increasing the thickness of the shell to 3mm if your patient is over 250 lbs.
Co-Poly: Thicknesses (1, 2, 3mm) Co-Poly is a semi-flexible material that is rigid enough to enforce correction. It is perfect for cases where a significant degree of correction can be obtained while still providing a degree of flexibility that is comfortable enough for daily use. It is our standard shell type for Youth orthotics.
Poly-Pro Thicknesses (3mm, *4mm) This is one of the premium shell types in the industry. Poly-Pro is a semi-rigid module type that is also very lightweight. It is perfect for patients who require maximum correction control but don’t want to compromise the bulk and weight of their orthotic. These characteristics make it perfect for orthotic types such as our Pro-Runner. *4mm is only used in the Marathon orthotic.
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XT Sprint: Thicknesses (2, 3mm) We are happy to introduce XT Sprint to our list of shell materials. XT Sprint is an incredibly lightweight, thin shell type that still maintains enough rigidity to promote correction. It is a fiber reinforced polypropylene, which allows us to make orthotics that are 30% lighter than other shell types of the same rigidity. It allows us to make subtle, lowprofile orthotics that can be fit into any shoe. It is offered in Dress, Casual, Pro-Skate, and Pro-Soccer orthotic types.
Subortholene: Thicknesses (1, 2, 3mm) Subortholene is known for its ability to create very deep heel cups and high medial and lateral flanges. This makes it the perfect shell type when a high degree of motor control is needed. Subortholene is used to make our U.C.B.L. orthotics.
EVA (Evalyte): Thicknesses (1,2,3mm) Density 55mm durometer) Carbon flex(35, is a semi-rigid shell material at 2mm thickness, but we also offer EVA is a lightweight, very flexible material that is soft and padded. it in 1mm (flexible) and 3mm (rigid). Because it has a degree of flexibility It is ideal for patients that cannot tolerate a rigid orthotic but are patients will find it comfortable and easy to get use to. Carbon Flex is the looking for comfort and correction. They need to be fit into a most widely used shell material in the industry. It is the standard shell type shoeand duesport to the thickness the shell. forgenerous casual, dress, orthotics. We of suggest increasing the thickness of the shell to 3mm if your patient is over 250 lbs.
Trilaminate: Density (45mm durometer) Trilaminate is a very soft and padded module created by laminating 3 layers of foam together. It is available in soft or firm if we add another layer of EVA to the plantar surface. It is perfect for patients that have general foot discomfort and accommodative footwear. Comfort is the goal with this module type.
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We at Orthotic Energy are proud to offer a large selection of top-covers to suit all of your patients’ needs. We have a variety of different materials, thicknesses, colours, and offer many of our top-covers free of charge.
Section 2
Top-cover and Midlayer Materials:
Vinyl: A nice subtle material that will resist odour and wears well. Thickness: N/A
Colour: Black, Navy Blue, Beige
Mesh: Mesh is a soft top-cover that has its own padding and is great for wicking away moisture. Thickness: 1/8” 1/16”
Colour: Thickness: Blue 1/16” Black
Blue is only available in a width of 1/8” and black is only available in a width of 1/16”.
Neoprene: Great for sport applications. It has a superb, nitrogen based cushioning layer with high tensile strength, wicks moisture, and resists odour. It also absorbs shock and reduces friction. (Free upgrade) Thickness: 1/8”
Colour: Black
Leather: Leather is a great look for patients that have orthotics in their dress shoes. It has great wearability and resists odour. (Upgrade) Thickness: Colour: Thickness: N/A Black, Brown (Napped) N/A
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Perforated Nora: A lightweight material that has its own padding. It is perforated to channel sweat and moisture away from the foot, keeping it dry. Standard top-cover for Pro-Runner orthotics. (Upgrade) Colour: Thickness: Beige, Blue, Navy Blue 1/8”, 1/16” Blue is only available in a width of 1/16”.
Soft Vinyl: This vinyl is wax-coated and softer on the feet. This material is great for orthotics with high flanges because it won’t bunch or wrinkle.
Thickness: N/A
Colour: Black
Puff: A closed-cell foam based material commonly used in Youth orthotics. Provides padding, has a great memory, and is hypoallergenic. Does not have the tensile strength of other options.
Thickness: 1/8”, 1/16”
Colour: Coloured, Rainbow, Dalmatian
Plastazote: A porous material that discourages bacteria growth, easily adheres to most materials, is non-allergenic, and may be used in direct contact with the skin. Plastazote is the recommended midlayer for Diabetic and Arthritic orthotics.
Thickness: 1/8”, 1/16”
Colour: Beige
Suede: Used in our Sandal orthotics. Given the colour and consistency of the suede, no one will even notice there is an orthotic beneath it. Thickness: N/A
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Colour: Tan, Grey
EVA (Evalyte): A copolymer of ethylene and vinyl acetate. Orthotic Energy offers red and blue EVA in medium density (35mm durometer) and white EVA in firm density (55mm durometer). EVA is commonly used for arch fills and for accommodative orthotics. Thickness: 1/8”, 1/16”
Colour: Blue, Red, White
Poron: Has high energy absorbing properties thus isolating the shock of impact. It easily adheres to shells and top-cover materials. Poron is the most common material used for midlayers. Thickness: 1/8”, 1/16”
Colour: Blue
Microcell: A closed-cell foam that provides excellent shock absorption and resists “bottoming out”. It is highly recommended for people who are allergic to neoprene or who are involved in high friction sports like tennis or basketball. Thickness: 1/8”, 1/16”
Colour: Black
Nyplex: A blend of nitrile rubber and P.V.C. that produces a 28mm durometer softness that has an excellent closed-cell cushioning capability, as well as being durable, and resilient. Thickness: 1/16”
Colour: Black
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Section 3
Orthotic Types:
These are the standard orthotic specifications. Your prescription will modify the standard orthotic specifications to meet your patients’ requirements.
Casual : Shell: Black carbon flex, 2mm Top-cover: Vinyl, black Midlayer: 1/16” Poron Design Feature: N/A Clinical Advantages: The Casual orthotic provides a good degree of correction but is still padded for comfort and wearability. Good for a wide variety of everyday casual shoes.
Dress: Shell: Black carbon flex, 2mm Top-cover: Vinyl, black Midlayer: N/A Design Feature: Select Dress Flat on the order form for high heel shoes, or a heel cup for men’s dress shoes. Clinical Advantages: The Dress orthotic is a low profile orthotic that is designed to be narrow with very little padding. Because of its sleek design it can be transferred into most dress shoes.
Cobra : Shell: Black carbon flex, 2mm Top-cover: Vinyl, black Midlayer: N/A Design Feature: A distinct “cobra” grind is applied to the shell that leaves the middle of the heel open. Clinical Advantages: The Cobra orthotic design allows for the heel of the orthotic to be compressed into different sizes. This makes it perfect for patients who frequently switch between dress shoes because it can be contracted to fit various heel profiles.
Sport: Shell: Blue carbon flex, 2mm Top-cover: Mesh 1/8”, blue Midlayer: N/A (if vinyl is selected it will come with a 1/8” poron midlayer) Design Feature: N/A Clinical Advantages: The Sport orthotic is designed to have a degree of flexibility and is also padded by our mesh top-cover. It is perfect for sport applications because of its flexibility and the mesh top-cover’s ability to wick away moisture and resist wear.
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Atlethic: Shell: Blue carbon flex, 2mm Top-cover: Neoprene 1/8”, black Midlayer: 1/16” Red EVA 35mm durometer Design Feature: A flange on the medial side of the top-cover for a snug fit inside of the shoe for increased stability. Clinical Advantages: The Athletic orthotic is made with a medial flange of the midlayer and top-cover. This flange helps anchor the orthotic in the shoe and provides stability when making hard directional changes given the cutting and running nature of court sports.
Pro-Runner: Shell: Poly-pro, 3mm Top-cover: Perforated nora 1/8”, beige Midlayer: 1/16” Blue EVA 35mm durometer Design Feature: N/A Clinical Advantages: The Pro-Runner orthotic is made from a lightweight, yet rigid poly-pro shell and is covered in perforated nora. These features allow it to be strong enough to withstand the pressures of long distance running but still be light enough to not affect performance. The perforated nora top-cover is soft on the foot and allows for moisture and sweat to channel away from the foot. The Pro-Runner orthotic is perfect for elite athletes.
Pro-Golf: Shell: Blue carbon flex, 2mm Top-cover: Mesh 1/8”, blue Midlayer: N/A Design Feature: 1st Ray Cut Out. Clinical Advantages: The Pro-Golf orthotic features a 1st ray cut out, which helps to promote a natural pivot point while turning through the hips. This helps golfers produce turning power and promotes swing speed; keeping you comfortable and helping improve your game.
Pro-Soccer: Shell: Blue carbon flex, 2mm Top-cover: Neoprene 1/8”, black Midlayer: N/A Design Feature: Extra narrow grind on medial side of shell to fit in soccer cleat. Clinical Advantages: The Pro-Soccer orthotic comes with a narrow grind on the medial side of the shell, which helps it fit into narrow soccer cleats. By having an orthotic for soccer cleats, you will increase performance and stability while decreasing the chance of injury. Given its narrow design it may not be transferrable to other types of footwear.
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Pro-Skate: Shell: Blue carbon flex, 2mm Top-cover: Mesh 1/16”, black Midlayer: N/A Design Features: The shell is ground to have a narrow heel and midfoot area as well as a flat heel. Clinical Advantages: The Pro-Skate orthotic is made with a very narrow grind in the heel and through the midfoot. This grind is essential given the narrow design of ice skates. To help ensure a perfect fit, it is advised that the patient include one or both of the skates with the order.
Cross-Trainer: Shell: Co-poly, 2mm Top-cover: Perforated nora 1/16”, blue Midlayer: 1/16” Poron Design Feature: N/A Clinical Advantages: The Cross-Trainer orthotic is designed for the all around athlete. The co-poly shell is rigid enough to provide correction but flexible enough to give relief while weightlifting, running, or playing a sport. The perforated nora top-cover will drain sweat and moisture away from the foot keeping your patients’ feet cool and dry while they are participating in the activities they love.
Marathon: Shell: Poly-pro, 4mm Top-cover: Neoprene 1/8”, black Midlayer: N/A Design Feature: Arch fill, 45mm durometer to sulcus. Clinical Advantage: The Marathon orthotic is designed for runners that put kilometers on their feet. The thick, rigid, 4mm poly-pro shell will provide support and correction that can withstand the punishing forces associated with marathon running. The 1/8” neoprene top-cover is soft and padded to provide comfort to the foot and wick away moisture.
Diabetic: Shell: Black carbon flex, 1mm Top-cover: Mesh 1/8”, blue Midlayer: 1/16” Plastazote Design Feature: Full, soft arch fill from heel to metatarsals with rubber heel caps. Clinical Advantages: The Diabetic orthotic offers a 1mm carbon flex shell to provide support without creating pressure points or “hot spots”. It also comes with a standard soft arch fill to gently reinforce the shell and provide support. Clinicians have the choice of selecting a plastazote top-cover. Plastazote is great for diabetic patients who have very sensitive feet as it is very soft and will not cause a lot of friction.
PF Design: (Plantar Fasciitis) Shell: Co-poly, 2mm Top-cover: Soft vinyl, black Midlayer: 1/16” Poron Design Feature: Full, firm arch fill, 1/16” heel cushion, 20° arch fill under cut, wide intrinsic grind. Clinical Advantages: The PF Design orthotic was created specifically to treat plantar fasciitis. This orthotic comes with a semi-rigid co-poly shell and firm arch fill. The mix of materials and design allows for a cradling effect of the plantar fascia and helps to relieve pain.
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U.C.B.L. : Shell: Subortholene, 2mm Top-cover: Mesh 1/16”, black Midlayer: N/A Design Feature: Ability to provide a very deep heel cup or very high medial and lateral flanges (based on prescription). Clinical Advantages: The U.C.B.L. orthotic can be designed to have drastic flanges and heel cups. This allows you to achieve general support or more severe pronation/supination control all in one shell type. Commonly used in younger patients because of the high degree of motor control.
Youth: Shell: Co-poly, 2mm Top-cover: Puff 1/16”, coloured Midlayer: 1/16” Poron Design Feature: N/A Clinical Advantages: The Youth orthotic combines a firm co-poly shell with a soft foam based top-cover. This ensures correction while the soft top-cover will provide comfort to the foot. The attractive top-cover options allow for the orthotics to look youthful and fun.
Accomodative:
Trilaminate & EVA Shell: Trilaminate (soft or firm) Top-cover: Blue EVA 1/8”, 35mm durometer Midlayer: 1/16” Poron Design Feature: Three layers of foam, varying in density, laminated together. Clinical Advantages: The Trilaminate orthotic offers various combinations of materials, which allows our clinicians to decide on a soft or firm option. This allows you to tailor the degree of support and correction for your patient. This orthotic will provide correction and still offer the proper accommodative properties for your patient’s feet.
Arthritic: Shell: Black carbon flex, 2mm Midlayer: 1/16” Plastazote
Top-cover: Mesh 1/16”, black
Design Feature: If plastazote is the top-cover then a 1/16” poron midlayer will be added. Clinical Advantages: The Arthritic orthotic has a 2mm carbon flex shell and is padded with a plastazote midlayer. This combination of materials gives the orthotic enough support for a patient to achieve correction but will be soft to the touch and gentle on the patient’s feet.
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Orthotic Lengths
F ull Length: Full length top-cover from heel to toes.
Sulcus Length: Top-cover will extend approximately 2.5 inches from the end of the shell. ¾ Length: Top-cover will only extend ¾ of an inch from the end of the shell.
How to Take a Foam Box Impression 1. Have your patient sit down on a stable chair with their knee and foot both flexed at 90 degrees. 2. Slide the foam box under the patient’s foot but ask them not to apply any pressure to it. 3. Place one hand on the medial and lateral malleoli, assuring it is in a neutral position. Make sure to line up the knee with the second toe during this step. 4. Ask the patient to dorsiflex their big toe and hold this position throughout the process. 5. Keeping your hand on the patient’s malleoli place the other hand on the top of their knee and press down. This will force the heel and forefoot into the foam box. 6. Take your hand from the patient’s knee and place it on top of their metatarsals. Asking the patient to keep their big toe in dorsiflexion, press the metatarsals down into the foam. 7. Repeat with the opposite foot and your orthotic impression is complete!
Top-cover Customization: Promote your practice for FREE! Orthotic Energy is happy to screen your clinic’s logo and address on all of your orthotic orders increasing patient retention. Every time your patients look at their orthotic they will remember where they got it and the great service they were provided. In order to get your logo screened on the orthotics we need you to provide us with a copy of your clinic’s logo in a digital format (i.e. JPEG file) and leave the rest to us. It’s a professional touch at no extra cost to you.
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Orthotic Accommodations
Heel Cut Out
Description: A 1” cut out imbedded in the orthotic module under the calcaneal area, covered with 1/8” poron. Clinical Conditions: Used in dress devices to allow the heel to sit deeper in the shoe.
Heel Cushion
Description: A 1/16”, 1/8”, or 1/4” cushion, covering the heel cup portion of the module. Clinical Conditions: Prescribed for patients with plantar fasciitis and for those who require extra rearfoot shock absorption.
Neuroma Pad
Description: A 1/16”, 1/8”, or 1/4” latex strip running vertically. Located on the dorsal surface of the module generally between the 3rd and 4th metatarsal heads, or in the other metatarsal spaces. Clinical Conditions: Treatment of neuroma. Allows for spreading of adjacent metatarsal heads.
Morton’s Extension
Description: A 1/16” firm or soft padded material is placed under the 1st metatarsal phalangeal joint from distal end of the module to distal end of the hallux Clinical Conditions: To slightly immobilize or stabilize the hallux. For patients with a dorsiflexed 1st ray, hallux limitus, or a short metatarsal.
Heel Spur Pad
Description: A 1/16”, 1/8”, or 1/4” horse shoe shaped poron pad, placed inside and around the outer edge of the heel/rearfoot cup of the module. Clinical Conditions: For the treatment of heel spurs. To lift the calcaneus off of the orthotic and relieve pressure at the site of the heel spur.
Well Cut Out
Description: A depression is created by removing a portion of the midlayer and padding of the top-cover. Clinical Conditions: Used to create relief for a protrusion on the foot. The depression created reduces pressure on the protrusion.
Cuboid Pad
1st Ray Cut Out
Clinical Conditions: Pressure relief within the cuboid area, used to force the cuboid dorsally.
Clinical Conditions: Used in hallux limitus/rigidus to prevent subluxation of the 1st MPJ.
Metatarsal Pad
Met Bar
Dancer’s Pad
Clinical Conditions: Treatment of callus deformity as in pes cavus. Can also have a 2-5 metatarsal bar when there is a 1st MPJ pathology.
Clinical Conditions: To relieve pressure on the tibial and/or fibular sesamoids.
Description: A 1/8” poron pad placed under the lateral cuboid portion of the module.
Description: A 1/16”, 1/8”, or 1/4” poron domed pad traditionally placed centrally at the distal edge of the orthotic. The metatarsal pad is designed to lift and spread the metatarsals, re-creating the transverse arch. Clinical Conditions: For treating the calluses, forefoot transverse pathology, Morton’s Neuroma, and plantar flexed metatarsals.
Rearfoot/Forefoot Extrinsic Post
Description: A material added on the underside of the rearfoot/ forefoot module. A rearfoot/ forefoot post is designed to add further correction and rigidity to the orthotics.
Description: The distal-medial edge of the module is removed under the 1st MPJ.
Description: A 1/16”, 1/8”, or 1/4” poron bar running horizontally beneath the metatarsal heads.
Heel Lift
Clinical Conditions: For patients who have anatomic leg length discrepancies or to treat Achilles tendonitis.
Scaphoid Pad
Description: A 1/16”, 1/8”, or 1/4” poron pad added on top of the module in the medial arch area. Clinical Conditions: As an additional cushioning support to the arch and to raise the medial arch slightly higher.
Description: A 1/16”, 1/8”, or 1/4” firm or soft padded material extending from forefoot to sulcus with a cut out under the 1st metatarsal head.
Arch Fill
Description: Material added under the arch. Clinical Conditions: To support the arch for patients weighing over 240lbs.
Clinical Conditions: Used when more rearfoot/ forefoot control (varus/valgus) is required than can be achieved with intrinsic posting.
We are confident that you and your patients will benefit from all of the materials and models that Orthotic Energy offers. If you have any questions feel free to contact us at (416)-444-7060 or 647-426-7777.
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3761 Victoria Park Avenue, Unit 8-9 Toronto, ON M1W 3S2 Tels: 416.444.7060 or 647.426.7777 Toll Free: 1.866.444.7060 Fax: 416.444.6653 Website: www.orthoticenergy.com Email: service@orthoticenergy.com
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