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Oct 4

Written by: Larry Huppin, DPM
10/4/2010 5:04 PM

There is really only one reason to send a negative cast to a laboratory that has a "C" shaped lateral border – for a patient with metatarsus adductus deformity. 

Casts occasionally arrive at the lab that are obviously not met adductus cases, but the lateral border of the cast is still "C" shaped with the forefoot adducted on the rear foot (like the cast on the left).  This error of casting results from the doctor not fully pronating the midtarsal joint around the oblique axis. This can result in an orthotic that is uncomfortable deep in the medial arch.

When we see these casts we call the doctor to let them know the patient must be recasted.

It is best to avoid this error by dorsiflexing the foot sufficiently during casting so that all the motion of the midtarsal joint is used up (pronated) and the ankle joint starts to come to its end of dorsiflexion. Careful…if you dorsiflex too far, the subtalar joint will start to pronate also!

This simple effort will significantly improve the comfort of your orthotics as well as allow us to make you a far more effective orthotic for your patients.

ProLab has a video demonstrating this casting technique and how to evaluate your negative cast. It is available to view here.

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