There are three main differences.
- Production Method:
- A vacuum-formed device is a ProLab exclusive technique which results in the polypropylene being precisely formed over the positive. The mold can be either a wood positive or a plaster positive mold. This vacuum-forming method ensures an exacting fit, long life, and allows the widest variety of orthotic modifications.
- The milled method produces a custom orthotic device without creating a physical positive mold. We individually scan, correct, and store the image of each cast in our CAD/CAM system. The orthoses are then milled directly from polypropylene based on the individually-corrected “virtual mold”. This production method allows us to offer fully corrected custom orthoses at a value price.
- Rigidity or thickness: For the same thickness of polypropylene, a milled orthosis will be more rigid than a vacuum-formed orthosis allowing you to prescribe a thinner device when using a milled orthosis. Practitioners can indicate the desired rigidity and the patient’s weight on the prescription form and we will select the appropriate thickness to provide the correct rigidity.
- Available options: There are a few modifications that can only be accomplished with the vacuum-formed method: sweet spot, plantar facial groove, EVA rearfoot post, Blake inversion, extra high medial flange.
The advantage of graphite orthoses is that they are very thin and fit into dress shoes as well as low-volume footwear used for cycling, soccer, skating and skiing. Unlike traditional graphite, the new ProLab graphite provides strength and variable rigidity required for high-performance activities and is easy to adjust in your office. We recommend using graphite in shallower or narrower shoes.
Several prescription items can increase orthotic thickness: shell choice, patient weight, rearfoot posts, and additions such as metatarsal bars and forefoot extension. Graphite is the thinnest shell material; however it is not always the most appropriate choice. Polypropylene thickness varies based on flexibility and patient weight (refer to Rx chart ). Additional layers of cushioning added to the orthosis cover also increases the overall thickness of the device.
No. Several studies have demonstrated that foam box impressions capture excessive forefoot varus relative to non-weightbearing impressions. This leads to excessive varus in the orthosis, and excessive varus in the orthosis can exacerbate certain pathologies, such as functional hallux limitus. For this reason, we require a non-weightbearing, neutral suspension casting technique for functional orthoses. More information is provided in our casting resource guide.
ProLab stores digital images of your patient’s feet for at least seven years. Although there are no hard and fast rules, we recommend recasting after 5 – 7 years or anytime that there has been a change in the foot. Always recast after surgery or significant trauma.
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2021 Shoe List
Get this free list of shoes that work well with custom orthoses. Use as an office reference or share with patients. These shoes have been evaluated by our DPM Medical Consultants.