1: Formthotics selection and fitting
Select the Formthotics model and size:
- Select from a wide range of foam densities
- Select a shape that suits the shoe
The Formthotics™ shell is custom formed to the shape of the sole of the neutral foot to create total contact foot orthoses. Total contact orthoses provide neuromotor facilitation and mechanical support.
- Carefully trim at the distal end if required
- Fit into the shoe (after removing the shoe liner if present)
- Heat Formthotics in the shoe. This is done by thermoforming (heat moulding) Formthotics to the foot and footwear.
- Fit to the patient - With the Formthotics and shoes fitted and the patient standing, the ideal foot position is approximated by having the anterior knee aligned over the second toe.
2: Patient adjustment period
Allow a 3 to 7 day break-in period for the patient to adapt to Formthotics.
During this time, Formthotics are slightly deformed, in accordance with the individual function and patterns of activity of the patient.
3: Rearfoot modification
The rearfoot is adjusted by functional modification by way of applying a wedge to the underside of Formthotics.
Wedges are used as a means of applying a force to the rear-foot in response to biomechanics or function that has been identified as being as contributor to a patient’s pain or dysfunction.
Most commonly, a medial or varus wedge applied to the rearfoot as a means of managing excessive pronation, will yield the most improvement in alignment, function and supination resistance.
Excessive foot supination can be managed with the application of a lateral or rearfoot valgus wedge.
The improvement in function should be verified by the patient. A heel raise may be used as a rearfoot functional modification.
4: Forefoot modification
The forefoot is adjusted by functional modification.
Wedges are used as a means of applying a force to the forefoot. The depth of insertion and angle of the wedge determine the force that is applied. A wedge is applied under the medial or lateral forefoot of the Formthotics.
Commonly, a lateral (or forefoot valgus) wedge will yield the most improvement in the Windlass Mechanism Test and Forefoot Stability Test.
When adding a forefoot post it is important it has not reduced the function of the windlass mechanism.
The improvement of function should be verified by the patient.
5: In-shoe testing
Check the patient’s stance and gait to assess the functional effects of Formthotics while the patient is wearing them in their shoes.
The technology and structural characteristics of footwear effect foot and leg function. Different shoe structure can alter the functional effect of orthoses. Orthotic therapy may fail if there is conflict between the design of the devices and the structure of the shoe so it is essential that footwear provides an adequate ‘base’ for Formthotics.
Forefoot stability, STAR excursion, single leg balance and knee bend tests can all be repeated with the Formthotics in place. Changes and improvements can be recorded immediately.
6: Follow-up and ongoing adjustment
Formthotics™ should be checked and modified at 3 to 6 month intervals especially in the initial period.
Forefoot stability, STAR excursion, single leg balance and knee bend tests can all be repeated with the Formthotics in place. Further changes and improvements in these tests can be recorded.
The patient's adaptation and functional response to orthotics varies over time and is affected by other therapies employed. Modifications include the addition or reduction of wedges and sometimes, reforming the device.
The end point of therapy occurs when the patient is able to perform their desired daily activities without pain or unacceptable restrictions of mobility.