We have currently three order forms:

• We have one standard premium orthoses order form.
• One Richie brace custom made AFO order form.
• One new specialised custom made orthoses order form. (Diabetic & RA)

All our order forms are available in digital pdf format, click the button below to access.  The video above sees Martin and Sarah discuss the standard device form. We advise you download the form as a point of reference while watching the video.

 

Each order form is designed to simplify the process of designing chosen patient specific custom made foot orthoses.

Premium Standard Orthoses form. 

The order form comprises of one front side only while the back allows you to capture observations and measurements that you may wish to share with the lab. 

On the front side the format is broken down into a row at the top with three columns below.

 

TOP ROW OF THE FIREFLY FORM

The top row passes on details regarding your patient, your clinic, the date and possibly previous order details pertaining to the same patient. 

It is essential that you clearly write the patients full name preferably in block letters. Please also provide your specific clinic identity as many podiatrists practice from multiple sites. 

It is imperative to provide body weight to determine shell stiffness and therefore anticipate material deformation characteristics. i.e. Each material has a shell matrix indicating at what shell thickness it is semi-flexible, semi rigid or rigid.  See shell matrix.

We also require shoe size to firstly determine reasonably accurate full length and sulcus length top covers. Please bear in mind that the toe box shape is standardised by us unless you provide an accurate shoe template. Please be mindful that you will have to trim extensions regularly to fit certain toe boxes. We often make full length devices marginally larger allowing accurate fit by trimming with scissors at the forefoot only.  

Secondly, lab technicians do not know the anatomy of the foot in a detailed manner and are taught to finish extrinsic support posts by shoe size to correspond with talo navicular and sustentaculum tali anatomy. 

So let’s summarise top row to highlight absolute essentials. 

• Date.
• Patients name, body weight and shoe size.
• Your name and clinic address.
• Previous order number if applicable. 
• RUSH service if required. 

  

LEFT COLUMN

Now let’s look at the first column on the left hand side of the order form. This column classifies our products into different categories and corresponds with detailed descriptions in our catalogue and online. It’s worth having the catalogue open at the corresponding categories to get an accurate understanding of each product description and optional shell choices.  

There are five categories, standard, dress, sport, moulds and specialised. Each of these categories has a number of products with specific lab descriptions. 

NB: when you see an option for direct milled this indicates that the shell is milled directly from white, clear, or black polypropylene or black Delrin (polypropylene & nylon). This creates a unitised extrinsic heel component producing a robust product. (Osirusoft CAD CAM)

All other shells are vacuum formed onto a milled MDF block of the corrected foot position as requested by your prescription. (Sharp Shape & manual manufacturing) 

NB. It’s useful to know and understand that a standard functional device has a heel height of 14mm and normal width shell grind while a standard sport has an 18mm heel cup and sport shell grind. 

The deeper the heel cup automatically creates a wider shell. This creates greater interaction between the foot and the orthoses altering the forces at the foot orthosis interface greater than with a standard or dress device. Hence product descriptions are important. 

If you select a product in this left hand column we will provide you with the identical description as outlined in the catalogue. This is relatively straight forward.

At the bottom of the first column is a section allowing special instructions to be included that our non standard. ie 50% met pad request. 

 

MIDDLE COLUMN

The middle column on the order form allows you to specify certain optional changes. In a sense go a la carte rather than set menu. 

The first option involves choosing a different shell material than that specified in the lab description. For example, standard functional, dress and sport devices can vary from white polypropylene and can be black polypropylene, carbon fiber TL 2100, performance PRX, carbon plastic XT sprint or direct milled Delrin. (polypropylene & nylon

You may choose a shell based on its deformation characteristics in various planes of motion or simply for fit and function characteristics. ie Delrin & TL2100 are thin strong shells suitable for dress footwear.  

The shell rigidity is normally semi rigid as lab standard and you can vary this on request. Some podiatrists prefer greater flexibility and some greater rigidity. It depends on your treatment objective. Do you want to enhance movement or limit it. 

Infills can be ordered here in EVA, Poron and cork. These fill the underside of the orthosis making the shell stiffer and imparting greater shock attenuation. We recommend combining with a side cut and under cut to make the device neater to fit in footwear. 

Forefoot extensions begin at the distal end of the dorsal aspect of the shell and extend to the sulcus or toes. Options and combinations exist as per form. 

The same applies to top covers although top covers do start at the heel counter and cover the entire shell extending to selected option of mets, sulcus or toes finish. 

Bottom cover options are available. 

NB We are open to creating your own bespoke selections and combinations that may not be highlighted on the form. Create your own bespoke version!

 

RIGHT COLUMN 

The right hand column on the order form is where you create your prescription, shell modifications plus additions and extensions. 

We balance all casts, impressions and 3D scans to calcaneal vertical unless you chose neutral as they sit. 

Bear in mind that balancing the cast to calcaneal vertical at the rearfoot and intrinsically correcting the forefoot to vertical will alter moments of force and may be all that is required. 

We recommend using neutral as they sit only when you are happy that the anatomy position captured is the position you wish to apply posting from or none at all.  

We then apply the postings as chosen by you. 

There is an option for lab intervention and we require as much information as possible to provide accurate technical support. This includes information on the back of the form plus special instructions on the row at the bottom of the form. We can view photos and video content if sent to us assisting in the process. 

NB Absolute essentials. 

• Diagnosis
• Goal of orthotic therapy
• Type of footwear for orthotic therapy
• Foot type and foot & ankle mechanics profile
• Activity / sport

In the posting and shell modification section we must use critical thinking to alter moments of force by traditional varus/valgus postings and shell design. It is imperative to understand how we apply these to the anatomy position captured and how we balance the cast. 

Think about what you want the foot to do and design your foot orthoses with this and footwear in mind.  

How do we create supination and pronation moments of force?

Let’s start with the rearfoot as we recommend balancing the forefoot to vertical on all occasions except when a true forefoot varus and severe pes cavus is present (severe forefoot valgus). 

The laser scanner can accurately measure for example the forefoot supinatus angle (correctable varus position) and allow us to accurately correct all met heads to vertical and hence the recommended Forefoot balanced intrinsically to vertical. 

Let’s say you ordered a 4 degree intrinsic forefoot post and the angle is actually 6. We will now only correct the 4 degrees as you requested. That’s why we prefer to recommend balance whatever the angle is to vertical.

BTW when these conditions are present here are the recommendations Re: forefoot posting. There’s lots we can do at the rearfoot and within shell design to help too. 

True forefoot varus, a fixed osseous varus deformity of the forefoot. In this instance you need to bring the ground to the foot (supination moment of force) by adding a varus extrinsic to sulcus post in 3 or 5 degrees depending on footwear. 3 degrees for std footwear, 5 degrees for boots etc. 

NB Extrinsic to sulcus as the post then acts across the MTPJs to the sulcus. 

Severe pes cavus, lateral unstable ankle. In this instance you need to create a pronation moment of force and we recommend a valgus extrinsic to sulcus post in 3 or 5 degrees as per footwear choice above. 

Ok, back to creating supination or pronation moments of force via traditional posting methods.

Rearfoot varus or valgus post. 

A varus post creates a supination moment of force while a valgus post creates a pronation moment of force. 

Methods of application because there are several options! 

Vacuum formed devices. (Sharp Shape software and manual manufacture) 

We add varus or valgus postings to the rearfoot by creating bi axial heel sectioning and rotating the heel in varus or valgus by the amount of degrees chosen without altering the plantar plane of the forefoot. Not a lot of people know this! The heel rotation is therefore in the shell and the EVA most commonly added to the underside is known as a support post. In other words it is flat and not angled like many other labs do and ultimately alter the forefoot plane of the device. Therefore the device sits flush with the table top or base of the shoe. Therefore its intrinsic with a support post in EVA and referred to as an extrinsic post. Hence a degree of confusion when using different labs  and different order forms. 

If you add “with motion” sometimes referred to as “grindoff” this is achieved by angling the EVA and therefore creating a rocking effect in the device from heel to forefoot. These concepts promote normal pronation, whatever that is and it depends on your school of podiatry and frame of references as to preferences. We don’t typically recommend this as we know foot orthoses bed into shoes and don’t rock anywhere! Unlike Biffy Clyro! They rock wherever they are.

If a device is returned to our lab for additional rearfoot varus or valgus posting it means we must add external EVA and angle it accordingly. Essentially we are creating “motion” in the device. Let’s say we add 3 degrees varus to the rearfoot. It means the forefoot aspect of the shell at the 1st MTP joint will be elevated. If we add valgus it would be advisable to add a 1st met or ray cut out to allow the shell to create movement medially at the 1st MTP joint. Make sense? 

There are two additional ways of adding supination moments of force.  

Firstly INVERT the entire anatomy by a requested number of degrees from calcaneal vertical or neutral. In this instance you will create a significant supination moment of force along the entire medial side of the foot. We did experiment with this for conditions such as adult acquired flat foot, however periodically you will get medial column irritation. We prefer to use a Richie brace as gold standard treatment or our adult acquired flat foot orthoses.

Secondly, add a Kirby skive which can be applied medially to create a supination moment of force and laterally to create a pronation moment of force. In this cast modification, the request is made in mm and heel cup height must be taken into account. For example, in dress devices, the max Kirby skive is 2mm due to low heel cup height of 12mm. In a sport device with 18mm heel cup height we can add higher Kirby skives of 4-6mm. 

How does it work? The skive is a modification to the positive cast whereby a depth of plaster in mm is removed under the sustentaculum tali medially or lateral heel. When the shell material is vacuum formed to the positive it is now closer to the soft tissue by the number of mm and hence creates a greater supination or pronation moment of force. This can be achieved in cad cam for the direct milled devices. 

 

Cast dressing

This is essentially a plaster or CAD CAM modification to allow for tissue spread and varies depending on method of anatomy capture. We need to adjust this based on the method of capturing foot anatomy and your cast dressing choice. 

Cast dressing is applied based on foot size and body weight. We apply less cast dressing on a semi weight bearing foam impression compared to a neutral negative plaster of Paris impression as there is a degree of soft tissue spread captured using a foam impression. 

You can also choose five different types of cast dressing and once more think about how you might use cast dressing to alter moments of force. 

• Skin: tight fit of the orthotic shell to patients anatomy. Typically 0 dressing
• Type one: 1-2 mm
• Minimum: 2-3 mm
• Moderate: 3-4 mm
• Maximum: 5-6 mm taking the orthotic shell further away from the anatomy. 

Our lab standard is minimum. 

We occasionally use two cast dressings in one order. Think critically! Let’s assume we have a severe pes cavus and we want to impart a pronation moment of force using cast dressing. 

We can opt for a type 1 cast dressing laterally and a max cast dressing at the MLA. This creates a tight fitting device to anatomy laterally at the foot orthoses interface maximising a pronation moment of force while allowing the foot medial space with the max cast dressing. We must be mindful that with a high MLA in pes cavus it’s quite possible to supinate the foot further by MLA contact. 

Shell modifications

These can be used with postings to create the geometry/ shape that alters moments of force as per your discretion.  

In this section most items are self explanatory and once more we urge you to think critically. For example a lateral flange will create a pronation moment of force while a medial flange creates the opposite supination moment of force. We can also make a 50 % flange if requested in special instructions. In vacuum formed devices the flanges tend to create width as well as height. Therefore think about footwear fitting issues. On direct milled devices the flanges create height respectively at medial or lateral aspect. 

In vacuum formed devices the higher the heel cup the wider the shell. This too will alter the interface between the foot and the orthotic shell changing moments of force. 

Additions & Extensions

We have included some of our more common additions and extensions and more are available in our catalogue and online. These are hand made for custom fit and allow you to offload and provide palliative shock attenuation where needed. Combinations can work particularly well for certain pathologies and our technical support department can advise on the options. 

For example: If your diagnosis is 2nd MTPJ synovitis complicated by a pes plano vagus foot type and hallux valgus and you have elected for conservative custom made orthotic treatment as a first phase you will want to improve the mechanics of the foot in terms of an accurate fitting shell creating supination moments of force and off loading of the 2nd MTPJ. We can achieve this with accurate shell fit to foot combined with a metatarsal pad and lesions accommodation for 2nd MTPJ. We can also fill the lesion accommodation with memory poron to enhance cushioning under the 2nd MTPJ. 

NB a lesion accommodation is made in cork and resembles a PMP with a cut out to off load a MTPJ.