“What I just did to you…do to them!”

I remember it like it was yesterday. The words of my boss as he had just finished explaining neutral position plaster casting to me while he was casting my own feet.
As I sat on the table, still shaken from the experience of having my boss touch my feet…the fear started to well up like tidal wave. I turned around and saw about 15–20 co-workers lined up to have their feet casted. Ignoring the silly grins on some of their faces, I dove in.

You see, up to this point I had been learning just how important the cast is in the orthotic making process. If the cast is off, the orthotic is off. In my position at this orthotic lab I was evaluating hundreds of casts per day. I had seen my share of bad casts.
No doubt that some of you have felt that initial trepidation when casting your first patients.

Keep reading and see why I think this is one of the best ways to capture a model of the foot for making orthotics.

How is it done?

This mode of casting is when you use plaster strips to wrap around the foot as the foot is held in neutral. As it is drying the foot is “loaded” by a slight dorsiflexory pressure from the bottom of the fourth and fifth met heads. This helps avoid an equinus position in the cast. As the dorsiflexory pressure is applied, a slight abductory pressure is added at the same time. This assures that the soft tissue in the foot stays elongated and the foot does not supinate while the plaster is drying. This is especially important when casting the patient in a supine position. Casting this way involves much more skill. If a practitioner can practice it enough to do it well, he or she will get a much more consistent orthotic from the craftsman or manufacurer.

Pros & Cons

This method takes more time and involves more preparation and clean up.However, forefoot to rearfoot relationships are captured accurately this way. These relationships are crucial to the making of a functional orthotic.If you were to cast a patient this way 10 times in a row, you would see a consistent arch height among the different casts.
The cast can be checked immediately to the foot as it is removed. For instance, if you measured a 10 degree forefoot varus on the foot, you can hold the cast next to the foot to see if the forefoot on the cast is inverted the same amount.

The Key to Accuracy

Plaster casting depends heavily on the skill of the orthotic craftsman. The estimated soft tissue splay in weight bearing must be applied to the cast in the fabrication process. Imagine that your patient is standing on a glass table and you can see the plantar surface of the foot. You would see the areas of soft tissue displacement clearly pressed against the glass. This is what the craftsman is trying to re-create in your cast so that the orthotic is comfortable.

You can provide a weight bearing tracing to help the craftsman. You can also provide helpful pictures and and videos to give a visual of the foot in weight bearing. Written and verbal results of your patient’s evaluation will also help the craftsman be more accurate the the plaster additions to the cast.

Your Future Success

Make an effort to know the name of the Pedorthist who is crafting your orthotics. It is important that you have a relationship with this person if at all possible. Communication between you and the Pedorthist will be the key to your training and development using orthotic applications. Also you will be able to get feedback regarding the quality of your casting.
If you are using a manufacturing lab, ask if you can have the name of the most experienced craftsman. Ask if they might be the assigned to do your devices everytime. Find out if the person would be available to consult with you directly from time to time to make sure that the instructions are clear.

Don’t be afraid to get started. Get some plaster and cast your co-workers (except the guy with the toe fungus.) If you cast at least ten co-workers in one day, you will be pretty confident after that.

View a quick tutorial here:
Dr. Dennis Timko

Do you use this casting method? Why or Why not?

How ugly was the first pair of casts that you made?