Kevin Orthopedic Clinic Prescribing Guide

Offloading Pads & Cushions E

Forefoot

Dancer’s Pad Dancer’s Pad 6  4.5  3  1.5  (mm)
6mm
Dancer’s pad of Myolite material
4.5mm
FUNCTIONS:
• Offloads sesamoids
• Drops 1st metatarsal head
• 2nd-5th metatarsal head cushioning

CLINICAL INDICATIONS:
• Lesion beneath 1st metatarsal head
• Sesamoiditis
• Rigid plantarflexed 1st ray
• Painful bipartite sesamoid

A dancer’s pad is Myolite padding added
to the superior midfoot and forefoot of the
orthotic. It begins at the midfoot, proximal to
the 1st metatarsal base and distal to the styloid
process, and extends to the distal edge of the
frame, where it continues beneath the 2nd, 3rd,
4th and 5th metatarsal heads, but terminates
proximal to the sesamoids and 1st metatarsal
head. The distal edge of the pad is left
unskived.

 CLINICAL PEARL
A 1st ray cut out modification is also
recommended to accompany this padding if
increased flexibility and less frame interference
with the sesamoids is desired.

3mm

Inferior view Medial view 1.5mm
(transparent) (transparent) 101.

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

E Offloading Pads & Cushions

Midfoot

Cuboid Offloading Pad Cuboid Offload 6  4.5  3  1.5  (mm)

Cuboid offloading pad of Myolite material

FUNCTION: 6mm
• Offloads the cuboid

CLINICAL INDICATIONS:
• Prominent cuboid bone
• Painful cuboid

A cuboid offload is a rectangular-shaped Myolite
padding that is placed on the superior lateral surface
of an orthotic’s frame and sits beneath the distal
calcaneus, proximal to the cuboid.

4.5mm

3mm

Inferior view 1.5mm
(transparent)
Lateral view
102. (transparent)

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

Offloading Pads & Cushions E

Rearfoot

Heel Cushion Pad Heel Cushion 6  4.5  3  1.5  (mm)
6mm
Heel cushion pad of Myolite material

FUNCTIONS:
• Heel cushioning
• Shock absorption

CLINICAL INDICATIONS:
• Plantar fasciitis
• Fat pad atrophy

A heel cushion is a Myolite padding on the superior
surface of an orthotic’s entire heel cup area and
terminates just distal to the calcaneal tubercles. Its
edges extend superiorly up the medial, lateral and
posterior heel cup walls and are skived and blended
along all of its borders. Its padding is thickest where
the plantar calcaneal tuberosity sits.

4.5mm

3mm

Superior view Inferior view Medial view 1.5mm
(transparent) (transparent) 103.

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

E Offloading Pads & Cushions

Rearfoot

Heel Spur Pad Heel Spur Pad 6  4.5  3  1.5  (mm)
6mm
Heel spur pad of Myolite material
4.5mm
FUNCTIONS:
• Offloads plantar calcaneal tuberosity
• Disperses plantar calcaneal pressure
• Shock absorption
• Adds cushion to surrounding inflamed area

CLINICAL INDICATIONS:
• Heel spurs
• Plantar fasciitis

A heel spur pad is a horseshoe-shaped Myolite
padding on the superior surface of an orthotic’s heel
cup area and terminates just distal to the calcaneal
tubercles. It possesses a parabolic wedge cutout
of its padding that borders the plantar calcaneal
tuberosity. Its outer edges are blended into the heel
cup walls, but the inside edges along the parabolic
cutout remains unskived.

3mm

Superior view Inferior view 1.5mm
104. (transparent)
Medial view
(transparent)

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

Offloading Pads & Cushions E

Device Length Cushion

Myolite Layer Myolite Layer 4.5  3  1.5  (mm)
Medial view
Device length Myolite cushion layer (transparent)
inferior of top cover 3mm, to toes

FUNCTIONS: 3mm, to sulcus
• Comfort performance cushioning
• Disperses pressure 3mm, to mets

CLINICAL INDICATIONS:
• Sensitive feet
• Leg length discrepancy
• Anatomy requiring offloading and pressure dispersement

A Myolite layer is a soft cushioning that covers the superior
side of a devices’ heel cup and extends to the device’s
selected length (mets, sulcus or toes). The posterior, medial
and lateral edges of the cushioning are skived and blended
into the trimlines of the frame. This cushioning sits beneath
the top cover and does not come into direct contact with the
patient’s plantar foot.

Plastazote Layer Plastazote Layer 6  4.5  3  1.5  (mm)
Medial view
Device length Plastazote cushion layer (transparent)
inferior of top cover 3mm, to toes

FUNCTIONS: 3mm, to sulcus
• Extra soft cushioning
• Conforms quicky to patient’s foot 3mm, to mets

INDICATIONS:
• Diabetics
• Sensitive feet

A Plastazote layer is an extra soft cushioning that
covers the superior side of a devices’ heel cup and
extends to the device’s selected length (to mets, sulcus
or toes). The posterior, medial and lateral edges of the
cushioning are skived and blended into the trimlines of
the frame. This cushioning sits beneath the top cover
and does not come into direct contact with the patient’s
plantar foot.

Notes: All illustrations and diagrams are of right foot 105.
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications

Forefoot

F

Frame
Modifications

Frame modifications not only customize the
design of the orthotic frame but can alter
coupled components as well.

106.

Frame Modifications F

Forefoot

1st Ray Cut Out 1st Ray Cut Out Full  65°  45° 

Frame resection proximal to Medial oblique
1st metatarsal head view

FUNCTIONS: Superior view Lateral oblique
• Offloads 1st metatarsal head view
• Increases 1st ray joint excursions
45°
CLINICAL INDICATIONS:
• Hallux valgus
• Hallux limitus
• Plantarflexed 1st rays
• Bunion deformities
• Sesamoiditis

A 1st ray cut out is a 45°, 65° or full clipping
of the distal medial portion of the orthotic
frame. The cut’s angulation begins at
the 1st innerspace of the distal frame and
terminates at the medial edge of the frame.
A full 1st ray cut out is a perpendicular cut
at the 1st innerspace, runs parallel along
the medial 1st metatarsal and curves 90°
outwards at the 1st metatarsal base and
terminates at the medial edge of the frame.

65°

Superior view Full
(transparent) 107.

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications 5th Ray Cut Out 65°  45° 
45°
Midfoot

5th Ray Cut Out

Frame resection proximal to
5th metatarsal head

FUNCTIONS:
• Offloads 5th metatarsal head
• Increases 5th ray joint excursions

CLINICAL INDICATIONS:
• Tailor’s bunions
• Abnormal deformities of 5th met head
• Callusing of 5th metatarsal head

A 5th ray cut out is a 45° or 65° clipping of the
distal lateral portion of the orthotic frame. The cut’s
angulation begins at the 4th innerspace of the distal
frame and terminates at the lateral edge of the frame.
This clipping reduces the pressure the frame places
on the 5th metatarsal head

108. 65°

Superior view
(transparent)

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

Frame Modifications F

Midfoot

Navicular Button Out Navicular B. Out 6  4.5  3  1.5  (mm)

Anatomical navicular bone 6mm
accommodation in frame contour 4.5mm

FUNCTION:
• Accommodates navicular

CLINICAL INDICATIONS:
• Navicular pain
• Accessory Navicular: Type I, II & III
• Soft-tissue growth of navicular tuberosity

A navicular button out is a slight to severe depression
made into the superior medial frame of an orthotic
device. This depression makes an accommodation for
the plantar and medial navicular area.

Note: Enlarged Naviculars require frame fillers to
elevate the surrounding areas to balance the boney
prominence and stabilize the device..

 CLINICAL PEARL
Select the depth of button out depression
corresponding to the anatomy of the prominent
navicular bone.

Anterior view 3mm

Medial oblique
view

1.5mm

Lateral oblique Medial view
view (transparent)

Notes: All illustrations and diagrams are of right foot 109.
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications 5th Button Out 6  4.5  3  1.5  (mm)
 CLINICAL PEARL
Midfoot Select the depth of button out depression corresponding
to the anatomy of the prominent navicular bone.
5th Button Out
6mm
Anatomical styloid of 5th metatarsal
accommodation in frame contour 4.5mm

FUNCTION:
• Accommodates styloid

CLINICAL INDICATIONS:
• Relieves styloid pain
• Iselin disease
• Jones fracture
• Dancer’s fracture
• Soft-tissue growth of styloid tuberosity
• Styloid prominence

A 5th button out is a slight depression made into
the superior lateral frame of an orthotic device.
This button out makes an accommodation for a
patient’s plantar and lateral styloid area.
Note: Enlarged 5th met bases require frame fillers
to elevate the surrounding areas to balance the
boney prominence.

Anterior view

3mm

Lateral oblique 1.5mm
view
Lateral view
Superior view (transparent)

110. Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

Frame Modifications F

Rearfoot

Heel Aperture Heel Aperture With Visco Plug  No Plug 

Hole in Frame at the Center of Medial oblique
Heel Cup view

FUNCTIONS: Superior view
• Lowers device height
• Disperses plantar heel tissues pressure Lateral oblique
view
CLINICAL INDICATIONS:
• Heel spurs
• Plantar fasciitis

A heel aperture is a circular cut out in the center
of the heel approximately 2.5-3cm in diameter.
This aperture accommodates more space for
the orthotic and reduces device bulk. This
modification is available with or without a visco
plug, a soft, viscoelastic material that provides
padding and reduces the sensation of a sharp
“drop off” around the aperture’s edge.

Note: A visco plug adds cushioning and maintains
an even elevation from aperture to frame.

No Plug

Superior view Visco Plug
(transparent) 111.

Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications

Rearfoot

Heel Lift Heel Lift 6  4.5  3  1.5  (mm)

Extrinsic elevation of orthotic heel Heel Lift Tapered 26  22  18  14  10  (mm)
inferior of frame and rearfoot posting

FUNCTIONS:  CLINICAL PEARL
• Elevates heel Please keep the patient’s shoe gear in mind when
• Balances leg length discrepancy selecting this modification. A maximum of 3-6mm
for athletic and dress shoes is recommended.
CLINICAL INDICATIONS:
• Leg length discrepancy
• Moderate to severe equinus
• Inflamed plantar fascia
• Achilles Tendonitis
• Plantar Fasciitis

A heel lift is additional rigid to very rigid (65-75 Shore A) EVA 26mm
material added to the inferior heel area of a device’s frame.
When a heel lift’s height is increased above 6mm, the lift will
occupy more space on the device by extending beneath the
frame’s arch where it tapers toward the distal edge.

22mm

6mm

18mm

4.5mm

14mm

3mm

10mm

Medial view

1.5mm

112. Notes: All illustrations and diagrams are of right foot

Colors on illustrations are for visual purposes and will vary on final product

Frame Modifications F

Frame Attributes

Frame Filler Frame Filler Rigid  Semiflexible  

Myolite or EVA reinforcement and shock Rigid - 65 shore A EVA
absorbing layer inferior of frame Semiflexible - 30 shore A EVA

FUNCTIONS:
• increases Orthotic Reaction Forces
• Shock absorption
• Increases midfoot frame rigidity
• Mild control of midtarsal joints

CLINICAL INDICATIONS:
• Strobel or board lasted shoes with
• Generous width in midfoot to allow frame filler

to sit flat and level

Frame filler is flexible, semiflexible or rigid
(15, 30 or 65 Shore A) Myolite or EVA material
added to the inferior medial and lateral arch
area of a device’s frame. On an extrinsic
device, it begins proximally at the device’s
distal rearfoot and extends distally, tapering
to the frame’s distal edge. On an intrinsic
device the frame filler will extend around the
entire heel cup area. This modification creates
a flat inferior surface for the device to sit
level. A filler skive can be modified to further
customize the frame filler.

Myolite - 15 shore A
Medial view

Notes: All illustrations and diagrams are of right foot 113.
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications Filler Skive Max  Med.  Min.  None 

Frame Attributes Inferior view Medial view

Filler Skive max
ORF
Inferior removal of frame filler to
accommodate shoe gear and/or medium
reduce filler function ORF

FUNCTIONS:
• increases arch flexibility
• Helps with proper and congruent fitting into

shoes with arch contour

CLINICAL INDICATIONS:
• Shoes with arch support
• Active patients requiring frame filler

A filler skive is the removal of the frame filler that
sits beneath the device’s medial arch. The removal
of frame filler begins medially at the inferior distal
rearfoot and extends distally in a circular curvature,
terminating proximal to the medial distal edge of
the frame. The apex of the circular shape does not
pass the device’s sagittal plane and imitates the
negative space of a patient’s plantar arch area.

Max skive bisects the 3rd metatarsal shaft
Medium skive bisects the 2nd metatarsal shaft
Minimum skive bisects the 1st metatarsal shaft

minimum
ORF

none
ORF

114. Notes: All illustrations and diagrams are of right foot

Colors on illustrations are for visual purposes and will vary on final product
ORF = Orthotic Reaction Force

Frame Modifications F

Frame Attributes

Heel Cup Depth Heel Cup Depth 30  24  18  12  6  0  (mm)

Measure of heel cup height from Medial view
plantar heel of positive model to
top of frame heel cup 30mm

FUNCTIONS: Most Deep
• Rearfoot stabilization and control
• Reduces lateral shearing
• Helps keep fat pad concentrated beneath

calcaneus

CLINICAL INDICATIONS: 24mm
• Orthopedic pathology
• Heel stabilization is beneficial in nearly all

applications

The heel cup is the curved rearfoot area of a Very Deep 18mm
device’s frame that encompasses a patient’s Deep 12mm
plantar calcaneus. The depth of a heel cup 6mm
refers to the superior height of its posterior, Standard
medial and lateral edges. Deep heel cups Shallow
range from 18-30mm in height, 12mm is the
standard heel cup height, 6mm is a shallow
heel cup depth.

No heel cup is when no curvature appears in
the rearfoot area of a device’s frame and its
posterior, medial and lateral edges possess no
superior height. However, the arch contour is
still maintained in this instance.

Note: Heel cup depths are scalable to the
patient’s foot size. The larger the foot, the
deeper the heel cup. Diagram measurements
and depth distinctions are based on a US
men’s size 10 and US women’s size 8 shoe, but
individual order may vary relative to standard
deviations in patient’s shoe and foot size.

 CLINICAL PEARL
Please consider the volume of patient
shoe gear when specifying heel cup depth.
Shallower depths are ideal for low volume,
dress shoes. Deep depths require more space.

no heel
cup

Flat Cup

Notes: All illustrations and diagrams are of right foot 115.
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications

Frame Attributes

Width of Frame Width of Frame Wide  Standard  Narrow 

Overall width of orthotic frame to
accommodate various shoe gear

FUNCTION:
• Proper fit and coupling with shoe gear

CLINICAL INDICATIONS FOR WIDE WIDTH: Wide frame
• Increased stabilization and control
• Dispersed orthotic pressure across a greater area

CLINICAL INDICATION FOR STANDARD WIDTH:
• Normal stabilization and control

CLINICAL INDICATIONS FOR NARROW WIDTH: Standard frame
• Reduced stabilization and control Narrow frame
• Fits narrow shoes
• Focused orthotic pressure among smaller area

Wide frame

A wide frame refers to the width of the distal edge of an
orthotic’s frame. When the medial trimline of the device is
extended linearly past the device’s distal frame, it reaches
the medial side of the tibial sesamoid. When the lateral
trimline is extended linearly past the device’s distal frame,
the lateral trim line would reach the lateral side of the 5th
metatarsal head.

Standard frame

A standard frame refers to the width of the distal edge of
an orthotic’s frame. When the medial trimline of the device
is extended linearly past the device’s distal frame, it bisects
the tibial sesamoid. When the lateral trimline is extended
linearly past the device’s distal frame, the lateral trimline
bisects the 5th metatarsal head.

Narrow frame

A narrow frame refers to the width of the distal edge of an
orthotic’s frame. When the medial trimline of the device is
extended linearly past the device’s distal frame, it bisects
the fibular sesamoid. When the lateral trimline is extended
linearly past the device’s distal frame, the lateral trimline
borders the medial side of the 5th metatarsal head.

Note: Narrow frames are not recommended with deeper
heel cups.

Inferior view

116. Notes: All illustrations and diagrams are of right foot

Colors on illustrations are for visual purposes and will vary on final product

Frame Modifications F

Frame Attributes

Device Undercut Device Undercut 30°  20°  15°  10°  0° 

Vertical angle of lateral and medial 0˚
aspects of orthotic frame filler and
extrinsic forefoot and rearfoot Wide lasted
postings shoes

FUNCTION: 10˚
• Reduces rearfoot bulk to fit in slip, strobel
15˚
or board lasted shoes

CLINICAL INDICATIONS FOR 0˚, 10˚
• Wide lasted shoes
• Increased stability and control
• Increased orthotic reaction force

CLINICAL INDICATIONS FOR 15˚, 20˚, 30˚
• Narrow strobel lasted shoes
• Slip lasted shoes

A device undercut is a superior to inferior
angled cut on any extrinsic posting or frame
filler. The cut begins at the posterior heel cup
and extends distally along both the medial
and lateral sides. The undercut will extend to
the distal edge of the frame filler or extrinsic
forefoot posting if present.

Note: If no undercut is selected, the device
will receive the lab standard 10° undercut.

Narrow lasted 20˚
shoes

30˚

Posterior view

Notes: All illustrations and diagrams are of right foot 117.
Colors on illustrations are for visual purposes and will vary on final product

F Frame Modifications

Frame Attributes

Detached Carbon Detached Carbon Foot Plate to Toes Rigid  Semi-rigid 
Foot Plate to Toes

Independent of orthotic device, carbon material
extending the full length of foot model: heel to toes

FUNCTIONS:
• Immobilizes forefoot
• Reduces forefoot stress

CLINICAL INDICATIONS:
• Turf toe
• Hallux limitus
• Hallux rigidus
• Metatarsalgia
• Plantar plate injuries
• Arthritis

The detached carbon foot plate to toes is a Superior view
1-2mm thick solid piece of carbon material (transparent)
that extends from the heel and terminates
just proximal to the end of the toes. This
modification sits under the orthotic device
between the shoe and orthotic.

Plate fabricated to fit Lateral view
patient’s foot
Oblique lateral view
118.
Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

Frame Modifications F

Frame Attributes

Detached Carbon 119.
Foot Plate to Toes

Active Lifestyle

Complete
Orthotic Line

Details at www.kevinorthopedic.com

120.

Active Lifestyle

Complete orthotic line - details at www.kevinorthopedic.com

A1 - Pro Sport A2 - Carbon Sport A3 - Classic Sport
Details on page 29 Details on page 31

A4 - Subo-Flex A5 - Supporter A6 - Cork & Leather
Details on page 32

A7 - Pro EVA A8 - DAS A9 - Coleman
Details on page 30

A10 - Easy Flex A11 - Cushion Plus A12 - Unit
121.

Dress

Complete orthotic line - details at www.kevinorthopedic.com

L1 - Fashion L2 - Princess L3 - Ultra Slim
Details on page 37 Details on page 34

L4 - Subo-Flex LP L5 - Supporter LP L6 - Perseus
Details on page 36

L7 - Cobra L8 - DAS LP L9 - Coleman LP
Details on page 35

122.

UCBL

Complete orthotic line - details at www.kevinorthopedic.com

T4 - UCBL T5 - Modified UCBL T6 - Pediatric UCBL T9 - EVA UCBL
Details on page 38 Details on page 41 Details on page 40 Details on page 39

Therapeutic

T1 - Care Soft T2 - Care Firm T3 - Premium Diabetic T7 - Diabetic Inserts
Details on page 43 Details on page 42 Details on page 45 Details on page 44

123.

Sport Specific

Complete orthotic line - details at www.kevinorthopedic.com

S1 - Ski S2 - Ski Pro S3 - Snowboard

S4 - Basketball S4.5 - Equipe Basketball S5 - Football

S5.5 - Lineman S6 - Baseball S7 - Soccer

S8 - Jogging S9 - Marathoner S10 - Volleyball
124.

Sport Specific

Complete orthotic line - details at www.kevinorthopedic.com

S11 - Tennis S12 - Water S13 - Skateboard

S14 - Track & Field S15 - Golf S16 - Road Cycling

S17 - Mountain Biking S18 - Trail Running S19 - Figure Skating

S20 - Ice/Roller Hockey S21 - Hunting & Fishing S22 - Hiker
125.

Pathology Designed

Complete orthotic line - details at www.kevinorthopedic.com

P1 - Achilles P2 - Adult Acquired P3 - Lateral Ankle
Tendinopathy Flatfoot Instability

P4- Hallux Limitus P5 - Hallux Rigidus P6 - Heel Spurs

P7 - Intoeing Gait P8 - Metatarsalgia P9 - Neuroma

P10 - Pediatric P11 - Pes Cavus P12 - Pes Planus
Flatfoot

P13- Plantar Fasciitis P14 - Sesamoiditis
126.

Military

Complete orthotic line - details at www.kevinorthopedic.com

M1 - Field M2 - Garrison M3 - Leisure

127.

Kevin Orthopedic has received feedback from
partnering clinicians to develop a prescribing guide
and ordering experience that allows the clinician
to provide the highest quality custom foot orthotic
outcomes for patients. This essential guide is for
the community of clinicians [podiatrists, orthopedic
surgeons, physiotherapists, physical therapists,
orthotists, pedorthists, chiropractors, osteopathic
physicians, biomechanists] whose mission and ambition
is improving life performance for patients. This
book reviews essential information with descriptive
illustrations covering: clinical foot impression methods,
laboratory frame fabrication methods, orthotic devices,
orthotic materials, pronation corrections, supination
corrections, orthotic extensions, offloading pads &
cushions and orthotic frame modifications.

Author and Illustrations: Kevin B. Rosenbloom
Design: Tomislav Leopold
Photography: Tomo Saito
Publisher: Kevin Orthopedic, Santa Monica, California
Printed in: The United States of America, 2019

tel. 1-877-767-3338
www.kevinorthopedic.com
[email protected]