Kevin Orthopedic Clinic Prescribing Guide

Materials A

Top Cover

Glove Leather  1 (mm)

Natural and breathable genuine leather Creme

FEATURES: Lateral view 1mm
• Durable
• Natural
• Breathable

CLINICAL INDICATIONS:
• Diabetics
• Dress devices

Glove leather is a thin, durable, natural top cover
material that sits on the superior surface of the
orthotic, covering the entire heel cup and extending
to a desired length: mets, sulcus or toes. It is
commonly selected for dress devices because of its
attractive appearance, great flexibility and resistance
to harboring bacteria and odor. However, it is not
recommended for high levels of activity because
it takes longer to dry if a lot of perspiration is
present. As a top covering, glove leather covers any
modifications or additional materials requested and
comes into direct contact with a patient’s plantar foot.

Note: Pairing glove leather with a cushioned layer
(e.g. Myolite) will provide more comfort if desired.

Superior view

Available lengths:

To Mets To Sulcus To Toes

Note: All illustrations and diagrams are of right foot 51.

A Materials  0.6 (mm)

Top Cover Black

Suede Lateral view 0.6mm

Soft, brushed top covering Superior view

FEATURES:
• Soft
• Durable
• Water-resistant
• Thin
• Non-animal product

CLINICAL INDICATIONS:
• Dress devices
• Pediatrics
• Patients who sweat profusely

Suede is an extremely thin, synthetic top cover material
that sits on the superior surface of the orthotic, covering
the entire heel cup and extending to a desired length:
mets, sulcus or toes. The synthetic nature of this material
mimics natural suede’s thinness, flexibility and attractive
appearance but also adds durability, stain protection,
odor resistance, and is more water-resistant than natural
materials. It is commonly selected for dress devices;
however, suede is extremely floppy and does not
provide any cushioning. As a top covering, suede covers
any modifications or additional materials requested and
comes into direct contact with a patient’s plantar foot.

Note: Pairing suede with a cushioned layer (e.g. Myolite)
will provide more comfort if desired.

Available lengths:

To Mets To Sulcus To Toes

52. Note: All illustrations and diagrams are of right foot

Materials A

Top Cover

Plastazote®  3 (mm)

Non-toxic polyethylene foam Pink

FEATURES: 3mm
• Moldable
• Favorable compression set ratio for Superior view

sedentary patients Available lengths:
• Protection against pressure points
• 15 Shore A durometer

CLINICAL INDICATIONS:
• Diabetics
• Patients with sensitive feet

Plastazote® is a thermoplastic polyethylene foam
with a uniquely cross-linked construction that sits
on the superior surface of the orthotic, covering
the entire heel cup and extending to a desired
length: mets, sulcus or toes. According to the
Center for Medicare Services (CMS), it has set the
standard for non-toxic, diabetic linings and insoles.
Plastazote is extremely light, washable, provides
soft cushion, discourages bacterial growth and
has good thermal properties. Plastazote does
damage and compress easily over time. As a top
covering, Plastazote covers any modifications or
additional materials requested and comes into
direct contact with a patient’s plantar foot.

To Mets To Sulcus To Toes
53.
Glue Only Heel of Cover for Place pads precisely
Placing Pads in Clinic in clinic

Precise Metatarsal Balance and Other Pad Placement Finish orthotic by glueing/
adhering top cover in clinic
The Glue Heel Only instruction indicates that the top coverings
will only be glued in the heel cup area and will only extend distally
approximately to the medial proximal arch and across the device
to the lateral calcaneus’ peroneal tubercle.

Note: Because this instruction allows precise placement pads for
clinician staff in-house, special adhesive is required to provide a
finished, durable orthotic.
Kevin Orthopedic recommends: Barge Glue

1 All illustrations and diagrams are of right foot

A Materials  0.6 (mm)

Bottom Cover Black

Suede to Toes

Durable brushed bottom covering With Frame Filler to Toes

FEATURES:
• Protects soft components of orthotic
• Durable
• Water resistant
• Thin
• Non-animal product

CLINICAL INDICATIONS:
• Sedentary to active patients

Suede is an extremely thin, synthetic bottom cover
material that sits on the inferior surface of the orthotic
and extends to a desired length: sulcus or toes.
The synthetic nature of this material mimics natural
suede’s thinness, flexibility and attractive appearance
but also adds durability, stain protection, odor
resistance, and is more water resistant than natural
materials. It is the most common bottom cover
selection on Kevin Orthopedic products because
of its minimal bulk and high durability. It protects
modifications, pads and other coverings. As a bottom
covering, suede covers any forefoot modifications or
additional materials requested.

to Sulcus

Inferior view

54. Note: All illustrations and diagrams are of right foot

Materials A

Bottom Cover

Suede Bottom Wrap  0.6 (mm)

Most durable orthotic protection Black

FEATURES: to Toes, with frame filler
• Protects soft components of orthotic
• Helps reduce squeaky noise within shoe to Mets, no frame filler
• Superior orthotic protection Inferior view
• Durable
• Water resistant to Mets, no frame filler
• Thin
• Non-animal product to Mets, with frame filler
CLINICAL INDICATIONS:
• Sedentary to active patients Medial view
Suede is an extremely thin, synthetic bottom cover
material that covers the entire inferior surface of the 55.
orthotic, encapsulating all the posterior, medial and
lateral surfaces and extending to a desired length:
metatarsals, sulcus or toes. The synthetic nature
of this material mimics natural suede’s thinness,
flexibility and attractive appearance but also adds
durability, stain protection, odor resistance, and
is more water resistant than natural materials. It
protects modifications, pads and other coverings
from moisture and frequent, heavy usage. As a
bottom covering, suede wrap any forefoot, inferior
medial, lateral or posterior materials requested.

Note: All illustrations and diagrams are of right foot

A Materials  0.75 (mm)

Bottom Cover Black

Extension stiffening bottom cover to Toes
Extrinsic Post to Toes
FEATURES:
• Stiffens floppiness with extensions to Sulcus

and top covers Inferior view
• Durable
• Anti-odor Note: All illustrations and diagrams are of right foot
• Anti-bacteria
• Thin
• Water resistant
• Non-animal product
CLINICAL INDICATIONS:
• Dress devices
• Sedentary to active patients
Protex is a thin 0.75mm, synthetic leather-type
bottom cover material that sits on the inferior
surface of the orthotic, covering the inferior
surface to a desired length: mets, sulcus or
toes. It is commonly selected for orthotics that
need stiffer extensions and higher durability. It
is resistant to bacteria and odor. As a bottom
covering, Protex covers any modifications or
additional materials requested.

56.

Materials A

Bottom Cover

Premium polyurethane bottom  1.5  3 (mm)
cover cushioning
Dark Grey
FEATURES: Non-abraded
• Plantar cushioning
• Viscoelastic cushioning Dark Grey
• No compression set Abraded
• Open microcellular foam
• Premium cushioning to Toes with frame filler and intrinsic rearfoot post

CLINICAL INDICATIONS: to Toes with frame filler and extrinsic rearfoot post
• Active patients
• Orthopedic pathology

Myolite is an open microcellular, polyurethane
cushion bottom cover that sits on the inferior
surface of the orthotic, extending to a desired
length: metatarsals, sulcus or toes. It provides
compression resistant viscoelastic cushioning
for patients who desire extra cushion. Frame
filler is required for a Myolite bottom cover. If a
device does not have a frame filler as standard,
but Myolite bottom cover is requested, the
frame filler will be automatically added to the
device.

Note: Myolite is not a durable bottom cover
material and will show wear quickly with
frequent use. It is recommended to apply
suede to protect the material.

Note: All illustrations and diagrams are of right foot dress device to Sulcus with frame filler
Inferior view
57.

A Materials

Frame Guides

Frame Calibration Guide Per Weight

Rigidity is the relative stiffness of the orthotic frame that allows it to resist bending or twisting under
loads of the foot and body.

RIGIDITY
Neutral is the lab standard

Flexible Semiflexible Semi-Rigid Rigid Very-Rigid Most-Rigid

< 120lbs -1 Neutral +1 +2 +3 +4

121 - 170lbs -2 -1 Neutral +1 +2 +3
PATIENT -3 -2 -1 Neutral +1 +2
-4 -3 -2 -1 Neutral +1
171 - 230lbs
WEIGHT

231 - 280lbs

> 281lbs -5 -4 -3 -2 -1 Neutral

Frame Material Rigidity Guide

RIGIDITY OPTIONS

Flexible Semiflexible Semi-Rigid Rigid Very-Rigid Most-Rigid

PolyPro (mm) N/A 2 3 4 5 6

Subo (mm) N/A 2  3  4  5  N/A

FRAME N/A 1.5  2  2.5  3  3 TL 
Carbon (mm)

MATERIAL

TPE (mm) 3  4  N/A N/A N/A N/A

EVA (Shore A) 15  30  45  65  N/A N/A
(frame filler) (Myolite)

 CLINICAL PEARL
The higher the shape of the arch the more rigid the material becomes, e.g. a flat foot shape with 3mm vacuum formed
polypro frame will have a less rigid property than a high arched foot with the same 3mm vacuum formed polypro frame.
Consider selecting a less rigid frame option for cavus feet and more rigid frame for flat feet.

58. Note: All illustrations and diagrams are of right foot

Materials A

Frame Options

Polypropylene PolyPro (mm) 2  3  4  5  6 
6mm
FRAME FABRICATION METHODS ACCEPTED:
Most Rigid
• Plaster positive model vacuum formed
• CAD CAM positive model vacuum formed 5mm
• Redimold positive model vacuum formed
• Direct mill frame Very Rigid

FEATURES: 4mm
• Excellent fatigue resistance
• Elastic rebound characteristics Rigid

(will return to vacuum molded congruency) 3mm
• High stiffness and good tensile strength
Semi-Rigid
CLINICAL INDICATION:
• Active to very active patients 2mm

Polypropylene is a thermoplastic material used for
orthotic frames, that makes up the solid foundation
of the heel cup and the material that extends distally
to proximal of the metatarsal heads. This material is
known for its strength, rebound and toleration for
repeated biomechanical stress, while maintaining
its shape and intimate congruent contours.
Polypropylene has a general lifespan of 2 years, but
depending on the patient’s weight, frequency of use,
frame thickness and contour shape, this time can vary.

Note 1: If no frame thickness is selected, then a
device’s thickness may be subjected to being
calibrated per weight if applicable. If not, a standard
thickness of 3mm may be selected. Please see page
58 for the Frame Calibration Guide Per Weight for
details.

Note 2: Distal edge thickness is depicted for
comparison purposes. The distal edge of all frames
are tapered to an approximated 1mm thickness to
provide comfortable transition off the frame.

 CLINICAL PEARL
Polypropylene is a thermoplastic and will soften each
time it is heated and harden each time its cooled. With
a heat gun, contour can be adjusted in clinic.

Semiflexible

*color depicted is black. Polypropylene
may also come in white

Note: All illustrations and diagrams are of right foot 59.

A Materials Subo (mm) 2  3  4  5 

Frame Options 5mm

Subortholene Very Rigid

FRAME FABRICATION METHODS ACCEPTED: 4mm
• Plaster positive model vacuum formed
• CAD CAM positive model vacuum formed Rigid
• Redimold positive model vacuum formed
3mm
FEATURES:
• High fatigue resistance Semi-Rigid
• Inelastic rebound characteristics
2mm
(deforms easily)
• High stiffness and good tensile strength Semiflexible

CLINICAL INDICATIONS:
• Sedentary to active patients
• Tarsometatarsal pathology
• Geriatric patients
• Arthritis
• Limited joint range of motion

Subortholene is a thermoplastic material that
makes up the solid foundation of the heel cup
and the material that extends distally to proximal
of the metatarsal heads. This material’s molecular
composition differs from polypropylene, making it
easier to thermoform around deep contours and can
be just as rigid as polypropylene if deep heel cups
and flanges are selected. The unique characteristic
of of subortholene, is it’s inelastic rebound and its
ability to deform easily. Subortholene is an ideal
choice when intricate contours, short break-in
periods and flexibility are required.

Note 1: If no frame thickness is selected, then a
device’s thickness may be subjected to being
calibrated per weight if applicable. If not, a standard
thickness of 3mm may be selected. Please see page
58 for the Frame Calibration Guide Per Weight.

Note 2: Distal edge thickness is depicted for
comparison purposes. The distal edge of all frames
is tapered to an approximated 1mm thickness to
provide comfortable transition off the frame.

*color depicted is flesh. Subortholene
may also come in opaque white

60. Note: All illustrations and diagrams are of right foot

Materials A

Frame Options

Carbon Carbon (mm) 1.5  2  2.5  3  3 TL 
3mm TL-2100
FRAME FABRICATION METHODS ACCEPTED:
• Plaster positive model vacuum formed Most Rigid
• CAD CAM positive model vacuum formed
• Redimold positive model vacuum formed 3mm XT

FEATURES: Very Rigid
• High stiffness and good tensile strength
• Thin 2.5mm XT
• Lightweight
Rigid
CLINICAL INDICATION:
• Active patients 2mm XT

Carbon XT is a mixture of high strength Semi-Rigid
carbon fiber and glass composite blended
with polypropylene material used for orthotic 1.5mm XT
frames. It is used to make up the solid
foundation of the heel cup and the material that
extends distally to proximal of the metatarsal
heads. Carbon fiber is used to provide thin,
strong and rigid frames.

The 3mm Carbon TL-2100 is a combination
of carbon fiber, graphite and acrylic based
thermoplastic resin material used for orthotic
frames. This carbon material is known to
provide an extraordinary strength when
compared to other carbon fiber materials while
maintaining its thinness. After extended wear,
the TL-2100 is prone to cracking.

Note 1: If carbon frames are selected, a top
cover is essential to protect the plantar foot
from potential cracks or splintering resulting
from extended use.

Note 2: Distal edge thickness is depicted for
comparison purposes. The distal edge of all
frames are tapered to an approximated 1mm
thickness to provide comfortable transition off
the frame.

Semiflexible

Note: All illustrations and diagrams are of right foot 61.

A Materials TPE (mm) 3 4

Frame Options 4mm Semiflexible
3mm
TPE Flexible
*color depicted is tan. TPE
FRAME FABRICATION METHODS ACCEPTED: may also come in off white
• Plaster positive model vacuum formed
• CAD CAM positive model vacuum formed
• Redimold positive model vacuum formed

FEATURES:
• Rubber-like characteristics
• High fatigue resistance
• Elastic rebound characteristics

(will return to vacuum molded congruency)

CLINICAL INDICATIONS:
• Patient’s who cannot tolerate rigid frames
• Sedentary to active patients

TPE is a thermoplastic elastomer material used for
orthotic frames. It makes up the solid foundation of
the heel cup and the material that extends distally
to proximal of the metatarsal heads. This material
is known for its flexible, viscoelastic property while
maintaining its durability. This material is best applied
to assist patients who cannot tolerate rigid frames.

Note: Distal edge thickness is depicted for
comparison purposes. The distal edge of all frames
are tapered to an approximated 1mm thickness to
provide comfortable transition off the frame.

62. Note: All illustrations and diagrams are of right foot

Materials A

Frame Options

EVA EVA (Shore A) 15  30  45  65 

FRAME FABRICATION METHODS ACCEPTED: 65 Shore A
• Plaster positive model vacuum formed
• CAD CAM positive model vacuum formed Rigid
• Redimold positive model vacuum formed
• Direct mill frame 45 Shore A
Semi-Rigid
FEATURES:
• Low to high compression set (depending on 30 Shore A
Semiflexible
rigidity)
• Excellent shock absorption 15 Shore A Myolite
• Viscoelastic properties Flexible

CLINICAL INDICATIONS:
• Sedentary to active patients

EVA, or ethyl vinyl acetate, is a closed-cell foam
material used for orthotic frames and frame
filler. It makes up the foundation of the heel cup,
the material that extends distally to proximal
of the metatarsal heads and the inferior arch
frame support. This material comes in a variety
of durometers or hardnesses based on Albert
Ferdinand’s Shore A scale. The prescribing
process is simplified based on rigidity scale:

• Myolite is flexible
• 30 EVA is semi-flexible
• 45 EVA is semi-rigid
• 65 EVA is rigid

For EVA vacuum formed frames, a 3-5mm thick
EVA frame is thermo-molded to the positive
model. Frame filler is then added to provide
reinforcement. For direct mill EVA lab processes,
subtractive manufacturing is used to mill out the
contour of the orthotic frame directly from the
block of selected EVA material.

Note: For flexible EVA rigidities (15 Shore A),
Myolite material is used as frame filler.

Note: All illustrations and diagrams are of right foot *color depicted may change between
density of EVA

63.

B Pronation Correction

Varus Forefoot Posts

B

Pronation
Corrections

Pronation corrections change orthotic reaction
forces, compression forces and tensional stress
in tendons and ligaments.

64.

Pronation Corrections B

Varus Forefoot Posts

Balance Forefoot Balance FF to RF 8°  6°  4°  2°  90° 
to Rearfoot
Consistent skeleton
Balance forefoot to rearfoot in an variation in frame
inverted-forefoot foot impression

FUNCTION:
• Increasing medial arch height

CLINICAL INDICATION: 8° ORF (Medial arch)
6° ORF (Medial arch)
• Unbalanced clinical foot impressions with 4° ORF (Medial arch)

forefoot varus

The process of balancing a patient’s forefoot to rearfoot begins with
drawing a line that bisects the posterior distal achilles tendon along
its sagittal plane on the positive foot model. The foot model is then
placed on level surface with the calcaneus, 1st and 5th metatarsal
heads plantigrade. The angle of the bisecting achilles tendon line is
observed. If the bisecting achilles tendon line is everted away from
90 degrees vertical, the 1st metatarsal is elevated within the foot
model, sometimes referred to as a forefoot supinatus. Balancing is
achieved by adding artificial material to the 1st metatarsal effectively
lowering the 1st metatarsal head thus stabilizing and balancing the
forefoot, maintaining a vertical achilles bisection line while the three
points of the plantar calcaneus, 1st metatarsal and 5th metatarsal are
plantigrade. Artificial material (plaster or digital contour) is smoothed
in a tapered fashion from the 1st metatarsal head to proximal base
of the metatarsals. If Perpendicular is selected by the clinician, the
rearfoot (vertical achilles bisection) will be leveled to perpendicular,
and propping and balancing of the forefoot will effectively increase
arch height and orthotic reaction forces. At the practitioner’s
discretion, this technique can be used to alter the contour of a
patient’s arch intrinsically by balancing forefoot to rearfoot at: 2°,
4°, 6° or 8° varus achilles bisection line, thus further propping or
artificially plantar flexing the metatarsal head with artificial material.
This effectively increases the arch height of the foot model and the
congruent orthotic frame.

The pink colored metatarsals depicts the position of 2° ORF (Medial arch)
the inverted metatarsals in an impression or foot model

before a forefoot to rearfoot balancing is achieved.

Posterior view Anterior view 90°
(transparent) (transparent)
Medial view

Notes: All illustrations and diagrams are of right foot 65.
Colors on illustrations are for visual purposes and will vary on final product
ORF = Orthotic Reaction Force

B Pronation Corrections

Varus Forefoot Posts

Varus Extrinsic (Bar) VR Extrinsic (Bar) 6°  4°  2°  0° 

Varus extrinsic forefoot bar post ORF
ORF
FUNCTIONS:
• Inverts the forefoot ORF
• Twists frame into varus ORF

CLINICAL INDICATIONS: ORF 6°
• Pronation Correction ORF 4°
• Hyper-mobile 1st ray 2°
• Overpronation

A varus extrinsic (bar) post is semi-rigid to very rigid (45-75
Shore A) EVA material added to the inferior distal frame. It
begins approximately 2cm proximal to the distal edge on the
medial side and terminates at the distal frame. The extrinsic
bar also decreases in height as it extends beneath the device
to the lateral side of the orthosis. The exact height and amount
of material added is dependent on the desired angulation. A
forefoot extrinsic bar post becomes a ‘tip’ post when it has
an angulation between 0°-2° because the minimal amount of
material used. A tip post doesn’t extend to the lateral side.
Because 2°-6° posts raise the distal medial frame, a “drop
off” will be created. If higher varus correction is desired, this
modification can be paired with intrinsic forefoot posting.

Note: Bar posts are recommended for frames calibrated to
neutral or higher in thickness and not recommended for flexible
or EVA frames.

 CLINICAL PEARL
0° varus forefoot posts can also be applied to prevent orthotic
frame ‘bite’ or cut in the shoe, which reduces the orthotic
effectiveness and shortens shoe life.

Tip post
0°-2°

Anterior view

ORF 0°
ORF
Inferior view bar post
(transparent) Medial view

66. 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

Pronation Corrections B

Varus Forefoot Posts

Varus Metatarsal Wedge VR Met Wedge 6°  4°  2° 

Varus metatarsal head wedge Inferior view
(transparent)
FUNCTIONS:
• Accommodates forefoot varus
• Supports non-plantigrade inverted metatarsal heads

CLINICAL INDICATIONS:
• Rigid forefoot varus
• Forefoot supinatus
• Overpronation throughtout rear-, mid- and forefoot

A varus metatarsal wedge is semiflexible to rigid (35-65 Shore A) EVA
material added to the superior edge of the distal frame where it extends
distally into the forefoot and terminates at the sulcus. Its distal edge
gradually decreases in height as it extends to the lateral side. The height
and amount of material added is dependent on the desired angulation.

Note: This type of extrinsic forefoot post is recommended for angulations
of 2°-6°. It can be coupled with varus intrinsic forefoot posting if higher
varus correction is desired.

6°
6°

ORF

4°
4°

ORF

2° 2°
ORF
Anterior view
(phalanges excluded) Medial view

Notes: All illustrations and diagrams are of right foot 67.
Colors on illustrations are for visual purposes and will vary on final product
ORF = Orthotic Reaction Force

B Pronation Corrections

Midfoot

Raise Medial Arch Raise Med Arch 6  4.5  3  1.5  (mm)

Raise medial longitudinal arch Skeleton illustrations change
to match effected joint
FUNCTION: articulation
• Increases medial orthotic frame height
6mm ORF
CLINICAL INDICATIONS:
• Pronation correction 4.5mm ORF
• Inadequate clinical foot impression

Raising the medial arch is when a frame’s
medial longitudinal arch is elevated
superiorly within the foot model.

Note: This procedure is done in the
modeling process. A positive model will
have material removed to achieve a new,
higher medial arch height.

 CLINICAL PEARL
When patients possess a flexible midfoot
(excellent midfoot joint excursions), this is
a fantastic method for increasing orthotic
reaction forces on the medial longitudinal
arch.

3mm ORF

1.5mm ORF
Medial view

68. 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

Pronation Corrections B

Midfoot

Scaphoid Pad Scaphoid Pad 6  4.5  3  1.5  (mm)

Medial longitudinal arch pad 6mm

FUNCTION: 4.5mm
• Cushions and supports medial longitudinal

arch tissues

CLINICAL INDICATIONS:
• Posterior tibial tendon dysfunction
• Overpronation
• Accessory navicular

A scaphoid pad is a Myolite padding added to the
medial side of the superior frame and runs along
its medial longitudinal arch. The padding begins at
the medial distal rearfoot, terminates just past the
medial 1st metatarsal base and extends laterally in a
curved shape that typically does not pass the lateral
cuneiform, replicating an arch’s negative space.

 CLINICAL PEARL
When patients possess a flexible midfoot (excellent
midfoot joint excursions), this is a fantastic solution
for increasing orthotic reaction forces on the medial
longitudinal arch.

3mm

1.5mm Medial view
69.
Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product

B Pronation Corrections

Midfoot

Varus Cuboid Pad VR Cuboid Pad 6  4.5  3  1.5  (mm)
6mm
Varus cuboid pad
4.5mm
FUNCTION:
• Inverts cuboid

CLINICAL INDICATIONS:
• Everted cuboid
• Cuboid syndrome
• Relieves adjacent joint pain

A varus cuboid pad is a wedge-shaped Myolite
padding that is placed on the superior lateral
surface of an orthotic’s frame and sits beneath the
cuboid, intermediate and lateral cuneiform, and
medial 5th metatarsal base.

 CLINICAL PEARL
1.5 and 3mm thicknesses are the more common
and tolerable options of the varus cuboid pad.

Inferior view 3mm
(transparent)
1.5mm
70. Lateral view

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

Pronation Corrections B

Midfoot

Medial Flange Medial Flange High  Medium  Low 

Medial frame flange Anterior view Posterior view

FUNCTIONS: High (above navicular tuberosity)
• Pronation correction
• Medial stabilization of 1st ray and calcaneus
• Adds rigidity and strength to frame

CLINICAL INDICATIONS:
• Extreme overpronation
• Severe pes planus
• Collapsed talonavicular joint
• Posterior tibial tendonitis

A medial flange is a curved increase in the
height of the frame superiorly on the medial
side of the orthotic. It begins at the medial mid-
calcaneus (distal rearfoot) and extends distally
with the curvature increasing in height to the
apex near the navicular tuberosity, and then
decreasing in height to terminate along the first
metatarsal shaft. The height of the flange can
be modified at the practitioner’s discretion.

Note: This modification adds bulk to a device,
so it is recommended a patient uses proper
shoe gear to accommodate.

Medium (bisect navicular tuberosity)

Low (below navicular tuberosity)

Medial view
(transparent)

Notes: All illustrations and diagrams are of right foot 71.
Colors on illustrations are for visual purposes and will vary on final product

B Pronation Corrections

Varus Rearfoot Post

Varus Intrinsic VR Intrinsic 8°  6°  4°  2°  0° 

Varus intrinsic of frame rearfoot post

FUNCTIONS: Medial view
• Stabilizes everting rearfoot
• Inversion of heel at heel strike
• Increases orthotic reaction force medial to STJ

CLINICAL INDICATIONS: Intrinsic post is small but effective
• Overpronation of subtalar joint
• Dress and low volume shoe gear Devices with standard frame fillers have
intrinsic posts leveled into frame filler at
A varus intrinsic rearfoot posting is a leveled, flat surface on
the inferior heel cup area of a device’s frame. This modification inferior rearfoot
increases the contact area of the device. An angulation can also
be ground into the inferior frame’s rearfoot to achieve a varus
rearfoot posting. The distal medial edge of the orthotic frame will
elevate matching angulation of the rearfoot posting angle.

 CLINICAL PEARL
The angle of the weight-bearing achilles insertion bisection
line relative to the normal force vector line can be used as an
indication to determine the adequate degree of rearfoot posting
to achieve equilibrium around the adjacent lower extremity
structures during ambulation.

The pink colored calcaneus depicts the
position of the everted calcaneus before the

intrinsic post force inverts the calcaneus.

Inferior view

ORF ORF ORF ORF
0° 2° 4° 6° 8°

Posterior view

72. 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

Pronation Corrections B

Varus Rearfoot Post

Varus Extrinsic VR Extrinsic 8°  6°  4°  2°  0° 

Varus extrinsic of frame rearfoot post Inferior view
(transparent)
FUNCTIONS:
• Increased stability Medial view
• Inversion of heel The pink colored calcaneus depicts the
• Stabilizes rearfoot position of the everted calcaneus before the
• Increases orthotic reaction force medial to STJ extrinsic post force inverts the calcaneus.

CLINICAL INDICATIONS:
• Overpronation
• Subtalar joint eversion
• Shoe gear with removable insoles

A varus extrinsic rearfoot post is semi-rigid to rigid EVA (45-75
Shore A) material added to the inferior heel cup area of a device’s
frame and then leveled to create a flat surface. This modification
increases the contact area of the device with the shoe when
compared to an intrinsic rearfoot posting. An angulation can also
be ground into the EVA and frame to achieve a varus rearfoot
posting. The distal medial edge of the orthotic frame will elevate
matching the angulation of the rearfoot posting angle.

Note: Device Undercut adjusts the vertical angles of extrinsic
posts. See page 117 for further information.

 CLINICAL PEARL
The angle of the weight-bearing achilles insertion bisection
line relative to the normal force vector line can be used as
an indication to determine the adequate degree of rearfoot
posting to achieve equilibrium around the adjacent lower
extremity structures during ambulation.

ORF ORF ORF ORF
6° 8°
0° 2° 4°
73.
Posterior view

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

B Pronation Corrections Heel Skive 6  4  2  (mm)

Varus Rearfoot Post The pink colored calcaneus depicts the
position of the everted calcaneus before the
Heel Skive heel skive force inverts the calcaneus.

Plantar heel foot model skive ORF 6mm
medial to subtalar joint axis

FUNCTIONS:
• Increases subtalar joint supinatory torque
• Stabilizes or inverts calcaneus

CLINICAL INDICATION:
• Subtalar joint overpronation

A heel skive is a slope on the superior medial
heel of an orthotic frame and its shape is similar
to an elongated oval. This slope begins from
the medial heel cup and declines laterally to the
foot’s sagittal plane. This creates a varus wedge
effect within the heel cup. The angulation of the
slope is consistent while the depth of the skive
can be chosen on a practitioner’s selection and
its diameter can range from 2-4cm depending
on foot size. This modification is created by
removing material from a positive model or
within the design of a CAD model.

Note: In order for this modification to be
effective, an extrinsic post is required. If no
extrinsic post is paired with this modification,
the rearfoot of the orthotic will be unstable.

ORF 4mm

Medial view ORF 2mm
(transparent)
Posterior view
(transparent)

74. 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

Pronation Correction B

Varus Rearfoot Post

Extrinsic Post

75.

C Supination Correction

Valgus Forefoot Post

C

Supination
Corrections

Supination corrections change orthotic reaction
forces, compression forces and tensional stress
in tendons and ligaments.

76.

Supination Corrections C

Valgus Forefoot Post

Balance Forefoot Balance FF to RF 8°  6°  4°  2°  90° 
to Rearfoot
Consistent skeleton
Balance forefoot to rearfoot in an variation in frame
everted-forefoot foot impression

FUNCTION:
• Slightly increases lateral arch height

CLINICAL INDICATION: ORF (Lateral Arch) 8°
ORF (Lateral Arch) 6°
• Unbalanced clinical foot impressions with ORF (Lateral Arch) 4°

forefoot valgus

The process of balancing a patient’s forefoot to rearfoot begins
with drawing a line that bisects the posterior distal achilles tendon
insertion along its sagittal plane on the positive foot model. The
foot model is then placed on a level surface with the calcaneus, 1st
and 5th metatarsal heads plantigrade. The angle of the bisecting
achilles tendon insertion line is observed. If the bisecting achilles
tendon line is inverted away from 90° vertical, the 5th metatarsal is
elevated within the foot model, sometimes referred to as a forefoot
valgus. Balancing is achieved by adding artificial material beneath 5th
metatarsal effectively lowering the 5th metatarsal head thus stabilizing
and balancing the forefoot, maintaining a vertical achilles bisection
line while the three points of the plantar calcaneus, 1st metatarsal
and 5th metatarsal are plantigrade. Artificial material (plaster or digital
contour) is smoothed in a tapered fashion from the 5th metatarsal
head to proximal base of the metatarsals. If Perpendicular is selected
by the clinician, the rearfoot (vertical achilles bisection) will be leveled
to perpendicular, and propping and balancing of the forefoot will
effectively decrease medial arch height and reduce medial orthotic
reaction forces and increase lateral orthotic reaction forces. At the
practitioner’s discretion, this technique can be used to alter the
contour of a patient’s arch support intrinsically by balancing forefoot
to rearfoot at: 2°, 4°, 6° or 8° valgus achilles tendon insertion bisection
line, thus further lowering medial arch or artificially plantar flexing the
5th metatarsal head with artificial material. This effectively decreases
medial arch height and slightly increases the lateral arch height of the
foot model and the congruent orthotic frame.

The pink colored metatarsals depicts the position of the
everted metatarsals in an impression or foot model before

a forefoot to rearfoot balancing is achieved.

ORF (Lateral Arch) 2°

Posterior view Anterior view Lateral view 90°
(transparent) (transparent, phalanges excluded)
77.
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

C Supination Corrections

Valgus Forefoot Post

Valgus Extrinsic (Bar) VG Extrinsic (Bar) 6°  4°  2°  0° 
6°
Valgus extrinsic forefoot bar post 4°

FUNCTIONS:
• Everts the forefoot
• Twists the frame into valgus

CLINICAL INDICATIONS:
• Supination
• Cavus foot due to rigid first ray

A valgus extrinsic (bar) post is semi-rigid to very rigid (45-75
Shore A) EVA material added to the inferior distal frame. It
begins approximately 2cm proximal from the distal edge on
the lateral side and terminates at the distal frame. The extrinsic
bar also decreases in height as it extends across the device
to the medial side of the orthosis. The height and amount of
material added is dependent on the desired angulation. A
forefoot extrinsic bar post becomes a ‘tip’ post when it has
an angulation between 0°-2° because the minimal amount of
material used. A tip post doesn’t extend to the medial side.
Because 2°-6° posts raise the distal lateral frame, a “drop
off” will be created. If higher valgus correction is desired,
this modification can be paired with valgus intrinsic forefoot
posting.

Note: Bar posts are recommended for frames calibrated
to neutral or higher in thickness and not recommended for
flexible or EVA frames.

 CLINICAL PEARL
0° valgus forefoot posts can also be applied to prevent
orthotic frame ‘bite’ or cut in the shoe, which reduces the
orthotic effectiveness and shortens shoe life.

2°

Tip post
0°-2°

Anterior view

0°

Inferior view Lateral view
(transparent)
Notes: All illustrations and diagrams are of right foot
78. Colors on illustrations are for visual purposes and will vary on final product

Supination Corrections C

Valgus Forefoot Post

Valgus Metatarsal Wedge VG Met Wedge 6°  4°  2° 
6°
Valgus metatarsal head wedge Inferior view
(transparent)
FUNCTIONS:
• Accommodates forefoot valgus ORF
• Supports non-plantigrade everted

metatarsal heads

CLINICAL INDICATIONS:
• Rigid forefoot valgus
• Elevates lateral metatarsal heads
• Oversupination throughout rear-, mid- and

forefoot due to rigid planterflexed 1st ray
• Positive Coleman Block test

A valgus metatarsal wedge is 6°
semiflexible to rigid (35-65 Shore A) EVA
material added to the superior edge
of the distal frame where it extends
distally into the forefoot and terminates
at the sulcus. Its distal edge gradually
decreases in height as it extends to the
medial side. The height and amount
of material added is dependent on the
desired angulation.

 CLINICAL PEARL
This type of extrinsic forefoot post is
recommended for angulations of 2°-6°.
It can be paired with intrinsic forefoot
posting if higher angulation is desired.

4°
4°

ORF

2° 2°

Anterior view ORF
(phalanges excluded)
Lateral view

Notes: All illustrations and diagrams are of right foot 79.
Colors on illustrations are for visual purposes and will vary on final product
ORF = Orthotic Reaction Force

C Supination Corrections

Midfoot

Lower Medial Arch Lower Med Arch 6  4.5  3  1.5  (mm)
Pink foot bones depict the position of the
Lower medial longitudinal arch foot before lowering of the medial arch.

FUNCTIONS: 6mm
• Lowering arch
• Reduces orthotic reaction force in the medial 4.5mm

longitudinal arch

CLINICAL INDICATIONS:
• Oversupination
• Flexible cavus foot type

A lowering of the medial arch is when a frame’s
medial longitudinal arch is lowered inferiorly.

Note: This lab procedure is done within the
positive foot model (plaster or digital CAD)
adding plaster material or lowering the contour
in the CAD model.

3mm

1.5mm
Medial view

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

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

Supination Corrections C

Midfoot

Lateral Flange Lateral Flange High  Medium  Low 

Lateral frame flange Posterior view
Lateral view
FUNCTIONS:
• Prevents foot from sliding off lateral side High

of orthotic
• Helps lateral ankle instability
• Adds rigidity and strength to frame
• Lateral stabilization of 5th ray and calcaneus

CLINICAL INDICATIONS:
• Midfoot supination
• Severe pes planus (when coupled with

pronation corrections)
• Collapsed calcaneocuboid joint

A lateral flange is a curved increase in the height
of the frame superiorly on the lateral side of the
device. It begins at the lateral mid-calcaneus
(distal rearfoot) and extends distally with the
curvature increasing in height to the apex near
the calcaneal peroneal tubercle, then decreasing
in height to terminate just proximal to the styloid.
The height of the flange can be modified at the
practitioner’s discretion.

 CLINICAL PEARL
This modification adds bulk to a device, it is
recommended a patient uses proper shoe gear
to accommodate.

Medium

Low Lateral view
(transparent)
Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product 81.

C Supination Corrections

Midfoot

Valgus Frame Filler VG Frame Filler 6°  4°  2°  0° 
6°
Valgus frame filler - lateral frame filler 4°

FUNCTIONS:
• Lateral stability
• Everts frame at midfoot

CLINICAL INDICATIONS: ORF
• Ankle instability ORF
• Peroneal tendon dysfunctions
• Rigid forefoot valgus
• Lateral pathologies

The valgus frame filler (lateral frame filler) is semi-rigid to
very rigid (45-65 Shore A) EVA material added to the inferior
lateral side of an orthotic frame. It begins at the distal
rearfoot, extends distally through the midfoot and tapers to
the distal edge of the frame, proximal to the lateral metatarsal
heads.

 CLINICAL PEARL
Extrinsic rearfoot posts matching in angulation are
recommended, but not required (e.g., for clinically controlling
an everted subtalar joint and inverted midfoot, a varus
rearfoot post with a valgus frame filler is acceptable. These
modifications will create a “twist” or alternating pressures
along the foot’s sagittal plane when the orthotic reaction
forces interacts with the foot).

ORF 2°

ORF 0°
Lateral view
Inferior view
(transparent) Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product
82.
ORF = Orthotic Reaction Force

Supination Corrections C

Midfoot

Valgus Cuboid Pad VG Cuboid Pad 6  4.5  3  1.5  (mm)

Everting cuboid pad 6mm

FUNCTION:
• Everts cuboid

CLINICAL INDICATIONS:
• Inverting cuboid
• Peroneal pathology

A valgus cuboid pad is a wedge-shaped Myolite
padding that is placed on the superior lateral
surface of an orthotic’s frame and sits beneath the
lateral cuboid and 5th metatarsal base. Its edges
are skived and blended along all of its borders.

4.5mm

3mm

Inferior view Lateral view 1.5mm
(transparent) (transparent) 83.

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

C Supination Corrections

Valgus Rearfoot Post

Valgus Intrinsic VG Intrinsic 8°  6°  4°  2°  0° 

Valgus intrinsic of frame rearfoot post

FUNCTIONS: Lateral view
• Stabilizes inverting rearfoot
• Eversion of heel at heel strike
• Increases orthotic reaction force

lateral to STJ

CLINICAL INDICATIONS:
• Oversupination of subtalar joint
• Dress and low volume shoe gear

A valgus intrinsic rearfoot posting is Inferior view Intrinsic post is minimal but effective
a leveled, flat surface on the inferior
heel cup area of a device’s frame. This Devices with standard frame fillers have
modification increases the contact area intrinsic posts leveled into frame filler at
of the device. An angulation can also be
ground into the inferior frame’s rearfoot inferior rearfoot
to achieve a valgus rearfoot posting. The
distal lateral edge of the orthotic frame The pink colored calcaneus depicts the
will elevate matching the angulation of position of the inverted calcaneus before the
the rearfoot posting angle.
intrinsic post force everts the calcaneus.
 CLINICAL PEARL
The angle of the weight-bearing achilles insertion
bisection line relative to the normal force vector
line can be used as an indication to determine the
adequate degree of rearfoot posting to achieve
equilibrium around the adjacent lower extremity
structures during ambulation.

ORF ORF ORF ORF
2° 4° 6° 8°
0°
Posterior view
84. (transparent)

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

Supination Corrections C

Valgus Rearfoot Post

Valgus Extrinsic VG Extrinsic 8°  6°  4°  2°  0° 

Valgus extrinsic of frame rearfoot post

FUNCTIONS:
• Stabilizes inverting rearfoot
• Eversion of heel at heel strike
• Increases orthotic reaction force lateral to STJ

CLINICAL INDICATIONS: Inferior view
• Oversupination of subtalar joint (transparent)
• Shoe gear with removable insoles
Lateral view
A valgus extrinsic rearfoot post is semi-rigid to very rigid (45-
65 Shore A) EVA material added to the inferior heel cup area The pink colored calcaneus depicts the position
of a device’s frame and then leveled to create a flat surface. of the inverted calcaneus before the extrinsic
This modification increases the contact area of the device post force everts the calcaneus.
with the shoe when compared to an intrinsic rearfoot posting.
An angulation can also be ground into the EVA and frame to
achieve a valgus rearfoot posting. The distal lateral edge of
the orthotic frame will elevate matching the angulation of the
rearfoot posting angle.

Note: Device Undercut adjusts the vertical angles of extrinsic
posts. See page 117 for further information.

 CLINICAL PEARL
The angle of the weight-bearing achilles insertion bisection
line relative to the normal force vector line can be used as
an indication to determine the adequate degree of rearfoot
posting to achieve equilibrium around the adjacent lower
extremity structures during ambulation.

ORF ORF ORF ORF
8°
0° 2° 4° 6°
85.
Posterior view
(transparent)

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

D Extension

Toe Length

D

Extensions

Extensions are materials coupled with the distal end
of the orthotic frame and contribute to increased
performance, comfort and treat pathology.

86.

Extensions D

Toe Length

Toe Extension Toe Extension 4.5  3  1.5  (mm)

Myolite material frame-extension to toes

FUNCTIONS:
• Forefoot cushion
• Metatarsal punch out material

CLINICAL INDICATIONS: Superior view
• Leg length discrepancy
• Sensitive feet
• Accommodations requiring material

A toe extension is a Myolite forefoot 4.5mm 4.5mm
padding that extends from the superior
dorsal edge of the orthotic frame to
approximately 12mm past the toe of
the patient’s foot. The extension is
oversized along with corresponding top
and bottom covers, so the orthotic may
be trimmed down for appropriate size of
patient shoe gear.

Note: If a met head punch is requested,
a forefoot extension is required.

 CLINICAL PEARL
Extensions add bulk and thickness to an
orthotic. Consider topcover thickness
and amount of space available in
shoe gear when selecting extension
thicknesses of 3mm or greater.

3mm 3mm

1.5mm Medial view 1.5mm
Anterior view 87.

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

D Extensions

Toe Length

Morton’s Extension Morton’s Ext. U.skiv  4.5  3  1.5  (mm)

EVA material morton’s frame-extension to toes

FUNCTIONS:
• Immobilizes the 1st MTP joint
• Decreases dorsiflexion force at the 1st MTP joint

and interphalangeal joint

CLINICAL INDICATIONS: Superior view
• Hallux rigidus
• 2nd met head pathology (unskived modification)
• Degenerative joint disease (DJD)
• 1st metatarsophalangeal joint arthritis or trauma

A Morton’s extension is a semi-rigid to very rigid (45-75  CLINICAL PEARL
Shore A) EVA extension that begins at the superior distal The ‘unskived’ request provides an immediate difference
edge of the orthotic frame, terminates just distal to the in elevation between the 1st and 2nd metatarsal heads that
toes and is placed beneath the entire hallux. Its lateral can also effectively treat 2nd metatarsal head pathology.
border does not extend past the 1st interspace, and the
lateral edge can be left unskived upon request.

4.5mm

4.5mm 4.5mm unskived

3mm 3mm unskived 3mm

1.5mm

1.5mm 1.5mm unskived
Anterior view
Medial view

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

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

Extensions D

Toe Length

Reverse Morton’s Rev. Morton’s U.skiv  4.5  3  1.5  (mm)
Extension

Myolite material reverse morton’s
frame-extension to toes

FUNCTIONS: Superior view
• Planterflexes 1st metatarsal head relative to

lesser metatarsal heads
• Increases 1st MTP range of motion
• 2nd-5th metatarsal head and toe cushioning

CLINICAL INDICATIONS:  CLINICAL PEARL
• Functional Hallux Limitus A 1st ray cut out modification is also recommended to
• Sesamoiditis accompany this extension if increased first MTP flexibility
• Rigid plantarflexed 1st ray and less interference with the sesamoids is desired.

A Reverse Morton’s extension is Myolite padding that begins
at the superior distal edge of the orthotic frame, terminates
just distal to the toes, and is placed only beneath the 2nd-5th
metatarsal heads and the corresponding phalanges, but excludes
the hallux. Its medial edge does not extend past the 1st interspace,
and the medial edge can be left unskived upon request.

4.5mm 4.5mm unskived 4.5mm

3mm 3mm unskived 3mm

1.5mm 1.5mm unskived 1.5mm

Anterior view Lateral view

Notes: All illustrations and diagrams are of right foot 89.
Colors on illustrations are for visual purposes and will vary on final product

D Extensions

Toe Length

Dynamic Wedge Dynamic Wedge 3  1.5  (mm)

Myolite material frame-extension to sulcus coupled
with EVA material dorsiflexion hallux wedge

FUNCTIONS: Superior view
• Planterflexes 1st ray
• Elevates 2nd - 5th metatarsal heads
• Accommodates 1st metatarsal head
• Dorsiflexes 1st MTP joint

CLINICAL INDICATIONS:
• Hallux limitus
• Jamming of the 1st metatarsophalangeal joint
• Inefficient windlass mechanism

A dynamic wedge is a modified Myolite forefoot extension Its medial edge does not extend past the 1st interspace,
to sulcus with a dorsi-flex, semi-rigid to very rigid (45-75 and its edges are unskived. The dorsi-flex wedge begins
Shore A) EVA wedge that sits beneath the 1st phalange. its incline just distal to the 1st metatarsal head and ends
The forefoot extension begins at the superior distal edge past the distal phalange. The lateral edge does not extend
of the orthotic frame, terminates just past the 2nd - 5th past the first interspace and is unskived.
metatarsal heads and excludes the 1st.

3mm unskived 3mm

1.5mm unskived 1.5mm
Anterior view
Medial view

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

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

Extensions D

Sulcus Length

Sulcus Extension Sulcus Extension 4.5  3  1.5  (mm)
4.5mm
Myolite material frame-extension Superior view
to sulcus
4.5mm
FUNCTIONS:
• Metatarsal head cushion
• Metatarsal punch out material

CLINICAL INDICATIONS:
• Low volume shoes
• Accommodations requiring material
• Forefoot fat pad atrophy
• Hammertoes
• Mallet toes
• Claw toes
• Leg length discrepancy

A sulcus extension is a Myolite forefoot
padding that extends from the superior
distal edge of the orthotic frame and
terminates just distal to the metatarsal
heads.

Note: If a met head punch is requested,
a forefoot extension is required.

3mm 3mm

1.5mm Medial view 1.5mm
91.
Anterior view
(phalanges excluded)

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

D Extensions

Sulcus Length

Morton’s Extension Morton’s Ext. U.skiv  4.5  3  1.5  (mm)

EVA material Morton’s frame-extension 4.5mm 4.5mm unskived
to sulcus

FUNCTIONS:
• Immobilizes the 1st MTP joint
• Sulcus length reduces forefoot bulk

CLINICAL INDICATIONS:
• Hallux rigidus
• 2nd met head pathology (unskived modification)
• Degenerative joint disease (DJD)
• 1st MTP joint arthritis or trauma

A Morton’s extension is semi-rigid to very rigid (45-75
Shore A) EVA extension that begins at the superior
distal edge of the orthotic frame, terminates at the
sulcus ( just distal to the metatarsal head) and is
placed only beneath the 1st metatarsal head. Its lateral
border does not extend past the 1st interspace, and
the lateral edge can be left unskived upon request..

Note: The ‘unskived’ request provides an immediate
difference in elevation between the 1st and 2nd
metatarsal heads that can also effectively treat 2nd
metatarsal head pathology.

 CLINICAL PEARL
Sulcus length Morton’s Extensions are the most
functional Morton’s Extensions for treating Hallux
Rigidus by delaying and reducing temporal
movements acting on the distal phalange during gait.

3mm 3mm unskived

1.5mm 1.5mm unskived

Superior view Anterior view
92. (phalanges excluded)

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

Extensions D

Sulcus Length

Reverse Morton’s Rev. Morton’s U.skiv  4.5  3  1.5  (mm)
Extension
4.5mm 4.5mm unskived
Myolite material reverse Morton’s
frame-extension to sulcus 3mm 3mm unskived

FUNCTIONS:
• Planterflexes 1st metatarsal head relative to lesser

metatarsal heads
• Increases 1st MTP range of motion
• 2nd -5th metatarsal head cushioning
• Sulcus length reduces forefoot bulk

CLINICAL INDICATIONS:
• Functional Hallux Limitus
• Lesion beneath 1st metatarsal head
• Sesamoiditis
• Rigid plantarflexed 1st ray

A Reverse Morton’s extension is a Myolite padding
that begins at the superior distal edge of the orthotic
frame, terminates just distal to sulcus ( just past the
metatarsal heads), and is placed only beneath the
2nd -5th metatarsal heads, excluding the 1st metatarsal
head. Its medial edge does not extend past the 1st
interspace, and the medial edge can be left unskived
upon request.

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

1.5mm 1.5mm unskived

Superior view Anterior view
(phalanges excluded)
Notes: All illustrations and diagrams are of right foot
Colors on illustrations are for visual purposes and will vary on final product 93.

D Extensions 4.5  3  1.5  (mm)
4.5mm
Sulcus Length 3mm

Foot Cookie Extension Foot Cookie Ext.

Myolite material foot cookie frame extension
sub 1st and 5th metatarsal heads to sulcus

FUNCTIONS:
• Elevates 1st and 5th metatarsal heads
• Disperses pressure away from 2nd, 3rd and 4th metatarsal

heads

CLINICAL INDICATIONS:
• Metatarsalgia
• Morton’s foot with forefoot pathology
• Propulsive phase metatarsalgia
• Freiberg’s disease
• Capsulitis of 2nd and 3rd metatarsophalangeal joints
• Elongated 2nd and 3rd metatarsals

The foot cookie extension are two forefoot Myolite paddings
that begin at the superior distal edge of the orthotic frame
and extend beneath the 1st and 5th metatarsal heads
only. The medial padding extends distally beneath the 1st
metatarsal head, terminates at the sulcus and does not
pass the 1st interspace laterally. The lateral padding extends
distally beneath the 5th metatarsal head, terminates at the
sulcus and does not pass the 4th interspace medially. Its
edges are not skived along any of its borders.

 CLINICAL PEARL
A Foot Cookie extension couples well with metatarsal
bars for exceptional clinical outcomes involving metatarsal
pathology.

Superior view 1.5mm
94.
Anterior view
(phalanges excluded)

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

Extensions D

Partial Foot Toe Filler

Toe Filler Toe Filler 5th  4th  3rd  2nd  1st 

Partial foot toe filler of Myolite,
EVA and Plastazote material

FUNCTION:
• Stabilizes anatomical segments adjacent to

amputations

CLINICAL INDICATION:
• Amputation

Toe filler is a wedge buttress of EVA, Myolite and
Plastazote that sits on the superior forefoot area of a
device’s top cover. It conforms to and occupies the
negative space from a patient’s amputation(s).

Note: Submission of patient’s shoe with impression is
required for optimal fitting.

Superior view

Notes: All illustrations and diagrams are of right foot 95.
Colors on illustrations are for visual purposes and will vary on final product

E Offloading Pads & Cushions

Forefoot

E

Offloading
Pads & Cushions

Offloading Pads & Cushions are used to disperse force,
increase shock absorption, change orthotic reaction forces
in a given area and provide comfort.

96.

Offloading Pads & Cushions E

Forefoot

Metatarsal Balance Met Balance 5th  4th  3rd  2nd  1st 
Note: A forefoot myolite extension
Metatarsal head balance pad with Myolite is required for met balance
cushion material
extension to sulcus
FUNCTIONS:
• Disperses metatarsal head pressure extension to toes
• Raises surrounding metatarsal heads
• Offloads targeted metatarsal heads

CLINICAL INDICATIONS:
• Metatarsalgia
• Bony or soft-tissue metatarsal head prominence
• Hyperkeratosis
• Ulcer

A metatarsal balance is a 3mm Myolite forefoot padding
that sits on top of an extension and extends from the
superior distal edge of the orthotic frame, terminates
distally to the metatarsal heads and has a parabolic
aperture that offloads a bony or soft-tissue prominence.
The curved side of the aperture is just proximal to the
metatarsal head, straightens at the adjacent interspaces.
The inside edges of aperture’s negative space are
unskived while the outer edges are all blended.

Note: Lab technicians may use discretion to increase the
amount of offloading dependent on patient foot size or a
significantly prominent plantar metatarsal head.

Superior view Inferior view
2nd met balance 2nd met balance

5th 4th 3rd 2nd 1st
97.
Anterior view
(phalanges excluded)

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

Forefoot

Metatarsal Punch Met Punch 5th  4th  3rd  2nd  1st 
Note: A forefoot myolite extension
Metatarsal head punch out of Myolite is required for met punch
extension material
extension to sulcus
FUNCTION:
• Accommodates and offoads metatarsal heads without extension to toes

additional forefoot bulk

CLINICAL INDICATIONS:
• Bony or soft-tissue metatarsal head prominence
• Plantar corn, callus or wart
• Hyperkeratosis
• Dropped metatarsal head
• Ulcer

A metatarsal punch is a circular aperture made in a Myolite
forefoot padding inferior to the target metatarsal head. The
aperture is made all the way through the Myolite’s thickness.

 CLINICAL PEARL
Multiple metatarsal heads can be selected.

5th 4th 3rd 2nd 1st

Anterior view
(phalanges excluded)

Inferior view
(transparent)

98. 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

Forefoot

Metatarsal Pad 2-4 Met Pad 2-4 4.5  3  1.5  (mm)
6mm
Metatarsal pad of Myolite material supporting
the 2nd, 3rd, and 4th metatarsal shafts 4.5mm

FUNCTIONS:
• Shift metatarsal head pressure to metatarsal shafts
• Elevates 2nd, 3rd and 4th metatarsals

CLINICAL INDICATIONS:
• Plantar plate pathology
• Metatarsalgia
• Forefoot callusing
• Neuroma
• Intermetatarsal phalangeal bursitis

A metatarsal pad 2-4 is a tear-shaped Myolite padding
added to the superior distal surface of the frame. It
begins beneath the midshaft of the 3rd metatarsal,
expands medially and laterally beneath the 2nd and 4th
metatarsal shaft distally and terminates just proximal
to the metatarsal heads. The padding is highest in its
center and tapered along its edges.

 CLINICAL PEARL
This padding is not recommended if a patient has a
rigid or immobile forefoot.

3mm

Superior view Inferior view Medial view 1.5mm
(transparent) (transparent) 99.

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

Forefoot

Metatarsal Bar 1-5 Met Bar 1-5 6  4.5  3  1.5  (mm)
6mm
Metatarsal bar of Myolite material dispersing
pressure to metatarsal shafts 1-5 4.5mm

FUNCTIONS:
• Disperses metatarsal head pressure to metatarsal shafts
• Elevates Metatarsals

CLINICAL INDICATIONS:
• Metatarsalgia
• Plantar plate pathology
• Forefoot hyperkeratosis
• Forefoot ulcerations

A metatarsal bar 1-5 is a Myolite padding added to the
superior, distal surface of the frame. It covers the distal
frame medially to laterally, from the 1st metatarsal base
to the distal styloid tuberosity, and extending distally to
the edge of the frame. Its proximal, medial and lateral
edges are blended into the frame, but the distal edge is
left unskived.

 CLINICAL PEARL
This padding is not recommended if a patient has rigid
or immobile forefoot.

3mm

Superior view Inferior view 1.5mm
100. (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