The next stop in our tour of the FootID Pro app configurator is listed under “Frame Options” and is titled “Width of Frame”. At this point I would like to backtrack a bit to the first page of the configurator titled “Select Orthotic”. Listed under “Most Popular” is “Root Performance”, “Root Dress” and “Root Control”. You will note that under the description of these three models the width of the frame for each is mentioned, standard width for the performance model, narrow width for the dress model and full width for the control model. The width of the orthotic device is generally defined by the relationship of the medial edge of the orthotic frame versus longitudinal bisection of the 1st metatarsal. Additionally, the relationship between the lateral orthotic edge and the longitudinal bisection of the 5th metatarsal also applies.The “Performance” profile orthotic will bisect the midline of 1st metatarsal and sesamoid apparatus (standard width). The “Dress” profile orthotic will have its medial edge bisecting the location of the Fibular sesamoid (narrow width). The “Control” profile medial edge will bisect the Tibial sesamoid (full width).
We return to “Frame Options” column in the configurator and scroll down to “Width of Frame”. This field now contains seven options for frame width, ranging from “Extra Narrow” to “Full Width” along with an option for “Extra Narrow w/ Cobra Heel Cut Out”. Many models, including the three mentioned above have default settings denoted by the orange checkmark in the upper right corner of the field, so you may keep this value or change it accordingly. The chainlink icon, if selected, will allow you to differentiate width on left versus right. The “Cobra Heel Cut Out” involves removing the center of the heel cup and the distal lateral portion of the frame, resulting in a cobra like shape to the frame. It is useful for high fashion women’s dress shoes, such as pumps, and I have found it adds additional medial arch support in cowboy boots with less rocking between the heel and forefoot portions of the device.
The next field in “Frame Options” is “Wide Arch Profile”. This option allows you to widen the frame only in the medial midfoot, under the Talo-Navicular joint. The forefoot and rearfoot portions of the frame will remain whatever width you chose in the previous field. This underutilized option is good for case of Lisfranc’s injuries with subsequent flattening and widening of the midfoot, or Posterior Tibial Tendon Dysfunction with severe medial displacement of the Talus and transverse plane deformity. It is generally easier to place this device in a deep seated shoe than a full width orthotic or UCBL device. It is also helpful in providing a platform for a Scaphoid pad or medial flap.
“Frame Reinforcement Skive Filler” is utilized in those cases where a dual density frame reinforcement may be optimum. For example, you want to create a softer more flexible device with a 15 shore EVA frame filler, yet create some stability under the device in the medial arch area with a firmer 45 shore EVA, this would be a good option.
“Intrinsic Metatarsal Pad” is a 2-4 metatarsal elevation that is incorporated into the structure of the orthotic frame, consisting of the same material as the frame. Not to be confused with the softer 2-4 metatarsal pad that is placed under the top cover and is separate from, but attached to the top of the frame. This modification may be used when elevation, or off loading of the three internal metatarsal heads is desired, but in an orthotic without the top cover. It is available in two widths and three heights, and either unilateral or bilateral.
“Gait Plate” is a frame modification in which the distal edge of the frame is extended distally either medially or laterally to promote a change in the angle of gait. To promote outtoeing in a case of intoe, the lateral distal edge extends to the base of the 5th toe. To inhibit out toe gait the medial distal edge extends to the base of the great toe. It is mostly used in pediatrics, with the effectiveness diminishing after age 2 in most cases.
“Sweet Spot Accomodation” is either a depression or opening created within the frame to decrease pressure under a bony or soft tissue prominence on the plantar aspect of the foot, similar to a Navicular or 5th Metatarsal Base Button Out, It can be placed virtually anywhere on the orthotic frame, as needed, however you should clearly demarcate the location on your scan or impression.
Customization of your prescription orthotic devices is only limited by your imagination. Many of these options are rarely needed, however it is best practice to keep them in mind for unusual cases and refer back to the configurator from time to time for a reminder of their availability.
