By now you’ve read our previous blog which addresses the “Lost Art” of taking foot impressions (if not skip back here and have a peep, it’s an interesting read). In a nutshell, it explores whether we’ve “deskilled” ourselves as technology has advanced around us.
In this section I’m going to discuss how we take foot impressions…. not whether you use a fancy scanner, an iPad, foam boxes, slipper socks, plaster of paris, cow dung or any other modality of recreating an imprint… In this discussion, we look at whether you choose to cast in non-weight bearing, semi weight bearing, fully weight bearing or, do you make that decision based on the method you are using and the patient in front of you?
" You don't pay for the nail being hit. You pay for the time of the professional that knows where and when to hit it... "
S Roeszler, Footprint Hub 2020
Food for thought ...
I’ve worked with many good, experienced (and not so experienced) clinicians. Many will use one preferred method for taking a foot impression and that usually governs how they take that impression. A classic example is semi-weight bearing casts using a foam box, but is that the best process for all your patients?
Before I go on, I must stress that there is no gold standard for what we can use to take a foot impression or how we choose to take it. This is probably why everyone thinks their way is the best and why we have countless debates on the matter, but let’s just consider a few extremely important points to consider which may or may not make a difference to you….
- Are you stuck with either non-weight bearing or semi-weight bearing scans because you’ve invested in a fancy new bit of kit? Is the new technology dictating what you do?
- Have you joined a new lab who have tied you into a fancy new bit of kit…? (see above point)
- Does semi-weight bearing create unnatural forces under the hallux and affect the forefoot to rear foot position?
- Does non-weight bearing not give an accurate enough representation of soft tissue spread?
- Does fully weight bearing elongate the foot too much resulting in an orthotic which protrudes the MPTJ’s?
- Does a fully weight bearing position provide an upper limit of where the foot functions within? or do we require need to guesstimate where the ideal foot position will be?
- Does non-weight bearing neutral suspension casting allow you to manipulate the foot into an optimum position (meaning less cast work by the lab)?
- Does semi-weight bearing or fully weight bearing work better for TCI’s where your patient has limited ranges of motion?
- Would you use the same method for a young fit marathon runner with plantar heel pain as you would an elderly diabetic patient with a pressure ulcer?
- Does it all depend on the type of orthoses you want?
These are just a few points but there are many more and we could debate at length, and probably still not agree J
To conclude, I think it’s important to keep your “casting freedom” and not get tied down by what your technology allows, or what your lab dictates. I will share with you that I am NOT a monogamous caster! I choose different methods and different positions based on my patient, but that’s just what works for me 😉
Think spatially. Tissue expansion parameters you prescribe will relate to fit to foot and/or reduced device control.
Patients typically mention “I’m sitting on top of the device”, “it’s squeezing my heel” or “it feels like I need more support”.
” Different technologies or casting positions cannot replace the need to review and reference the “position in space” of the information you are submitting for manufacture “