Geri,

HMO is as curse word in my dictionary. They are in the business of making money, not spending it. Getting a custom last paid for would be nearly impossible in my experience. They may offer custom molded shoes as a covered benefit for selected diagnosis, mostly limited to diabetes with severe foot deformities and/or amputations but in order to bill, a shoe has to be made and dispensed by the provider, not just a last. I have never seen a billing code for lasts.
There are variations on codes and allowed items per HMO and by state. Some states mandate coverage for certain conditions by law. I can only speak of my experience in Massachusetts where coverage of footwear for diabetics with complications is a state law. The law does not set quality standards and HMO are notorious for demanding deep discounts from providers. Ultimately you get what you pay for.
Check with your HMO and state if there is coverage and what they actually cover.

Is your pedorthist going to make the last herself? If not what lab will she use? Only a very few are willing to give up their last and most of those lasts are accommodative and offer no correction for your daughter's condition. It is my opinion that in this stage correction is not only possible but also desirable.
Be careful adding heel height to the last. I realize your daughter may insist on some height but it will add to the instability in the ankle.

Hope you can get somewhere with your insurance to provide a good pair of shoes and also end up with a good pair of lasts that you can continue to use.
Keep us posted.

Rob

Hi Geri and Rob

Rob you are lucky were I live the diabetic foot is so mired in polotics and turf stomping equaling no service. I lost my billing privilidge to a side swipe from our national association. It took out 13 old timers and we are trying to get it back. don't know how 10 people can cover Canada!!! Don't want to get my blood pressure up any more. I studied at the G.W. Long Hansons Diease centre at Carville Louisiana. an old leper colony as leprers and diabetics have similar neuropathy and they with the aid of the US public health developed the "Gold Standard" for foot healing and after care. I am one of the few Canadians that have studied there, but to bad. EEERRRR

Geri
As for getting a last made to accomodate and orthotic is in my mind the hardest way to beat a ford into a chev. You have to many variables to contend with. with the orthotic be made exactly the same way each time will it fit period? I see this all to often. If you look at some old posts I put on this thread you can see how I handled it.
The last should resemble the foot in it's deformed condition and corrected for toe shape, heel alignment, and fore foot alignment then you form an orthotic insole to bring the last/insole to resemble a "Normal Last" Ie Heel height, waist shape, rocker sole if necessary and level feather line. This is possible with less fuss than you think. then make the upper and make the shoe over last and orthotic insole and when done take out the last and leave the insole in forever. Make it removable though for modification or cleaning that's why I use EVA for the insoles.

You done. BUT the last will be made with a fixed heel to ball height you can't play with much. You can disquise some , stylinsing buy how you shape the insole. so a slightly higher heel to ball height is more versatile it is easier to build a insole heel thicker ie. to made a runner style shoe. Rob mentioned the heel height can unstabalize the ankle I agree to a point. Depending on the achilles gastroc muscle tone. If you have tight rear leg muscles you might not tolerate a low heel, as that might be a contributer to the initial pronation as seen in your pics. This is hard to descibe how to assess for this over the net but your pedorthist hope fully can show you the theoretical netral sub-taler position , load the 4th and 5th met heds and note the angle of foot to leg. This should show you the minimum heel height to start with. I did a presentation years ago about this I'll try ti find it and scan it.
Rob if I am stepping on toes or not coming thru clearly please help. If I could get a good cast (bivalve) pedographic print and measurements I'll make a set of lasts for what you think its worth. I love to barter. My old mentor had spina bifita and had to learn how to make shoes for himself. He than taught me all he knew. so I can sure understand you condrum and determination to help your daughter. HMO's are thankly not alive in Canada.
Regards
Brendan

Brendan,

Not to worry, you won't step on my toes, in fact I think your offer is a very generous one. Wonder if there is anything I have to in the basement or shed to barter with.

Even with insurance coverage it's a tricky field, so much so that I have chosen not to accept any insurance. I believe that I make a high quality product to the best of my ability for a fair price. I am a shoemaker, not an accountant or lawyer who want to spends his days fighting with the insurance to get paid. If my customer chooses to use my services I will assist them in getting reimbursed by their insurance where possible. There are plenty of providers out there that do not think twice about taking a cut rate from an insurance company to deliver a poor quality product. Once the customer realizes that doesn't help they come looking for me.

I went to school with a guy originally form Suriname who had also worked at the Hanson Center in Louisiana. That is indeed an impressive facility for what comes out of it. That of course doesn't mean anything to a pencil pusher who has to find a way to save a couple of bucks so their CEO can get an other million in bonuses. Let's not drive ourselves crazy trying to figure out the insurance companies. It's a battle we can't win, just grin and bear while doing the best we can.

Geri,

Once you get the casting on film it may be nice to contact our admin to find how the video can be added to the video section of the site. I know there are a lot of people interested in casting and I usually do not have the extra hands and equipment available to do it myself

Rob.

Hi Rob and Geri

Thanks for hearing me rant! and I guess I got garbled I offered to make a last for Geri but if want one sure why not.
Geri if you do a video I also would like to see it. It is always nice to see how others work and every body has something to contribute to the gentle art.

Rob
You mentioned the "other Providers" in your last post. What kind of education/certification do these people have to meet the insurers criteria? As far as I know there is no governing body for custom shoe makers in the US, correct me if I am wrong.

Do the insureres respect your training? I know in Canada we have lots of offshore Doctors driving taxi and Nurses babysitting due to non transferable credentials or a beauraucry that is caving in on it's self. They are screaming for Doctors and Nurses especially in the rural areas and it just don't make sense, to have trained people unable to fill these positions. I used to be an RN for 15 years but burnt out and I an considering a re-entry program after a 4 year brain break.

As for the pencil pushers I heard an evolving story last couple of weeks of one insurance company that sells top up benifits not covered by our national heath policy. Will only honor an orthotic prescribed by a Podiatrist. They didn't even consider an Othopeadic Surgeon as crediable. This is part of an ongoing saga which makes me cringe and hope one of the pencil pushers/policy makers, mothers need some service and It will be long gone, not to be had for any amount of $.

Rant over.

Regards
Brendan

Brendan,

Driving a cab in order to make some real money for a change is something I should look into. How hard can it be, I already know how to drive, eat breakfast, read the paper and let the guy three lanes over know what I think about his driving all at the same time.

Seriously, Initially I was told by a past president of the PFA that my credentials would be transferable but when push came to shelf they were not honored. I have not been able to convince myself that it's a good idea to lay out close to 10K to become certified just so I can work for an insurance that in turn will demand a deep discount for my work. Talk about frustration, having to deliver a product you know to be inferior simply because you won't get paid for doing the job correctly in the first place. If the certification stood for anything more than an money generating opportunity for the PFA I would seriously consider it. Maybe that day will come, one can hope.

Most HMO's require one to have a Cped (certified pedorthist) certification or a state license but there is no governing body for custom shoemakers, nor an educational program to base credentialing on. From the outside looking in it seems to me that many insurance companies first look for someone willing to work for the (low) price they set, if faced with multiple options they add additional requirements to their vendor list.
Licenses are issued by some states, not Massachusetts but requirements vary and initially people were grandfathered in without the proper education or background. Unfortunately this undermines the value of the license drastically.
The Cped courses used to be 120 hours and an exam, things have changed lately and I have not payed very close attention to the changes. I'm sure some others have more information on it. The weak point is that though there seems to be realization that passing the exam is only the beginning of the learning process, the guidance and continued education leaves much to be desired.

That concludes today's ranting from this end. It sure does make one feel good to be able to vent.

I do need to clarify that even though I choose not to pursuit certification as a pedorthist, that does not mean that I do not appreciate the knowledge and hard work that goes into becoming a Cped. I had the luxury of a very thorough education in pedorthics and shoemaking followed by an medical internship that's simply not available to many. In lack thereof the certification program is certainly a good start to get into the field.

Brendan, If you decide to step back from full time shoemaking make sure to hang on to your hand tools. Being able to put together a pair of shoes every now and than is better therapy than any shrink has to offer (and much cheaper, or eco friendly if you will).

Rob

Rob,Brendan,Geri,I have been following your discussion and have not figured anything worthwhile saying in view of the healthcare situation.I am not a fan of Medicare ,HMO`s or any other like the V.A.or Workmans Comp.Even though I have done work for a few mentioned.The obvious need for the Diabetic foot under the Medicare Diabetic Bill is serious for practicioners as ourselves in small practices.I get no interest either from Podiatrist,but hope to in time as our services are unique as long as we surpass mediocrity.

In order to excell we must exhaust all chanels of furthering our understanding of bio-mechanics,lastmaking and shoemaking.Our practices require a life time of study ,passion and devotion to help our clients that are handicapped.

The PFA is one resource for learning and developing quality standards in practice.I regard the pedorthic/orthopedic shoemakers in the U.S. highly, and have learned from them and others in the past 35 years.I do appreciate your sentiments and share with you similar frustration regarding referrals and billing.Most of my work is private pay and sometimes pro bono or barter.Rob is right when our client is not satisfied with services from other providers they find us.

The HCC has been an incredible source of furthering my ability and humbled my own abilty as a shoemaker leathercraftsman,designer,etc.

I have learned a lot from several PFOLA[podiatric foot orthotic laboratory association]annual meetings.They are picking up attendees from the pedorthic community and other allied health care providers.I prefer these meetings over the PFA[Pedorthic Footwear Association]where Arnie Davis has been making an annual presentation on custom footwear therapy.

I do hope to make the meeting in Guthrie for the HCC AGM,perhaps we could collectively combine our efforts in orthopedic last making,biomechanics and orthotic casting ,design and shoe fitting.I do believe over a span of 3 days some amount of planning and effort in plaster work,vacuum forming , grinding ,and demonstration not to mention Video for the HCC archives ,pedorthics in action will lead us all into better shoemakers and bootmakers.

Any suggestions,comments from all interested are welcome,Thanks,Fred

Hi Fred and Rob
I have been involed with our association since the humble beginings in the late 80's. Yes there education is valuable and yes repetative. The Pedorthists are well versed in a lot of areas but I don't think they understand that we exemplify the definition of pedorthics!

I was in Chicago in 83 at Nothwestern University. The main speaker refered to us custom shoemakers as "just Technician's, not fitters" One gent from Mighigan explained our inventory was in lasts and sheet goods not a many thousand doller inventory of shoes. These two just about came to blows and I explained to this fellow I can make a shoe faster that getting a special size ordered in, he didn't like that. I also asked him if he ever made a shoe? I got a terse NO.

Later he was explaining how every child need ortho shoes. I asked him how Biomechanicly this would alter a childs foot? His response was " If you want to ruin your kids feet go ahead" Not the answer I expected from an expert.

My girls now teenagers wore hand made shoes for a couple years but when fashion took over they wore the same crap as the rest. I don't see a generation or two with deformed feet

As a kid we wore hand me downs and I or younger brother don't have huge foot problems. So what are some of these grand statements based on. I have looked long and hard for any scientific studies for childs footwear and the only one said there was no statistical differance from runners to firm shoe or firm shoes with a arch pad. I also tried to find statistics on injury from closed/open heel shoes and steel toes. NONE.

If you look at some world class runners they don't even wear shoes. Their feet by our standards should be none usable. So what has our version of foot binding done to us?.

An old Ortho Surgeon said if we could all grow up walking on beach sand we would never have a foot problem.

I agree when people get exhausted with poor footwear they come to us but by that time they are usually mad, frustrated and used up a bunch of money. Leaving small picking for us. The pencil pushers would gladly pay for a prosthesis than shoes to prevent an amputation. Last study I saw about 5 years ago an simple uncomplicated below knee amputation was $176,000.00 to our social medicine stream. this included doctor's fee's hospital bed and therapy. Then a simple BK prosthesis is minimun $3,000. Hmmm. So much for the"wellness model"

Rob don't worry I will never part with my tools. I do wood work and a finisher will do work no tool on the market can do. And yes a good day in the shop is better than a shrink. I have also incorported some leather work with the wood. I have people ask where did you get that antique? I said 3 weeks ago it was rough wood and a brand on a peice of leather. They were impressed.
I can't make it to your AGM but sure would like to. Maybe we can colaberate and come up with some resource materials so this trade may not go the way of the dinosauer.

Thanks to the HCC for passing the information world wide. Can you record any workshops on Video for us? I sure would like to see these presentations. Please.

Regards
Brendan

Brendon,The PFOLA conference is the exact dates as the Hcc AGM .It is in Vancouver and they offer CEU`s.The PFA symposium is Nov.6th to 9th in Nashville.I honestly prefer the HCC AGM .

I think that old orthopedic surgeon is wrong simply because any unwanted over compensation in the foot leads to flexible deformities and flexible deformities lead to fixed deformities.

Barefoot and knowledge of good foot posture is important and altogether neglected.Yes our feet are somewhat bound and heels unnaturally elevated on heeled shoes and boots and sometimes lowered in negative heels.Most of the time and in our evolution we are defying nature without even being aware of it.

I feel first we have the responsibility to know how to stand and I think the majority of the whole worlds population especially the medical establishment does not know.

I consider foot orthotics to be somewhat of a crutch and in order to avoid that crutch I spend time with my clients in standing in their barefeet and show how some painfull problems in their feet,legs,hips and back can be relieved of pain related to overstretched muscles,overuse and overcompensation.I believe these lessons are needed in pre K,grammar school,secondary school, and in Phys.Ed.classes in colleges.

Foot Orthotics have relieved symptoms and pain. Custom shoe therapy does enable people with severe deformities,providing the ability to ambulate and function normally.

I serve the people in my community and receive more from helping then receiving financial gains and am happy to do so to my best abilities.I know very well the sacrifices and long hours of arduos labor and like you and Rob avoid the HMO`s like the plague.

The day we started to learn was the same day we started to teach.The lineage we came from is the same continuum we are part of despite ourselves.I hardly can call my self shoemaker in light of others much more skillful then me.When I look at and meet men and women young and old,I only see passion for shoemaking and never have the sense of extinction.

Fortunately,I subidize my orthopedic/pedorthic practice with leatherwork,retail and wholesale to stay constantly busy,so I don`t know how I could truly undertake a presentation but I am willing to try.I think collaborating of resource materials and tecniques is a good start,Brendon.

Wish I could just keep these transmissions to 25 words or less ,but I guess its the best we can do to communicate.

Well whata ya say DW?

Peace,Fred

Hi Fred
Your comments are always food for thought.
as for the old doc I think he was refering to the intrinsic muscles as so many parents wqnt to get shoes and get the child to walk. Instead of letting them walk around the house with bare feet and a hands up position as they learn to walk. I watched my girls start to walk and it was fun. I as a father helped as usual but let them learn as me old MAMA said. She was a wise women,

Being a shoemaker and Nurse I have worked with the moderate to the severe. To long to get going on this.

We have been trying to get equal recogntiiion with a Prothetist and Orthotist since 1980's.

I as a kid out of high school got a job with Heath and Welfare Canada now Medical Services. I was a O+P tech for 5 years and two shoemakers who mentored me worked there also. Mr H.G. Relke who was a Spina Bifida client was so frustrated to get footwear he learnd late in life to make shoe for him and is empathey for other's rubbed off.

In 1980 they decided to move us to the provincial hospital and during the time I developed a severe allergyy to polyester resin hardener. Had to switch professions so I went to apprentice with Fred Van Santen in Edmonton Alberta. A brilliant man who went to nearly the same school as Rob did.

I got trained in the full meal deal. Lastmaking, uppers, closing and finishing. I took to them my knowledge of laminating plastic and Otto Bock foam for lasts. We did well til old Fred declined in Heath and so on.... At the time I downhill skied alot
in the magazines they talked about "canting" a full lenght angled shim to better transmit of the 1st met head to the ski. so the next time I went out to Banff I made wedges and swapped them out. Big differance as I wedged my medial heel and fore foot. 1982 I realised what I was doing. I was not able to put enough pressure on number one to turn effectly. so pre load and I could turn on a dime.

Yes this is a pursuit of will and hopefully get me into the Big House when I throw the fiinal stitch.

To my Mentor's
Howard. G. Relke COFS LM
Robert Patten Shoemaaker AKA "the Right Honourble Robert"
Ted Sheard CPO/CO
EdDumont
P. Chang
W. SIlver
J. Emble

Regards
Brendan

Brendan,Thanks for your thoughts especially on your children.I think pediatric early intervention can be jumping the gun sometimes ,but I do believe necessary and appropriate with others.

One recent 3 year old down syndrome had from Hanger Laboratory bi-lateral AFO`s that were intolerable.She would not where them at all.She had only started to stand and walk at 2 to 2 1/2years old and her doctor prescribed AFO`s.Hence I was called in through her physical therapist and started with what I call, modified UCB`s,fabricated one lamination at a time.1st,Otto Bock lite {EVA},2nd 2MM sub-ortholen and 55 durometer soleflex for the balance layer.I recently used Quick form for a more flexible device to replace the 2mm S.O.

Working out a plaster cast with very fast setting specialist roll bandages non-weight bearing with her sitting on a board on her mom`s lap proved to be the best way of capturing her trust,confidence and forefoot to rearfoot anatomy.I also mold into the negative cast a moderate metatarsal support.

After 4 to 6 months her body rejects the devices and we recast because of growth.It is interesting seeing the timing and growth change in the positive orthotic molds.

Where her feet are purely pronated with 4th metatarsals dropped and medial arches dropped to the floor in barefoot standing,In shoes she looks like a tai chi,chi gung master with near perfect foot posture.And she runs all over the place,so Mom and Dad are pleased.We just don`t know what her later childhood years or teenage years will bring.I also have another 30 year old I could only capture her foot impressions wit Bio Foam at lightning speed because of hyper active activity.I review her case every year ,she is completely tolerant and her Mom brings her in with her new shoes every year.

On skiing,the plantar 1st metatarsal is a Racers Foot and prominant world class downhill racers almost always have this condition.

After producing a new pair of ski thotics this season.for myself I was not able to get hold of the right medial ski edge.I had tried in the past to support the entire medial column and it was always worse.So I canted the right heel in the heel only with aa piece of 1/4"S.O.[sub.ortholen]on the ski binding with Locktite 411,and it held all season .I am really delighted that made a huge improvement.

I will tell you that observing both my legs in open ski boots and mounted in the ski bindings tibial varum was the obstacle to overcome.For others tibial varum is AKA bowlegged,which increases an inverted angle from the lower leg to the foot.Complicated with Sub talor varus the foot has to increase rearfoot motion in eversion to get flat on the ground,therefore often the higharched foot needs medial rearfoot wedging just to get flat on the ground.The rearfoot wedge therefore brings the ground to the foot allowing the high arched foot enough range of motion to pronate into midstance where the foot then should supinate.

Brendan,Is the "Big House" Heaven?

I think those O & P people look down their noses at Pedorthics and as Arnie Davis told me one day there is too much mediocrity in our field .We do need to raise this profession ,I agree.

The Canadian Pedorthic Association and our own PFA are still our best resources in raising our status in the medical world,and at that I probably convinced myself to forego the Pfola conference and attend this years symposium in Nashville ,TN.After all they are our advocate and need our support.So hopefully I will get to the HCC AGM too.They are 2 weeks apart so the expense in $`s and time is enormous ,but fruitful,I am sure.

OK brother Brendan,Many stitches and many moons before we meet,Peace,Fred

Fred and Rob
I think we are barking up the same tree.

Rob you mentioned you did a medical practicum as part of your training Can you tell me more? I worked in the OR for 6 years plus. we did eveything except Cardiac. I scrubbed on many total joint replacments. Bunionectomies. Shattered bodies from car accidents Premi babies 500gms. So I have a real anatomy class under by belt, Had to scrub for my daughters emergency C section that is another story.

Fred
You mentioned methods of adapting casting as all clients are different. I think this is some or the neuances that people miss with there statements of " Mediocrity". If you don't have a broad horizon and probmlem solving skills, you are caught in mediocrity . To often I encounter people who are afraid of asking a question or say I don't know. Rarely will they take the time to do some research and do something different cause that's the way I was taught, and change is impossible.
I heard on old nurse say "If you don't know why you are doing something, you better stop and think it out"

As for the big house I have a suite booked at the St. Crispen
location. it is non denominational all shoemakers welcome! I hear our crooked backs and finger will straighten. callous disapper, Scars from knives and awls will be gone, Single Malt at 4 pm. It also accepts the spouses of the shoemaker for there understanding ways and occasional pair of shoes. See you all there!
Last ramble. Notice how the term "shoemaker" is gender neutral, I guess it's we come from a breed of forward thinking people.

Going to go out and enjoy the nice spring day
Regards
Brendan

Brendan & Fred,

Great food for thought.

The Canadian Pedorthic association seems to be more serious about the quality of care and standard of education. Not having worked with many Canadian Cpeds I can only speak of those I have come across in my travels and business dealings but the Canadians seem to have a better understanding of foot function and practical solutions to a given situation. Don't know if this comes from the course they are taught or if I just happen to come across some bright ones.
I realize these comments may make me very unpopular and just like all other aspects of life, there are many exceptions, both to the good and bad side of the argument. These are just my observations, take them as such.

Remember that many come into the field with other backgrounds, doctor, orthotist and prosthetist. They bring a level of knowledge and experience that benefits pedorthics and will make them a much better practitioner than the average Joe who has just finished the course. As much as this helps the profession, the chain is only as weak as it weakest link so by allowing “unqualified” individuals to become certified brings a degree of mediocrity and does little good in bringing the level of the profession up to par.

The attitude Bendan ran into in the early 80s is still commonplace, more so along the old timers. Failure to explain or resistance to be challenged in ones opinions seems common. I think part of the problem in this is the lack of a thorough knowledge of the matter. Making strong statements is easy, being challenged on them and being able to explain them in depth to others requires a lot of in depth knowledge.
For me, I enjoy discussing these matters, there are perspectives out there that are other than my own and there are more than one way to come to a desirable solution. If I an learn from the ways others approach any given issue it makes me better, even if I choose never to use their way.

I like the idea of collaborating on a project either leading up to the AGM in Guthrie or starting something there and continuing through he Colloquy. I am hoping to make it to Guthrie but it's too early for me to make a firm commitment.
Any ideas are welcome on this. If any of the readers / HCC members have anything they would like to see addressed put it up.

Brendan, you asked about my medical training, I was given the opportunity to spend a year long internship in the Massachusetts General Hospital covering podiatry, orthopedic surgery, O&P, radiology, PT and the gait lab. During that time I had the opportunity to take part in all orthopedic surgery and podiatry lectures given in the Harvard Medical School residency program, observe surgeries, mostly ortho & podiatry. During this time I finally got a good understanding of foot function and learned to appreciate many aspects of the gait cycle that brought an understanding going well beyond just having read about it in a book.

One of the most enjoyable memories I have from that time is from the pediatric orthopedic clinic. 85% of the cases coming through there were gait related. The usual intoeing, flat feet, genu valgum / genu varum (knock knees / bow leggedness). Most are normal growth related conditions, as the body grows the bones and soft tissue do not develop a the same rate, causing an imbalance that is projected in the joints. Going crazy trying to correct this is not desirable in the opinion of most doctors. There are situations where there are more than just growth imbalances, those should be addressed. Not all that common but it's really up to a physician to decide when to intervene and to what degree.
Generally I agree with letting children run around barefoot as long as it's out in the grass and on the beach, not on concrete. The runners that run a full marathon barefoot have not worn shoes from the moment they took their first step, they did not grow up with pavement everywhere. Their feet actually function as intended. Once one starts the practice of wearing shoes regularly there is no way back and in our society it's not feasible to go without footwear. (lucky us)

Brendan, I like your interpretation of the big house. As long as St. Crispin has a voice in the admitting committee there is hope.

That's going to do it for tonight. Hope I haven't stepped on too many toes, didn't mean to.

Rob

Its been a while. But I am back. With 2 teenagers driving this ship sometimes... I am better late than never. I have been weathering a terrible storm and I still want to make an ortho last. So any help is welcomed. I do not have videos but I do have some still shots to demonstrate what I have.


My daughter who was my intended guinea pig was absent for the casting but no matter, she has a brother with similar issues. He is also severely flat footed. Fatter feet. Much wider feet. Shorter toes and hairy. But I learned how to wedge the foot and how to position the leg. Bones were marked with a marker on the cloth sock. A plastic tube was placed on top of electrical tape to provide a safe place to cut off the cast.
A polyester resin casting sock from a company called STS was then placed over the cloth sock. Water was used to activate the resin sock.

Now I still have to remove the cloth sock but I am told that the marks will remain. So now I want to make a plaster orthotic shoe last. Any takers?

Geri

Hi Geri
Well what a trooper.
First of many questions? What is the intended style of shoe to be boot or oxford?

In the mean time you can tape the cast closed and fill the cast with a good mix of Plaster use dental plaster instead of plaster of paris it is stronger and may cost couple bucks more. Let is set for 4 hours and peel STS off.
Regards
Brendan

Brendan,

Thanks for your speedy response. I want to make an oxford type lace up shoe that will of course fit the custom made orthotic insole, which is made of carbon steel and leather.The wdge that was used was for a 1/2" heel. Can you reccomend a good source for the dental plaster?







Geri

Also. The shoe size that my son wears is a New Balance 134E gym shoe because that is all that we can find that will fit him. I generally have to sew a little bit of leather around the topline area above the heel just to keep the shoe on his foot because the orthotic pushes his foot up and the shoe will not hold on to his foot.

Geri

Feel free to move this to another section. I'll post here since Geraldine has brought up the subject of casting socks.

I want to make casts of both legs to make a pair of custom boot trees for treeing completed boots of the over the knee and riding boot ilk. If I can simplify the procedure, I'll use it on others.

I have no one here in the Los Angeles area to help me with this. And my husband is not a candidate.

While we're in Guthrie for the Annual General Meeting in October, I'd like someone to help with the project. I'll buy and bring the casting socks.

I'll need one or several of you to help with the application. We can do this after the meeting schedule or I'll even be part of the "program" for the edification of others. After I bring the leg casts home, I'll report on the development of the trees and do a photo essay to post. I plan to cast them with resin, split them with a bandsaw and either use wedges or furniture clamp screws to activate the treeing motion.

So, I'm seeking volunteers, hopefully from those of you out there with experience with casting socks--the tall ones.

Just for the record, because I know this quest may sound weird to some, I use the metal Mallory trees for regular boots.

Any collaborators out there? Any considerations I need to evaluate before, during or after the caper?

Regards,

Georgene

Geraldine and others attempting the STS castings...
I did not see any plastic/foot leg liner used in your demo above. Maybe it was inadvertantly omitted. But I wish to warn all those attempting the STS casting method that there needs to be an impervious barrier between the skin and casting sock! This also applies to the hands of the practitioner (wear gloves).The casting socks PERMANANTLY BOND TO THE SKIN when contacting the skin! Please be careful to follow the instructions provided with this product and put the enclosed plastic bag over the foot/leg before using the sock. It is a great product, and I have no affiliation with the company, but I know there are grave consequences when it contacts skin.
David Ulan

The plastic liners are there, you can see them in the background in the first two pictures!!! Luckily Geraldine used stockinette, or her son would have had a very unpleasant time removing the STS sock. The preferred marker for casting is a water soluble indelible pencil, this would be wetted before marking up.The water in the casting resin would pick it up and transfer it to the final cast ( in a pinch lipstick works very well)however on the foot most of these landmarks are very obvious so you should be able to see them in your final cast even if the marks do not transfer.
I was under the impression that you planned to make foot orthotics, are you now planning to make shoes? If you are planning on making orthotics I can give you some tips if you let me know what style and material you want to use.
Anyone who is planning on using these socks should follow a few precautions. The resin is a water activated polyurethane resin, if you have ever used Liquid Nails, Gorilla Glue,or expanding builders foam you know how hard it is to remove from skin, it will come off but it can take days!! if you do get it on your skin remove as much as you can before it hardens, washing your hands ( or other area of contact) with white vinegar MAY help, soaking the affected area in warm water for a long time will make it easier to slough off. The best practice is to use gloves and the included plastic barrier bag, work fast after the resin has been wetted- if it has been on the shelf for a while it will set up very quickly.
Georgene, I do not think STS still makes an above knee casting sock, but there is no reason you could not buy casting plaster bandage and have someone cast your leg.Check with local medical supply houses to locate a supplier, you will need 3-4 roll of 6"x5 yards per leg ( not including the foot)

(Message edited by jask on July 21, 2008)

Thanks Jask,

The person who made the cast explained that the plastic liner is normally used. However we wanted as accurate as possible of a cast without the added wrinkles of the plastic liner. He also mentioned a product called smear...similar to vasaline that can be applied to the skin and hair to keep any seepage of resin from sticking.

I want to make a last to make orthotic shoes. So each shoe will contain its own orthotic.
It doesn't make much sense to me that a shoe is almost flat on the inside anyway.

Robert,
You were right. HMO's are now a curse word in my dictionary too. I fought with them for months over this.

Geri

Geri,
Did you utilize a casting platform with half inch heel pitch and a one quarter inch wedge under the toes tapered to the ball of the foot for toe spring?Just thought I`d ask because these are 2 factors important to your shoe last design.

Georgette,

I do hope to make Guthrie this year and would be happy to help you cast in AFO STS socks.Is heel height a consideration.I think it should be maybe just to capture the ankle plantarflexion and toe spring for posterity`s sake,whatever that means.
Also in regard to a spiral wrap with 4 inch plaster bandage a preliminary elastic/plaster bandage wrap helps capture soft tissue with compression.The down side is needing a cast saw.

Rob and Brendon,

Recently I casted for an orthopedic last using a combination of a non weight bearing slipper cast capturing the metatarsal arch with extra fast setting plaster splints,to the MPJ 1 through 5 then incorporated a bi valve method with the casting platforms etc and proceded to fabricate the lasts.I have lowered the arches to not irritate or overcorrect for a very sensitive client.So far I have made the orthotic insoles and a trial shoe out of sealing tape and cork bottoms with wedges and lift for leg length discrepancy.

My reason for the first part slipper cast was to get an accurate metatarsal support even though I have done so with the sts sock,so I was wondering if you would be so kind to give this some thought and offer your instintive feedback.Thank you kindly.

To All,

I have mostly been following all threads in the past few months and have been building and remodeling home,shop and clinic for over a year and just been way busy with clients etc.....

Many pairs of shoes in process and will start getting back to the digital camera soon as I feel I owe it to all the generous members out there since I am learning with you all.Thanks!

Peace,Fred

Hi Fred
I have used plaster on the bottom of the foot and STS over it for volume. This worked well. The STS is a great product but dosn't capture fine detail like you describe.
And for casting with a heel and toe spring wedge is something I use often and wondered about that with Geri's casting.
As for renovation we had a storm blow threw here last night and I have a few trees down so out comes the chain saw! Must have had two-three inches or raIn in 3 hours.
Regards and slighty wet
Brendan

Fred,

The person casting my sons foot was told that I am trying to make an orthopedic shoe. They told me that this is exactly what they a do when they hand this over to a shoemaker. They did use a wedge that was covered with a layer of foam. The extra layer of foam went past to toes. They found the spot on the wedge that measured 1/2" and marked a line on the top surface to line up the heels to. I do not recall if anything was specifically added for toe spring. Actually I am pretty sure that there was not. If not, is it too late to fix that? Do I need to recast the foot?

Thanks, Geri

Geri,
You need toe springwith 1/2"heel height .You will have to add plaster to the top forepart of your plaster last and grind away the bottom part under the toes from the distal part of the met heads to the end of the toes in order to not drive the end of the toes into the ground.

I suggest to place a 1/2" block under the heel of your cast and see the toes touching the ground devoid of toe spring.

The finished shoe should have at least 1/2"height at the toe.Probably 3/4" for your sons 13 EEE,OK.

Fred,

Thanks. Thats great to know that these cast are salvagable. And more toespring for fatter wider feet or is that just a general rule in accordance with the general long length of the foot?


Geri