Cast; Casting for Orthotics

There are a number of ways to cast the feet and I am going to show you one of them. Foam impressions are the most popular casting procedure in chiropractic. It is very important to learn how to cast the foot in the neutral position, so that you and the lab can see and measure the degrees off of true horizontal the foot assumes, if any.

Sitting is the preferred position to foam cast a patient. This allows the doctor to better control the depth of the impression.

The doctor should be facing the lateral side of the foot being cast. Place the foot directly over the open foam impression box, making sure the knee is directly above the ankle.

With your rearward hand, lift the foot into dorsiflexion at the 4th and 5th metatarsal heads to prepare for finding neutral position.
Place your forward hand finger and thumb into the medial and lateral fossas of the talo-navicular joint and find the congruency of the subtalar neutral position. When neutral position is found, use the fingers and palm of this hand to grasp the midfoot to hold this position.
Now remove the rearward hand from the metatarsal heads, and grasp the rear and sides of the calcaneus to prevent any lateral movement.

Now guide the foot down into the center of the foam cast one half the depth of the foam. Do not have the patient step into the foam.
Here is where most people have trouble getting neutral. To achieve neutral, you must now release the hand around the calcaneus and place a finger each on top of the 4th and 5th metatarsal heads. Press down on these deeper into the foam until tissue resistance of the lateral foot stops you.