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What is a Balanced Orthotic Device? Part 1 | KevinRoot Medical

 1. Forum
 2. Dr. Blake
 3. Clinical pearls
 4. What is a Balanced Orthotic Device? Part 1


WHAT IS A BALANCED ORTHOTIC DEVICE? PART 1

--------------------------------------------------------------------------------

   
   
   
 * Richard Blake KRM team
   7d
   
   This is the part 2 of a series that should be read in order.
   
   Key Points: What are Balanced Orthoses?
   
                        What is the Difference between B1 and B2?
   
                        What does the impression we Capture have to do with any
   heel correction we want?
   
                         What are Modified Root Corrections?
   
                         Goal: Have your Measurement of FF/RF Deformity within 4
   Degrees of your cast/scan impression when making a B1 Device.
   
                          In +/- scale, Forefoot Varus is (-) and Forefoot
   Valgus is (+)
   
                         Up to how much Forefoot Balancing of Forefoot Varus is
   typical without blocking first ray plantarflexion using full correction?
   
                          One of the Modified Root Corrections Uses A
   Combination of Intrinsic and Extrinsic Varus Posting with Forefoot Varus
   
                           Review below of all orthotic types 
   
   
   
   
   
   
   
   Typical KevinRoot Balanced Orthoses
   
    
   
        The Balanced Orthosis is designed for both balance and support to the
   foot and lower extremity. It is symbolized by B and divided into B1 and B2.
   B1 is your classic Root forefoot to rearfoot balancing. It is my Gold
   Standard device that I grew as a Podiatrist using. B1 requires that the
   casting or image collection be a non weight bearing suspension technique
   captured with the subtalar joint in neutral position and the midtarsal
   joint(s) be maximally pronated. The impression of the foot shows the forefoot
   deformities and not heel position to the ground. Below, I demonstrate a
   positive cast with either a forefoot varus or valgus deformity. Will you want
   to push the heel to vertical or inverted or everted to the ground in each
   case? If you are balancing the forefoot deformities completely, you are
   centering the heel to vertical. Since many patients have rearfoot
   deformities, or other needs, the heel may ultimately be inverted or everted.
   The classic Root balancing can be prescribed with FF/RF angles in varus (-)
   or valgus (+) degrees. I have previously discussed the maximum limits of
   classic Root balancing as 5 varus and 20 valgus. Some laboratories have
   methods to achieve more correction by some modification of the original
   technique. I call this Modified Root corrections. Here I must emphasize the
   importance of learning the Forefoot to Rearfoot Measurement, and some
   Podiatrists just utilize the degrees captured in the cast. Generally, there
   appears to be a standard 4 degree margin of error in the measurement and what
   is captured in the casting/imaging, but occasionally I am spot on. 
   
    
   
   
   
   Positive Casts showing Forefoot Varus (left) and Forefoot Valgus (right)
   
    
   
       One of these Modified Root corrections with widespread usage (especially
   in forefoot varus feet) is typically done to achieve a 50% overall
   correction. Therefore, if 20 degrees of forefoot varus is captured in the
   cast/image, only 10 degrees will be corrected. Of these 10 degrees, 5 degrees
   is posted intrinsically and 5 degrees extrinsically. I have not seen over 20
   degrees of forefoot varus supported with Root techniques. This allows partial
   correction of -6 to -20 (varus) degrees of forefoot deformity, and full
   correction of +20 (valgus) to -5 degrees (varus) of forefoot deformity. With
   me?
   
    
   
        I will discuss B2 in the next post, not used in Forefoot to Rearfoot
   Balancing. B1 however really helps when we are attempting to place a foot
   near Subtalar Joint neutral. I have attached a post from my personal blog
   with more information here. 
   
   
   
   
   
   Review of Orthotic Types:
   
             Corrective Orthotic Devices
   
                                     ↓
   
    * Balancing (B): (B1 and B2)
    * Pronators (P): BP, P1, P2, P3, P4, P5, and P6
    * Supinators (S): BS, S1, S2, S3
    * M/L Instability (M): BML, ML1, ML2, ML3, ML4, ML5, and ML6
    * Shock Absorption (C): BC, C1/C2, C3/C4/C5, C6, and C7
    * Sagittal Plane (H): BH, H1, H2, and H3
   
    
   
    
   
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