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Foot Orthotics

Order Form Guide

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Professional Foot Orthotics Order Form
Professional Foot Orthotics Order Form Professional Braces Order Form

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Page 1 of 2

Clinician Information

Patient Information

Methods & Optimizations

Materials

Page 2 of 2

Pronation Corrections

Supination Corrections

Extensions

Offloading Pads & Cushions

Frame Modifications

Key words:

foot impression frame fabrication methods Top Cover Prolite Orthotics
  • Page 2
  • Frame Modifications
  • Heel Lift

Heel Lift

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Rx form option box:

 

Extrinsic elevation of orthotic heel inferior of the frame and rearfoot posting

FUNCTIONS:
• Elevates heel
• Balances leg length discrepancy

CLINICAL INDICATIONS:
• Leg length discrepancy
• Moderate to severe equinus
• Inflamed plantar fascia
• Achilles Tendonitis
• Plantar Fasciitis

A heel lift is additional rigid to very rigid (65-75 Shore A) EVA material added to the inferior heel area of a device’s frame. When a heel lift’s height is increased above 6mm, the lift will occupy more space on the device by extending beneath the frame’s arch where it tapers toward the distal edge.

CLINICAL PEARL
Please keep the patient’s shoe gear in mind when selecting this modification. A maximum of 3-6mm for athletic and dress shoes is recommended.