Education Center

Clinical Notes from the Lab

Shell Material & Rigidity

Polypropylene in Flex (2 mm), Semi-Rigid (3 mm) or Rigid (4 mm); rubber cork for an adjustable accommodative-functional hybrid; carbon fiber for the thinnest rigid shell.

Shell Width

Narrow, standard or wide trim of the shell to fit the footwear the patient actually wears.

Heel Cup Depth (0–34 mm)

Deeper cups grip the calcaneus and contain the fat pad; shallower cups fit lower-volume shoes.

Arch Height

Sets how much of the captured arch the shell keeps — lowered for comfort and tolerance, standard, or raised for maximum arch contact.

Morton's Extensions (L/R)

Shell extensions under the first ray (to toe or sulcus) or reversed under rays 2–5 — see the device catalog for each variant.

Reverse Morton's Extension

A forefoot extension under rays 2–5 that leaves the first ray unsupported, letting the first met head drop and plantarflex.

Medial / Lateral Flange (Low–High)

Raises the shell edge into a wall along the arch (medial) or lateral border, blocking the foot from escaping the device.

Lateral Clip

Raises outer heel-cup extension that improves heel containment and rearfoot stability.

Heel Punch Out

An aperture in the shell under the central heel, backfilled with soft material.

1st / 5th Ray Cut Out

Removes shell under the named ray so it can plantarflex freely off the device edge.

Cuboid Offload

A relief under the cuboid with surrounding support, unloading the lateral midfoot.

5th / Navicular Button Out

A localized bulge or relief pressed into the shell over a bony prominence.

Fascia Groove

A channel ground along the shell’s medial arch so a taut plantar fascia sits in relief instead of on the shell.

Left unchecked, lab standards apply: semi-rigid 3 mm polypropylene, standard width, medium heel cup, post to neutral, 1/8" neoprene top cover full length, 1/16" urethane cushioning, non-perforated vinyl bottom cover.

Post to Lab Standard

The default when unchecked: post to neutral with an extrinsic rearfoot post and intrinsic forefoot post.

Extrinsic / Intrinsic

Extrinsic posts add material to the outside of the shell; intrinsic posts are built into the shell from the corrected positive, keeping the device thinner.

Forefoot Post (varus / valgus °)

Angles the forefoot platform — extrinsic (added material) or intrinsic (ground into the shell) — to support a forefoot-to-rearfoot deformity at your specified degrees.

Rearfoot Post (varus / valgus °)

Controls the heel at contact; a varus post resists pronation, a valgus post resists supination. Extrinsic posts add control, intrinsic keep the device slim.

4/4 Motion

The classic Root rearfoot post: 4° varus with 4° of motion ground into the post, letting the heel pronate through contact before the post takes control.

1–5 / 2–5 Forefoot Post Bar

A full-width bar posting the selected rays as one platform for even forefoot loading.

Medial Heel Skive (mm)

A wedge ground into the medial heel of the positive model, tilting the heel cup to add a supination moment — stronger pronation control without bulk.

Lateral Heel Skive (mm)

A wedge ground into the lateral heel of the positive model, tilting the heel cup to add a pronation moment — the mirror image of the medial skive.

Medial / Lateral Wedge

A wedge added under the heel or the full device, tilting the whole platform medially (varus) or laterally (valgus) by the degrees specified.

Heel Lift (mm)

A lift built under the heel of the device, per side.

Posting Material

Polypro and EVA cork are firm and durable; EVA and rubber cork trade some control for shock absorption and easy grinding at chairside.

Met Bar (1–5)

A full-width bar placed just proximal to all five metatarsal heads, shifting load onto the metatarsal shafts.

Met Pad (2–4)

A teardrop pad proximal to the central met heads that lifts and separates the metatarsals, unloading heads 2–4.

Heel Pad

A cushioned pad under the calcaneus for added shock absorption at heel strike.

Horseshoe Pad

A U-shaped heel pad with a central relief that suspends the tender central heel while supporting its border.

Neuroma Pad

A small dome placed just proximal to the involved interspace to spread the met heads and decompress the nerve.

Toe Crest Pad

A crest filling the sulcus beneath the toes, supporting them and taking pressure off the distal tips.

Dancer's Pad

A pad relieved under the first met head, transferring load laterally to protect the sesamoid complex.

Scaphoid Pad

A medial pad under the navicular reinforcing arch support beyond what the shell alone provides.

Arch Pad

A soft pad along the medial longitudinal arch on top of the shell, adding arch contact and cushioning without changing the shell.

Medial Flap

An extension of cover material carried medially over the arch for added contact and comfort at the medial border.

Arch Fill (EVA or Cork)

Fills the void between the shell arch and the ground, stiffening the device and preventing shell fatigue. Cork is the firmer fill.

Met Balance Pad (by ray)

Selective padding under chosen rays (mark 1–5, L/R) to balance the metatarsal parabola around a plantarflexed or unstable ray.

Met Punch / Off-Load (by ray)

A punched-out relief under a specific met head (mark 1–5, L/R), backfilled soft, for total off-loading of one lesion.

Sweet Spot

Mark any off-load area on the plantar view and the lab builds a custom relief exactly there.

No Top Cover

Shell only — the thinnest possible device, wiped clean in seconds.

Neoprene (1/8", 1/16")

Resilient closed-cell rubber cover with good rebound and shear reduction; springy underfoot.

EVA (1/8", 1/16")

The general-purpose cover: firm cushioning, durable, grinds cleanly at dispensing.

Accuzote (1/8")

Soft cross-linked PE foam that heat-molds to the foot for total contact; protective rather than corrective.

Urethane (1/8", 1/16")

Open-cell urethane (PPT-type) that absorbs shock and shear without bottoming out over time.

Vinyl (perforated / non-perf.)

Low-bulk wipeable finish; perforated version breathes for moisture control.

Leather (upcharge)

Premium full-grain top: breathable, durable, and the classic dress-device feel.

Cushioning middle layer

A layer of urethane, EVA or Accuzote laminated between shell and top cover — adds shock absorption without changing the shell’s control.

Full length

Cover or cushioning runs heel to toe — maximum protection and a finished look.

To Shell

Cover or cushioning ends at the distal edge of the shell — the lowest-volume option, with nothing forward of the device.

To sulcus

Ends just behind the toes — near-full protection with less toe-box bulk.

Sulcus Extension

Extends the cover or cushioning past the shell to the sulcus, padding the met heads without adding bulk under the toes.

Forefoot Extension

Extends the cover or cushioning past the shell under the whole forefoot to the toes, carrying forefoot pads and accommodations.

Bottom cover

Vinyl (perforated or non-perforated) or nonwoven fabric sealing the underside of the device against wear and moisture.

Tri-Laminate (Lab Standard)

1/8" pink Zote Foam over 1/16" blue PPT over an EVA base, medium density, medium heel cup — the standard A5513 total-contact build.

Zote Foam Top (1/8", 1/16")

Heat-moldable cross-linked PE that conforms to the foot for total contact with near-zero shear on the skin.

PPT Cushioning (1/8", 1/16")

Open-cell urethane middle layer that keeps absorbing shock and shear without bottoming out.

Base: EVA / Cork EVA / Cork

The structural bottom layer; cork blends are firmer and more supportive, EVA softer and more forgiving.

Base Density (Soft–Hard)

Sets how much the whole insert gives underfoot.

Heel Cup (Low–Deep)

Deeper cups center the heel and contain migrating fat pad.

Toe Filler / TMA

Fills the void of missing digits (mark 1–5) or a transmetatarsal amputation, restoring shoe fit and stopping the foot from sliding forward.

Elongation & Toe Box Height

Standard elongation is 5/8" beyond the tracing; specify more, or a high toe box (+1/4" or measured), to clear the toes vertically.

Match to Length / Short Shoe

Matches one shoe’s length to the other, or builds a shortened shoe for the affected side.

Closure: Laces / Velcro®

Velcro closures don and doff one-handed.

Opening: Regular / Semi-Surgical / Surgical

How far the upper opens: a surgical opening lays the shoe fully open for easy entry.

Lining: Soft Cloth / Mesh / Leather

The material against the skin — soft cloth is seam-friendly and protective, mesh breathes, leather wears longest.

Tongue & Collar Padding

Extra padding — or a neoprene collar — cushions the instep and ankle against pressure.

Soling: Light / Heavy Duty / Rigid

Sets outsole weight and stiffness — lighter for frail walkers, rigid to pair with rockers and shanks.

Forefoot / Mild Rocker

Curves the sole in front of the met heads so the shoe rolls instead of the forefoot bending.

Heel-to-Toe Rocker

A continuous rocker from heel strike through toe-off, substituting for lost ankle and MTP motion.

Severe Angle Rocker

A steeper, more aggressive forefoot rocker for maximum forefoot pressure relief.

Double Rocker

Rockers fore and aft of the midfoot, unloading its center.

Negative Heel Rocker

Sets the heel lower than the ball, shifting load rearward off the forefoot.

Rocker Bar

A simple external bar just behind the met heads — the lightest-touch rocker option.

Steel Shank (3/4" / Full)

Stiffens the sole so rockers work and the shoe can’t flex at the met heads.

Bevel / SACH / Snug Heel

Bevel eases heel-strike rollover; SACH adds a cushioned heel wedge to absorb impact; snug narrows the heel seat.

Reinforced Heel Counter

A stiffened counter that grips the rearfoot and resists collapse.

Flares, Buttresses & Wedges (M/L)

Widen the outsole base (flare), extend it up the upper (buttress), or tilt it (wedge) — medial or lateral — to resist roll toward that side.

Build-Ups (Heel / Ball / Toe)

External outsole lifts at the measured heights, per side.