The Truth about Direct-Milled Orthotics

Fall 2013
THE ORIGINAL NEWSLETTER OF APPLIED PODIATRIC BIOMECHANICS
The Truth about Direct-Milled Orthotics
By Dr. Glenn Cornwell DPM, Director of Paragon Orthotic Laboratory
There has been a lot of misinformation, if you will, about
direct-milled orthotics. This article will help you to
understand the technology.
In my opinion, the direct-milled device is superior to
thermo-formed devices because the corrected information to
mill the device is applied to the actual device. Eliminating
the step of making a model (mold), and then thermo-forming
material over that mold, effectively removes all possible
errors in the process. Also, thermo-forming weakens
chemical bonds in the material.
Empirically, I have experienced superior clinical results in
my private practice with direct milling over all the various
materials we have thermo-formed over the last 32 years.
This is especially true in the accuracy and longevity of the
rearfoot and forefoot posts. I believe if more doctors started
checking the rearfoot posts at two-month, six-month, and
one-year intervals, they would be amazed at how much
accuracy has been lost on thermo-formed devices.
The paradox is that very few laboratories promote the use of
direct-milled orthotics and, in fact, disparage the device as
inferior or cheap, etc. Most do not even offer the device. I
think the reason for this in most cases is lack of knowledge
and/or capital to invest in the high-tech equipment needed to
mill these devices.
We have found that to produce high-quality devices, a highend mill has to be dedicated to just making them. Our mill is
the same as is used in the aerospace industry. Then to get an
effective finish, a two-step polishing process is required.
A lot of clinicians will not use the device because of the way
they look. When I explain to my patients in detail not only
about how the posting works but the direct-milled process,
how it is made and the superior durability of the device, they
are thrilled and could care less about covers, extensions, etc.
We do direct mill a covered orthotic, the Unitized, for those
doctors who have to have a cover and/or an extension. Some
doctors have told us they have tried direct-milled devices
and found them too inflexible. Although the flexibility can
be varied, I recommend using the most flexible type for 98%
of patients. I find the rigid and the standard orthotics too
inflexible for most.
s
~200
5
on Orth
ag
38
rs
nce
1975
2013
l
le
Upcoming Events
r
3
s Pa
Tips on Adjusting Orthotics
75
ics s
ot
2
9
a
3 7 Ye
The Truth about Direct-Milled Orthotics
1
1
of Exc
rs
lence s
el
30 Yea
I prefer the UFO direct-milled device because I can
make almost any kind of adjustment in my office using a
sani-grinder. But most of all I like the accuracy which is
unequivocally superior to thermo-formed devices.
of Exce
Making Technology Work Through Knowledge and Experience
ParagonNews-Fall2013-Final.indd 1
9/5/13 4:19:09 PM
Tips On Adjusting Orthotics
by Glenn Cornwell, D.P.M., Director, Paragon Orthotic Laboratory
Orthotic Length is Critical
Having an adjustment center in your office can improve the
effectiveness of your orthotics as well as save you time and
money. Here I will show how to do some basic adjustments as
well as give you some tips on designing an adjustment center.
Back to adjusting a laterally long orthotic. Shown in
picture #3, is a sani-grinder with 3" fine sanding drum.
Simply reduce the length to the grease marks and re-bevel
the dorsal distal edges.
Dispensing Orthotics
The first step in dispensing an orthotic is to check the
orthotic length against the foot. The metatarsal heads 1, 2,
and 5, should be marked by putting a dot in the approximate
center of the metatarsal head (see picture #1). The distal end
of the orthotic should come to approximately 1/8" to no more
than _" to _" from these dots (see picture #2).
At this point I would like to discuss orthotic materials.
One of the reasons I like to use the Unitized Functional
Orthotic is because of the fact it has no covers and is nontoxic to grind. Materials such as carbon graphite should
have forced ventilation when adjusting by grinding. Also,
the fine sanding drum rarely has to be changed when
grinding polypropylene or polyethylene. Other materials can
require frequent changing and lower grit grades of sandpaper.
The most common problem is the orthotic is too long
laterally. Mark the orthotic using a grease pen
(see picture #3).
Adjusting rearfoot post angles (see picture #4). To decrease
grind at angle to effectively remove small amounts of
material, check the angle on a flat surface prior to grinding
and compare periodically until you have desired point (see
picture #5). N.B.: In some cases you might go through
the plantar aspect of the orthotic creating a dimple or
even a hole.
At this point I would like to discuss orthotic length. Because
orthotic laboratories do not actually have the patient present
in order to check the orthotic length, they must make an
educated guess as to where to end the distal aspect of the
orthotic. If the orthotic is too long the patient may or may
not complain about it. However, if the orthotic is too short
the patient usually never complains. In both instances, but
especially the latte, significantly decreased clinical results
will occur.
This will not adversely affect the function of the orthotic.
1
3
2
4
continued on page 3
ParagonNews-Fall2013-Final.indd 2
9/5/13 4:19:11 PM
Tips On Adjusting Orthotics
continued from page 2
Adjusting the calcaneal inclination angle or medial arch height
(see picture #6 and picture #7).
7
Grind the dorsal medial edge of the orthotic after the appropriate
amount of material has been removed; smooth by lightly touching
with grinding wheel and/or use scissors to smooth (see picture #8).
These are just some of the many adjustments you can make with
your sani-grinder. When designing your adjustment center (see
picture #9), use PPT or Poron under the Sani-grinder. Do not bolt
down. A _” glass tabletop is preferred to make it easy to remove
dried glue, etc. Ventilation is a must when grinding acrylics, but
not necessary for polypropylene or polyethylene.
If there are any questions about adjustments, etc., please call my
office Monday to Wednesday. I will be happy to assist you.
8
5
9
6
UPCOMING EVENTS
October 4 & 5, 2013
2013 CFPM Annual
Conference
International Plaza Hotel
(formerly the Doubletree
by Hilton)
655 Dixon Rd., Toronto, ON
1-800-668-3656
www.podiatryinfocanada.ca
January 19-26, 2014
International Foot and
Ankle Foundation
Western Caribbean Cruise
Winter Seminar at Sea
RCCL, Freedom of
the Seas
www.international
footankle.org
February 13-15, 2014
Lake Tahoe Ski Seminar
South Lake Tahoe,
California
The Lake Tahoe Resort
www.international
footankle.org
July 24 - 27, 2014
The National 2014 APMA
Annual Scientific Meeting
Hilton Hawaiian Village
and Convention Center
Honolulu, Hawaii
www.apma.org
Paragon News is published three times annually by Paragon Orthotic Laboratory in the interest of enhancing foot health. Entire contents
copyright Paragon Orthotic Laboratory, 2013.
ParagonNews-Fall2013-Final.indd 3
9/5/13 4:19:12 PM
1. Accuracy. Our Hass milling machine is the same milling
machine that makes Boeing Aircraft Parts. You can’t get
more accurate than this. If you have tried direct-milled
products from other labs and been disappointed, the
major reason could be the milling machine was designed
to build furniture.
2. Low bulk. This is especially attractive for women. All too
often bulky orthotics are the reason for non-compliance,
especially in women’s lower profile footwear.
3. Durability of the posting systems. Nothing lasts longer –
Period. Most other types of orthotics will lose their post
angles significantly within a year.
4. Lower price.
5. Works best in heels 1½" or less.
6. Adjustability. With a sani-grinder the length, the arch
height and the posts can be adjusted in minutes.
UFO
UÊ "ÛiÀÊÎxÊÞi>ÀÃʜvʜÀ̅œÌˆVÊ
“>˜Õv>VÌÕÀˆ˜}ÊiÝ«iÀˆi˜Vi
UÊ ˆ}…ÞÊÌÀ>ˆ˜i`ÊÌiV…˜ˆVˆ>˜ÃÊÊÊ
UÊÊÊiÀœÃ«>Viʓˆˆ˜}ÊÌiV…˜œœ}Þ
Most importantly, patients find that the UFO, while simple
in its appearance, has the look of a high-tech orthotic. Its
ergonomic design, together with its smooth, polished look,
makes it stand out above the standard orthotic. Placing layers
of accommodations and extensions not only reduces the
bio-mechanical functionality of an orthotic, it increases the
chances of your patients coming back for minor (and major)
adjustments.
With the UFO’s simple sleek design and a high-tech aircraft
manufacturing production process, we have a product that has
as much eye-appeal as an orthotic with all the accommodations
and extensions typical in the marketplace – and with less
repeat visits. It’s up to the practitioner to remind the patient
that ‘less is truly more’ (but at the same price you charge them
for standard orthotics with all the bells and whistles!).
For our complete catalogue and details call 1-800-665-8900
details
call 1-800-665-8900
For our complete catalogue and UK
toll-free:
0808-1000-631
UK toll-free: 0808-1000-631
Email: info@paragonorthotic.com Web: www.paragonorthotic.com
Email: info@paragonorthotic.com
Web:
www.paragonorthotic.com
1650 Cedar Hill X Road
Victoria,
BC Canada V8P 2P6
1650 Cedar Hill X Road Victoria, BC Canada V8P 2P6
MAKING TECHNOLOGY WORK THROUGH KNOWLEDGE
Making Technology Work Through Knowledge
ParagonNews-Fall2013-Final.indd 4
AND
and
EXPERIENCE
Experience
9/5/13 4:19:13 PM