There are many ways to modify and customize QUADRASTEP® and littleSTEPS® orthotics so that you get the perfect fit for your customer. You can add some of the modifications yourself, or have us do it for you for an additional cost. If you have any questions about modifying your orthotics contact us.
Adding a topcover is a great way of adding additional cushioning to our range of orthoses. Many runners and athletes like topcovered orthoses to provide extra shock-absorption and cushioning. As people age their own intrinsic fat pads under the plantar surface of their feet that provide natural cushioning can get thinner and atrophy over time. In this case adding a topcover for extra cushioning would be indicated. Just keep in mind that adding topcovers can add bulk and may make it more difficult to get their orthotics in "fashion" shoes. Extra depth footwear with a cushioning sole in addition to their orthotics may be indicated, especially for older or diabetic patients. Topcovers can also be used to reduce the amount of shear and protect bony prominences.
Topcovers can be the length of the device only, ¾ length or to the sulcus or full-length. If shoe fit might be a problem consider ordering a ¾ length or sulcus length topcover.
Our topcovers are typically made from J-foam which is low-density EVA closed-cell foam (35-40 durometer). All foam materials bottom-out over time and a topcover will need replacing every 6-12 months, depending on typical use and the weight of the patient.
Heel Lifts are used unilaterally in the case of a leg length inequality on the shorter side or can be used bilaterally to take strain off the Achilles tendon. We recommend that you try a temporary heel lift first to determine the exact amount of lift needed before adding a permanent heel lift to your patient's QUADRASTEP® or littleSTEPS® orthotic devices. Our prefabricated "peel & stick" heel lifts are available in 4mm, 6mm & 8mm heights. Or we can do a customized heel lift height to your exact specifications. The maximum amount of heel lift that you can normally add to an orthotic is 10-12mm, more than that and the patient won’t be able to get the device in their shoes. Any additional lift amount needed to correct for a larger leg length inequality would best be added to their footwear.
If you feel that your patient needs additional extrinsic posting, either forefoot, rearfoot or both, you can use our "peel and stick" posting material which is included in the Widget Kit, or can be purchased separately. This wedge shaped material allows you to change the degrees of additional posting depending on where you place the wedging material. If you place the wedge all the way under the orthotics so the thickest part if under the medial edge of the device you will get the maximum amount of correction and the highest number of degrees of additional posting. If you need less correction, start with the narrowest part and don’t place the entire wedge under the orthotic, then trim off the excess with scissors once the desired amount of correction has been achieved. This is best done while the patient is standing on the orthotics to see the desired amount (number of degrees) of correction.
The purpose of metatarsal domes is to restore the transverse metatarsal arch. They work by lifting the 2nd, 3rd & 4th metatarsals to redistribute more weight onto the 1st & 5th metatarsal heads. This distribution is meant to place the foot in a more stable tripod position. Those Quads like D & F , that have a transverse metatarsal arch reversal tend to find a metatarsal dome or mound very comfortable. Often the E Quad which has a rigid Forefoot varus finds Metatarsal Domes hard to tolerate because the rigid forefoot tends to slide off the edge of the dome.
We commonly get asked if an office can do their own customization on our QUADRASTEP® and littleSTEPS® prefabricated foot orthoses. We sell a number of items like heel lifts, metatarsal domes and wedges that are "peel & stick" and are easy to apply in an office setting. They can be trimmed around the edges to remove excess material (if needed) using scissors, no grinder or specialized lab set-up is needed.
Our Widget Kit is a sampler of the common items like heel lifts, met domes and wedge material (to add additional posting) that you can add to our orthotics to make many common modifications to them.
If you just want heel lifts you can order them separately. These come in 4mm, 6mm or 8mm, so you can get the precise amount of heel lift that you want, which is very useful for treating leg length inequality. You also have the option to change the amount of lift over time by removing one size and then adding another size. The self-sticking adhesive sticks very well, (but it can be removed) and the material used has a decent amount of durometer and strength. It is very durable and long lasting, especially with children, but with some adults who are heavier you may decide you want to use a stronger more durable material for longer terms results. Using these peel and stick lifts on a trial basis first can allow you to work out the precise amount of lift that will work best for your patient before more permanent modifications are made to the orthotic.
Widget Kit include: A pair each of heel lifts/elevators in 4mm, 6mm & 8mm and one pair of metatarsal domes/mounds, plus 4 pieces of wedge material for posting.
The Widget Kit is a very cost-effective way to make instant modifications to your QUADRASTEP® and littleSTEPS® orthotics, and a great way to sample and try all the self-adhesive widgets that are available and find out which ones you like the best or would use the most. If you wish to purchase a Widget Kit or separate components contact us for pricing.
About 30% of the population has two quite different feet that may be different Quads, this is especially the case where there is a leg length inequality. Keep in mind, that we sell our QUADRASTEP® orthotics as singles, so it is possible to order one Quad for the left foot and another Quad for the right foot. Often someone with a leg length inequality has a supinated foot on the shorter side and a pronated foot on the longer side. Make sure that you get the correct foot type for each foot and order two different Quads as needed. In the case of a leg length inequality it may also be appropriate to add a heel lift to the shorter side.
On the extended-length Quad designs, which are also generally more corrective, you may need to grind back parts of the device. This can be done in-house if you have the facilities to make orthotic adjustments or we are happy to this for you. The most common adjustment that may need to be done to the sulcus-length devices, A, E & F, is to shorten the anterior edge because the forefoot posting is too long. When checking for fit, it is important to get the right fit based on the main shell of the device when the forefoot extension may be too long and would need to be ground back. To improve fit in shoes, flares or flanges can be ground back slightly but keep in mind that this will reduce the amount of correction. Often you need to balance the amount of correction desired with what will fit in shoes but in the most severe cases that need more correction it is better to get the patient to change into appropriate extra depth and width footwear to accommodate the orthoses that are really needed to achieve optimal results. After all, all orthoses only work as well as the shoes you put them in and if the shoes aren’t appropriate then results will be compromised.
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