PATHOLOGY ORTHOTICS
Transcript of PATHOLOGY ORTHOTICS
PATHOLOGY ORTHOTICS
9960 Indiana Ave. Suite #15 Riverside, CA 92503 Phone: (951) 353-8127 Fax: (951) 353-8107
___ Pes Cavus Orthotic Description:• 3mm Polypro shell• RF Post Neutral Extrinsic• Deep Heel Cup• 3mm Black Spenco Top Cover To Toes• 3mm Eva Valgus Extension• Suede Bottom Cover To Toes
Patient Information: Patient Name: ____________________________ Address: __________________________________ City:_____________State:_______ Zip:_________Age:____Sex: M F Weight:____Shoe Size:_____
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Account InformationPractitioner: __________________________________Address:_____________________________________City:__________ State:___ Zip:____________Telephone:________________ Fax:________________
__Achilles Tendinitis Orthotic Description:• 3mm Polypro Shell• RF Post Neutral Extrinsic• Deep Heel Seat• 3mm Black Spenco Top Cover To Toes• 2mm Blue Poron Extension• 4mm Heel Lift: Relieve pressure on tendon
__Calcaneal ApophysitisOrthotic Description:
• 3mm Polypro Shell• Extra Deep Heel Seat• RF Post Neutral Extrinsic• 4mm Medial Heel Skive• 3mm Heel Lift: Relieve pressure on tendon• 3mm Black Spenco Top Cover To Toes• 3mm Heel Cushion
___Pes Planus-Flatfoot : (Device provides medial control) Orthotic Description:
• 3mm Polypro Shell• Deep Heel Seat• 4R RF Extrinsic• Medial Flange• 3mm Black Spenco Top Cover• 2mm Blue Poron Extension To
Toes
___Plantar Fasciitis Orthotic Description:• 3mm Polypro Shell• RF Post Neutral Extrinsic• Deep Heel Seat• 3mm Black Spenco Top Cover To Toes• 2mm Blue Poron Extension To Toes• Heel punch W/ Visco plug to reduce pain
*Additions:____2mm Heel Cushion & 3mm Heel Spur Pad (Max Cushion)____P.F. Groove
__ Sesamoiditis Orthotic Description:• 3mm Polypro Shell• Deep Heel Seat• RF Post Extrinsic 3 Degrees Varus• 2mm Medial Heel Skive• 3mm Reverse Morton's Extension• 3mm Black Spenco Top Cover To Toes• Suede Bottom Cover To Toes• 1st Ray Cut-Out
___Functional Hallux Limitus: Orthotic Description:
• 3mm Polypro Shell• RF Post Extrinsic 2 Degrees Varus• Deep Heel Seat• 4mm Medial Heel Skive• 3mm Reverse Morton's Extension• 3mm EVA Top Cover To Toes• Suede Bottom Cover To Toes
__ Neuroma Orthotic Description:
• 3mm Polypro Shell• Shallow Heel Seat• RF Post Intrinsic 2 Degrees Varus• Neuroma Pad 3rd Innerspace• 3mm Black Topper To Sulcus• 2mm Poron Extension To
Sulcus• Suede Bottom Cover To Sulcus
___MetatarsalgiaOrthotic Description:• 3mm Polypro Shell• Standard Heel Seat• RF Post Extrinsic 2 Degrees Varus• 3mm Met Bar• 3mm EVA Swirl Top Cover To Toes• 2mm Poron Extension To Toes
___Pediatric Flat Foot:Orthotic Description:
• 3mm Polypro Shell• Medial Flange• RF Post Extrinsic 4
Degrees Varus• Deep Heel Seat• 4mm Medial Heel
Skive• 3mm EVA Top
Cover To Toes
____Lateral Ankle Instability: Orthotic Description:
___ Gait Plate:Orthotic Description: • 3mm Polypro Shell Gait
Extension• Standard Heel Seat• RF Post Extrinsic Neutral
__Posterior Tibial Tendon Dysfunction:Orthotic Description:(Adult Acquired Flatfoot)
• 3mm Polypro Shell• Deep Heel Seat• Medial Flange• RF Post 4R Extrinsic• 3mm EVA Paisley Top Cover To Toes• EVA Medial Arch Filler
__Sinus Tarsi SyndromeOrthotic Description:
• 3mm Polypro Shell• Deep Heel Seat• RF Post Extrinsic Neutral• 4mm Medial Heel Skive• 3mm EVA Swirl Top Cover To Toes
__Tarsal Tunnel Syndrome Orthotic Description:
• 3mm Polypro Shell• Deep Heel Seat• RF Post Extrinisc 2 Degrees Varus• 4mm Medial Heel Skive• 4mm Heel Lift• 3mm EVA Swirl Top Cover To Toes
• Deep Heel Seat• 3mm Ploypro Shell• RF Post Neutral
Extrinsic• Medial Flange• Lateral Flange• 3mm Black EVA Top
Cover To Toes 3mm Valgus Extension
• Suede Bottom Cover to Toes
• RF No Lateral Undercut
___ Promote In-toe___ Promote Out-toe