It is important that ICB Orthotics be fitted and moulded to the patient's Subtalar Joint Neutral Position, which will assist in correcting and limiting excessive pronation. To find the subtalar neutral position you can use the ICB Anterior Alignment Method:
- Locate the depression anterior to the medial malleolus by asking the patient to over pronate their foot.
- Mark the depression
- Repeat steps 1 & 2 for the lateral depression.
- Bisect the lateral and medial depressions and mark the bisection.
- Locate and mark the 2nd metatarsal head and join it with the bisection mark made in step 4.
- Locate and mark a dotted line along the tibial crest to meet up with the bisection of the medial and lateral depressions.
- To find subtalar joint neutral, ask the patient to roll their foot outwards - when the dotted line along the tibial crest down to the 2nd metatarsal head is straight, the foot is in the subtalar joint neutral position.
Before fitting the orthotic device ensure the patient's shoes are in good condition. If they are badly worn, they should be replaced and any lining or insoles removed ICB Dual Density Heat Moulding orthotics are highly versatile in their application. ICB Orthotics can be custom fitted to the individuals’ foot contours:
- Attach any forefoot or rearfoot additions (if required) prior to heat moulding.
- With the patient seated, remove 1 of the orthotics from the footwear (the other orthotic must remain in the shoe and we worn also during the moulding process), and using a heat gun, apply heat to the device. It is best to hold the orthotic at the distal edge, and concentrate the heat on the plantar surface of the arch. Heat for 10-15 seconds, distributing the heat by making circular motions with the heat gun, until the words ‘left’ and ‘right’ appear to fade.
- Insert the heated orthotic into the shoe and tie up any laces or fasteners on the shoe.
- With the patient still seated locate the subtalar joint, and ask the patient to stand - with equal weight bearing.
- Place the foot into the subtalar neutral position (if you have used the ICB Anterior Alignment Method markings as a visual guide). With your other hand apply pressure to the medial arch and rearfoot to ensure correct moulding. Hold this position for 30-40 seconds.
- Ask the patient to sit down (whilst still maintaining your hand positions). Remove the moulded device and allow to cool for approximately 2 minutes (or until it is cool enough to touch). Then place the moulded orthotic back into the shoe, and repeat the process for the other foot.
- Attach any required heel lifts, metatarsal domes, medial arch infills, flanges or inversion/eversion ramps, after heat moulding.
Almost every shoe size, style and design varies slightly. To accommodate for these differences ICB Full Length Orthotics can be trimmed to ensure a good fit. Before trimming, remove the manufacturer insoles and use them as a template to trim around the distal edges of the orthotic with scissors. It is not recommended to trim any other area of the orthotic, as this may affect the comfort and effectiveness of the orthotic.
Do not over-trim, as this may cause discomfort.
When fitting any style of orthotic it is recommended to remove any insoles inside the shoe (if possible), as this will allow extra room for the orthotic, and provide a comfortable fit.
Using ICB Orthotic to mould to a plaster cast is also quick and easy. Being made of 100% EVA ICB Orthotics can save time over using sheet EVA, by reducing the amount of grinding and time required to create the desired orthotic shape.
Simply place the heated orthotic onto the plaster cast and use a vacuum former to mould into shape. ICB Orthotics can then be ground using a bench grinder, dremel or nail drill.