Off-Loading - Machined EVA

This page explains all relevant features on the Off-Loading page of LaserCAM Prescribe for Machined EVA prescription.

Overview

Click Off-Loading from the menu to access this page in LaserCAM Prescribe.

Page Layout

Page Fields

Cuboid Raise/Dell

Default Value	Minimum Value	Maximum Value
0mm	-20mm (dell)	10mm (raise)

The adjustment will generally be blended with a smoothing function in software, or during manual finishing post-machining.

Cuboid Raise

A positive value in this field will request a Cuboid Raise. Selecting a positive value will display a list of available materials that can be selected.

The Cuboid Raise adjustment is not commonly requested in Machined EVA orthoses manufactured from non-weight bearing morphology. This is because the calcaneocuboid inclination angle is captured within the orthosis leading to an extremely conformational fit in this region compared with traditional vacuum forming manufacturing techniques.

Cuboid Dell

A negative value in this field will request a Cuboid Dell. Selecting a negative value will display a list of available materials that can be selected.

Styloid Raise/Dell

Default Value	Minimum Value	Maximum Value
0mm	-20mm (dell)	10mm (raise)

The adjustment will generally be blended with a smoothing function in software, or during manual finishing post-machining.

Styloid Raise

A positive value in this field will request a Styloid Raise. Selecting a positive value will display a list of available materials that can be selected.

Styloid Dell

A negative value in this field will request a Styloid Dell. Selecting a negative value will display a list of available materials that can be selected.

Remember that the depth of a Styloid Dell is limited by the height of the styloid from the ground.

Navicular Raise/Dell

Default Value	Minimum Value	Maximum Value
0mm	-20mm (dell)	10mm (raise)

Navicular Raise

A positive value in this field will request a Navicular Raise. Selecting a positive value will display a list of available materials that can be selected.

Navicular Dell

A negative value in this field will request a Navicular Dell. Selecting a negative value will display a list of available materials that can be selected.

You can mark the area that requires the Navicular Dell directly on the foot prior to 3D colour scanning for optimal placement.

Apertures

Apertures are regions of a Machined EVA orthosis that are removed in order to alleviate pressure at a specific region. Apertures may be filled with a selected material, or may be left as a void.

Apertures are applied manually to Machined EVA orthoses are are not part of the computer-aided design process.

Heel

The centre of the heel of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

Forefoot

The entire forefoot region of a Machined EVA orthosis is removed. This region may be filled with a selected material.

We do not recommend requesting No Fill from the material selection list as this will result in an orthosis that is prone to quick degradation.

1st MPJ

The 1st MPJ region of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

If treating sesamoiditis keep in mind that it is important to not only off-load the sesamoids, but also to decrease the degree of MPJ dorsiflexion. You may want to consider a Morton's Extension in combination with a Poron U-Pad in cases where a decrease in motion is critical.

2nd MPJ

The 2nd MPJ region of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

3rd MPJ

The 3rd MPJ region of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

4th MPJ

The 4th MPJ region of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

5th MPJ

The 5th MPJ region of a Machined EVA orthosis is removed. This region may be filled with a selected material, or may be left as a void.

Plantar Cover

A Plantar Cover is a protective covering that is applied to the plantar surface of the orthosis when an aperture is requested. A user may select a particular Plantar Cover material from the drop down list.

It is recommended that a Plantar Cover be requested when an Aperture is requested. This greatly improved the longevity of the Machined EVA orthosis.

Poron U-Pad

For extra pressure reduction you can combine a Poron U-Pad and an Aperture of a specific MPJ.

A Poron U-Pad is a forefoot addition that helps to decrease pressure at the location of a U-Shaped cutout. This adjustment is commonly requested to help minimise metatarsal head pressure that put patients at risk of ulceration.

The Poron U-Pad material should first be selected from the drop down list.

A user may then tick the appropriate checkbox next to the metatarsal head that they would like off-loaded.

Available U-Cutout Locations
1st MPJ
2nd MPJ
3rd MPJ
4th MPJ
5th MPJ

EVA U-Pad

EVA U-Pads are essentially the same as Poron U-Pads, however different EVA densities and thicknesses can be offered allowing for differences in pressure reduction and longevity.

An EVA U-Pad is a forefoot addition that helps to decrease pressure at the location of a U-Shaped cutout. This adjustment is commonly requested to help minimise metatarsal head pressure that put patients at risk of ulceration.

The EVA U-Pad material should first be selected from the drop down list.

A user may then tick the appropriate checkbox next to the metatarsal head that they would like off-loaded.

Available U-Cutout Locations
1st MPJ
2nd MPJ
3rd MPJ
4th MPJ
5th MPJ

Metatarsal Dome

A Metatarsal Dome is commonly manufactured from PPT of varying density/hardness and is designed to conform to the contour of the transverse arch. They are commonly used in the treatment of Morton's neuroma, metatarsalgia and other conditions in which redistribution of plantar pressures at the forefoot is deemed appropriate.

A Metatarsal Dome style should first be selected from the drop down list.

A modification option may also be selected. These additional modifications are performed manually in a laboratory environment.

Metatarsal Pad

A Metatarsal Pad is commonly manufactured from PPT of varying density/hardness and is designed to alleviate pressure from the metatarsal heads.

A Metatarsal Pad style should first be selected from the drop down list.