Device Options - Machined EVA
- Konrad Job
This page explains all relevant features on the Device Options page of LaserCAM Prescribe for Machined EVA prescription.
Overview
Navigation
Click Device Options from the menu to access this page in LaserCAM Prescribe.
Page Layout
Page Fields
Device Options is divided into multiple categories that help a user to easily navigate between prescription options.
Intrinsic Options
Laminated Arch
A Laminated Arch requests the adhesion of EVA to the medial longitudinal arch (MLA) to ensure that the contour of the MLA matches the 3D scan morphology.
It is good practice to request a Laminated Arch if you would like your Machined EVA orthoses to closely conform to the MLA region of the foot.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| None (Default) | ||
| Yes (Morphology Based) | ||
| Yes (Specific Height) | 20mm | 90mm |
None
This is the default selection and indicates that the MLA will not be laminated being the standard height of the EVA used during machining.
Not requesting a Laminated Arch can result in a less conformational MLA.
Yes (Morphology Based)
This selection indicates that a user requires the medial arch to be laminated if required, and to follow the morphology of the foot.
Some laboratories will provide a Laminated Arch as a default. We recommend you confirm with your laboratory as to their specific standards.
Yes (Specific Height)
This selection indicates that a user requires the medial arch to be laminated to a specific height in millimetres.
If you are unsure about what height to request, try selecting Yes (Morphology Based) instead.
First Ray Grind
A First Ray Grind requests the removal of EVA from the midpoint of the first metatarsal and is specified in millimetres.
| Default Value | Minimum Value | Maximum Value |
|---|---|---|
| 0mm | 0mm | 20mm |
A great alternative to a First Ray Grind is to plantarflex the first metatarsal during 3D scan capture.
Maintain Plantarflexed First Ray
The Maintain Plantarflexed First Ray option can be selected when a user would like the transverse arch to be intrinsically maintained based on the foot morphology.
As a general rule, the transverse arch that will be maintained intrinsically will be more pronounced as the forefoot valgus angle increases. Plantarflexing the first metatarsal during 3D scan capture can also result in an increase in the transverse arch height relative to the 1st and 5th metatarsal heads.
The image below shows a wireframe view of a 3D scan with a forefoot valgus alignment.
The image below shows the transverse arch region in red, which will be maintained if Maintain Plantarflexed First Ray is selected.
This will be positioned according to individual foot morphology, however the image below provides an approximation of the area of this transverse arch.
Maintain Forefoot Varus/Valgus
The Maintain Forefoot Varus/Valgus option allows a user to have a greater level of control regarding the specificity of any intrinsically captured Forefoot Varus or Forefoot Valgus morphology.
| Available Selections |
|---|
| None (Default) |
| Morphology Based |
| Specific Thickness (mm) |
You must have captured a Forefoot Varus or Forefoot Valgus if requesting this Device Option.
None
This is the default selection and allows a user to request that no Forefoot Varus or Forefoot Valgus be maintained intrinsically within a Machined EVA orthosis.
Morphology Based
This allows a user to request that any intrinsically captured Forefoot Varus or Forefoot Valgus be maintained intrinsically within a Machined EVA orthosis.
| Available Selections |
|---|
| Standard Taper (Default) |
| Taper to Sulcus |
| Taper to Distal Edge |
| No Taper |
The image above represents a Forefoot Varus.
Standard Taper
This allows a user to request that a laboratory taper the intrinsically captured Forefoot Varus or Forefoot Valgus wedging as per their discretion.
Taper to Sulcus
This allows a user to request that a laboratory taper the intrinsically captured Forefoot Varus or Forefoot Valgus to the sulcus as per their discretion.
Taper to Distal Edge
This allows a user to request that a laboratory taper the intrinsically captured Forefoot Varus or Forefoot Valgus to the distal edge of the orthosis, leading to a more gradual taper.
No Taper
This allows a user to request that a laboratory taper the intrinsically captured Forefoot Varus or Forefoot Valgus suddenly from the centre of the 1st (Forefoot Varus) or 5th (Forefoot Valgus) metatarsal head.
Specific Thickness (mm)
This option can only be selected if a 3D scan has a Forefoot Varus or Forefoot Valgus alignment, or the 3D scan is everted to create a Forefoot Varus or Forefoot Valgus alignment. If these conditions are not met, then an Inversion Ramp or Eversion Ramp are potentially superior prescriptive options as they allow for a more objective and less manual addition of this type of addition.
This allows a user to request that a laboratory taper the intrinsically captured Forefoot Varus or Forefoot Valgus to a specific thickness in millimetres (mm).
The image above represents a Forefoot Varus.
This is often used in combination with a First Ray Extension manufactured from PPT that comes into direct contact with the foot, and a Morton's Extension manufactured from polypropylene on the plantar surface.
Heel Cup Height
The Heel Cup Height option allows a user to select from non-specific or specific heel cup height selections.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| Standard (Default) | ||
| Maintain Maximum Height | ||
| Specific Thickness (mm) | 0mm | 30mm |
Standard
This allows a user to request that a laboratory lower the height of the medial and lateral heel as deemed appropriate for the strength and best application of top cover materials.
Please note that this heel cup height is dependent on the Orthosis Top Width (US) selection. An Orthosis Top Width (US) selection that is too narrow for the patients foot will result in a low heel height.
Try requesting an increase in Orthosis Top Width (US) in order to achieve a higher heel cup.
Maintain Maximum Height
This allows a user to request that a laboratory maintain the maximum height possible at the medial and lateral heel.
Specific Thickness (mm)
This allows a user to request a specific medial and lateral heel height.
If the Orthosis Top Width (US) is too narrow, then a Specific Thickness (mm) may not be achievable due to a lack of material.
Extra Heel Expansion
The Extra Heel Expansion option allows a user to request additional material be removed from the internal aspect of the medial, rear and lateral heel region of an orthosis.
| Available Selections | Default Value | Minimum Value | Maximum Value |
|---|---|---|---|
| Lateral | 0mm | 0mm | 10mm |
| Medial | 0mm | 0mm | 10mm |
| Rear | 0mm | 0mm | 10mm |
Please note that you can select Lateral, Medial and Rear in a single prescription if required.
Lateral
This allows a user to request that a laboratory remove a specific thickness of material from the internal lateral heel cup.
The red region indicates the region of the heel that is manually removed when requesting this option.
This is the region of the foot that expands the most under weight-bearing conditions. It is recommended that you consider the soft tissue expansion more closely if capturing patient 3D scans or casts from a non-weight bearing position.
Medial
This allows a user to request that a laboratory remove a specific thickness of material from the internal medial heel cup.
The red region indicates the region of the heel that is manually removed when requesting this option.
Please note that requesting this option may effect the degree of Rearfoot Posting that may be intrinsically present in the same region of the orthosis.
Rear
This allows a user to request that a laboratory remove a specific thickness of material from the internal rear heel cup.
The red region indicates the region of the heel that is manually removed when requesting this option.
This is performed manually by technicians and is commonly measured using thickness callipers for accuracy.
MLA Bulk Reduction
The MLA Bulk Reduction option allows a user to request that material be removed intrinsically from either the medial, lateral or both sides of the Plantar Fascia Accommodation in the MLA.
| Available Selections | Default Value | Minimum Value | Maximum Value |
|---|---|---|---|
| Medial | 0mm | 0mm | 10mm |
| Lateral | 0mm | 0mm | 10mm |
| Both | 0mm | 0mm | 10mm |
None
No material will be removed from the MLA on either side of the Plantar Fascia Accommodation.
The image above represents a cross section of the foot orthosis in the frontal plane. The medial side is on the left and the lateral side is on the right.
Medial
A specified thickness of material will be removed from the MLA on the medial side of the Plantar Fascia Accommodation.
The red region represents the material removed by selecting this option.
Lateral
A specified thickness of material will be removed from the MLA on the lateral side of the Plantar Fascia Accommodation.
The red region represents the material removed by selecting this option.
Both
A specified thickness of material will be removed from the MLA on the both sides of the Plantar Fascia Accommodation.
The red region represents the material removed by selecting this option.
Extrinsic Options
Extrinsic Heel Lift
The Extrinsic Heel Lift option allows a user to request a custom EVA wedge be adhered to the plantar surface of the orthosis. The thickness may be customised, as well as the degree of taper and the density of EVA.
| Available Selections | Available Materials | Minimum Value | Maximum Value |
|---|---|---|---|
| Standard Taper | EVA 350 (Default) EVA 400 EVA 260 EVA 220 EVA 190 EVA 125 | 0mm | 30mm |
| Tapered to MPJ's | 0mm | 30mm | |
| Tapered to Sulcus | 0mm | 30mm | |
| Tapered to Distal Edge | 0mm | 30mm |
Please note that you should contact your laboratory for specific information on the available materials.
Standard Taper
The Extrinsic Heel Lift will be tapered from the proximal heel to no thickness in-line with the peak of the medial longitudinal arch. The specified thickness will be measured from the heel centre as indicated by the pink line in the image below.
Tapered to MPJ's
The Extrinsic Heel Lift will be tapered from the proximal heel to no thickness in-line with the metatarsophalangeal joints. The specified thickness will be measured from the heel centre as indicated by the pink line in the image below.
Tapered to Sulcus
The Extrinsic Heel Lift will be tapered from the proximal heel to no thickness in-line with the sulcus. The specified thickness will be measured from the heel centre as indicated by the pink line in the image below.
Tapered to Distal Edge
The Extrinsic Heel Lift will be tapered from the proximal heel to no thickness at the distal edge of the orthosis. The specified thickness will be measured from the heel centre as indicated by the pink line in the image below.
Full Length Wedge
The Full Length Wedge option allows a user to request a custom EVA wedge be manufactured at a specified angle of Inversion or Eversion. A specific EVA density can also be selected.
| Available Selections | Available Materials | Minimum Value | Maximum Value |
|---|---|---|---|
| Inversion | EVA 350 (Default) EVA 400 EVA 260 EVA 220 EVA 190 EVA 125 | 0° | 45° |
| Eversion | 0° | 45° |
This option is often requested in the place of an Inversion Ramp or Eversion Ramp, as this is an extrinsically applied wedge that may be more easily adjusted.
Please note that you should contact your laboratory for specific information on the available materials.
Inversion
The Full Length Wedge will be inverted at the specified angle.
Eversion
The Full Length Wedge will be everted at the specified angle.
Gait Plate
The Gait Plate option allows a user to request a polypropylene plate of a specific thickness be adhered to the plantar surface of the orthosis.
Gait Plates are commonly used in paediatric cases where there is a rotational deformity that is effecting the lower limb.
| Available Selections | Available Materials |
|---|---|
| In-Toe | Polypropylene 2.0mm Polypropylene 3.0mm Polypropylene 4.0mm |
| Out-Toe |
In-Toe
The Gait Plate will be manufactured for an in-toeing gait pattern. The Gait Plate will start proximal to the 1st metatarsophalangeal joint and then extend distal to the 5th metatarsophalangeal joint.
Ganjehie (2017) found that In-Toe Gait Plates can be used to improve gait appearance in children with in-toeing gait pattern due to excessive femoral anteversion.
Out-Toe
The Gait Plate will be manufactured for an out-toeing gait pattern. The Gait Plate will start proximal to the 5th metatarsophalangeal joint and then extend distal to the 1th metatarsophalangeal joint.
Extensions
First Ray Extension
The First Ray Extension option allows a user to request an extension that is adhered to the dorsal surface of the orthosis prior to top cover application. This extension begins at the midpoint of the 1st metatarsal and is extended to the distal edge of the orthosis.
| Available Selections | Available Materials | Minimum Value | Maximum Value |
|---|---|---|---|
| EVA | Intrinsic EVA 400 EVA 350 EVA 260 EVA 220 EVA 190 EVA 125 | 0mm | 30mm |
| PPT | PPT (PORON) PPT (PORON Patina) PPT (PORON Slow Release) PPT (PORON XRD) | 0mm | 30mm |
Please note that you should contact your laboratory for specific information on the available materials.
EVA
Selecting this option allows a user to pick from the EVA material list.
PPT
Selecting this option allows a user to pick from the PPT material list.
Reverse Morton's Extension
The Reverse Morton's Extension option allows a user to request an extension that is adhered to the dorsal surface of the orthosis prior to top cover application. This extension begins at the midpoint of the 1st metatarsal and is extended to the sulcus of the orthosis.
| Available Selections | Available Materials | Minimum Value | Maximum Value |
|---|---|---|---|
| Intrinsic | 0mm | 15mm | |
| EVA | EVA 120 3.0mm EVA 190 2.0mm EVA 190 3.0mm EVA 220 3.0mm EVA 350 3.0mm EVA 350 4.0mm | ||
| PPT | PPT (PORON) 1.6mm PPT (PORON) 3.2mm PPT (PORON) 6.4mm PPT (PORON) 10.0mm PPT (PORON Patina) 3.2mm PPT (PORON Slow Release) 3.2mm PPT (PORON Slow Release) 6.4mm PPT (PORON XRD) 3.2mm PPT (PORON XRD) 6.4mm | ||
A user is not able to specify thickness for a Reverse Morton's Extension when selecting the EVA or PPT selection options. This is due to the difficult in manufacturing this adjustment at non-standard thicknesses.
Intrinsic
Selecting this option allows a user to request the Reverse Morton's Extension be designed intrinsically. This results in an adjustment of a specified thickness that is the same density as the requested Density & Colour that is selected from the Shoe Fitting page.
EVA
Selecting this option allows a user to request the Reverse Morton's Extension be manufactured from a specific density and thickness of EVA.
PPT
Selecting this option allows a user to request the Reverse Morton's Extension be manufactured from a specific density and thickness of EVA.
This prescription option is often selected in combination with an Aperture to the 1st MPJ.
Morton's Extension
The Morton's Extension option allows a user to request an extension that is adhered to the plantar surface. This extension begins at the midpoint of the 1st metatarsal and is extended to the distal edge of the orthosis.
| Available Selections | Available Materials | Minimum Value | Maximum Value |
|---|---|---|---|
| EVA | EVA 120 EVA 190 EVA 220 EVA 260 EVA 350 EVA 400 | 0mm | 30mm |
| Polypropylene | Polypropylene 2.0mm Polypropylene 3.0mm Polypropylene 4.0mm | ||
EVA
Selecting this option allows a user to request the Morton's Extension be manufactured from a specific density and thickness of EVA.
Polypropylene
Selecting this option allows a user to request the Morton's Extension be manufactured from a specific thickness of polypropylene.
It is important to consider the patient's weight and activity as this will contribute to the required thickness and resultant stiffness of the selected material.
A Morton's Extension is commonly used to alter motion and plantar loading patterns in patient's with hallux rigidus.
The image below represents a hypothetical example of the maximum achievable flexion at the forefoot of an orthosis with a Morton's Extension applied.
Custom Shaping
It is important to note that a Flange is an increase in the width and the height of an orthosis, and a Flare is simply an increase in the width of the orthosis.
Medial Heel Flange/Flare
The Medial Heel Flange/Flare option allows a user to request that an orthosis be manufactured with an increase in width and height (flange), or width alone (flare) at the medial heel.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| Flange | 0mm | 100mm |
| Flare | 0mm | 100mm |
Flange
Selecting this option allows a user to request a Medial Heel Flange of a specific width. The height will be dependent on the morphology of the top surface of the machined EVA orthosis.
Flare
Selecting this option allows a user to request a Medial Heel Flare of a specific width.
Lateral Heel Flange/Flare
The Lateral Heel Flange/Flare option allows a user to request that an orthosis be manufactured with an increase in width and height (flange), or width alone (flare) at the lateral heel.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| Flange | 0mm | 100mm |
| Flare | 0mm | 100mm |
Flange
Selecting this option allows a user to request a Lateral Heel Flange of a specific width. The height will be dependent on the morphology of the top surface of the machined EVA orthosis.
Flare
Selecting this option allows a user to request a Lateral Heel Flare of a specific width.
Medial Midfoot Flange/Flare
The Medial Midfoot Flange/Flare option allows a user to request that an orthosis be manufactured with an increase in width and height (flange), or width alone (flare) at the medial midfoot.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| Flange | 0mm | 100mm |
| Flare | 0mm | 100mm |
Flange
Selecting this option allows a user to request a Medial Midfoot Flange of a specific width. The height will be dependent on the morphology of the top surface of the machined EVA orthosis.
Flare
Selecting this option allows a user to request a Medial Midfoot Flare of a specific width.
Lateral Midfoot Flange/Flare
The Lateral Midfoot Flange/Flare option allows a user to request that an orthosis be manufactured with an increase in width and height (flange), or width alone (flare) at the lateral midfoot.
| Available Selections | Minimum Value | Maximum Value |
|---|---|---|
| Flange | 0mm | 100mm |
| Flare | 0mm | 100mm |
Flange
Selecting this option allows a user to request a Lateral Midfoot Flange of a specific width. The height will be dependent on the morphology of the top surface of the machined EVA orthosis.
Flare
Selecting this option allows a user to request a Lateral Midfoot Flare of a specific width.
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