The 6 Steps

The 6 Steps are an essential stage of the Formthotics Medical System. It is a progressive approach to prescription, modification, and ongoing patient-centred management using the information gained in the assessment stage, the 6 Tests. (Learn more about the 6 tests here).

Step 1: Selecting, fitting and heating Formthotics orthotics

When selecting the right Formthotics it is important to consider the needs of the patient. A key consideration is the shape of the shoe that the Formthotics will be fitted into. Learn more about selecting the right Formthotics orthotics for your patient here.

Selection – How do you do it?

If you are unsure of the right Formthotics products to use, check out our Selection Tool.

Selection – Important notes to watch out for

It is important to consider the footwear being worn and to remember to remove any existing shoe inserts insoles or orthotics in the shoes.

Fitting

For the best results Formthotics orthotics should be available in-clinic so they can be fitted to your patient on their first visit.

To ensure the best fit and custom mould for your Formthotics, the Formthotics V20 Heating Machine should be used.

To fit the Formthotics:

• Remove any existing insoles or orthotics

• If the Formthotics orthotics are too big check whether a smaller size is appropriate. They should be a snug fit in the shoe. If the Formthotics are still too big carefully trim the distal end of the orthotics. It is not advisable to trim the heel of the orthotic.

• Fit the Formthotics orthotics into the shoe, do this by curving the sides of the Formthotics at the midfoot, and slide it into the shoe. Press the heel firmly into place and check the Formthotics fits snugly in the front of the shoe

• Before heating, ask the patient to try on shoes with Formthotics inside. This ensures they are a good fit and not too tight.

Heat Formthotics insoles in the shoes

Then ask the patient to put the shoes on again to allow the Formthotics to be moulded to the foot.

Ask the patient to stand hip-width apart, knees slightly bent and toes pointing forward. The knees should be directly over the second toe. Hold the position for 30 seconds.

The patient should then go for a short walk to complete the moulding process and provide feedback to you.

Fitting – Important notes to watch out for?

It is important to remove any existing insoles or orthotics.

It is not advisable to trim the heel of the orthotic as this will reduce the orthotics ability to sit correctly in the shoe. It may also affect the stability of the rearfoot of the orthotic.

STEP 2: Patient Adjustment Period

Patients will need time to adjust to their Formthotics, as their shoes may feel different.

How to do it?

Patients should allow time to adapt and ‘break-in’ their Formthotics. Ideally wearing for an hour each day for the first 3 to 7 days. Unlike most orthotics, Formthotics orthotics are heat-moulded to the patient’s feet in-clinic, so they may find break-in periods are shorter than traditional orthotics.

Important notes watch out for

If your patient’s find their Formthotics insoles are causing them pain, blistering, or bruising they should stop using them immediately. Reassess your patient using the 6 Steps and try to identify what caused the issues.

Step 3: Rearfoot Modification

A rearfoot modification is a modification applied medially or laterally to the rear of an orthotic. For example, wedges are used as a means of applying a force to the rear-foot in response to biomechanics or function that has been identified as being as contributor to a patient’s pain or dysfunction.

How to do it?

Usually, a wedge is applied to the underside of Formthotics orthotics, this may be done using glue, adhesive tape, or the self-adhesive backing on the wedge itself.

Important notes to watch out for?

Most commonly, a medial or varus wedge applied to the rearfoot as a means of managing excessive pronation, will yield the most improvement in alignment, function and supination resistance.

Step 4: Forefoot Modifications

Forefoot modifications apply force to the forefoot. The depth of insertion and angle of the wedge determine the force that is applied. Metatarsal domes and bars are also considered forefoot modifications.

How do you do it?

Usually, a wedge is applied to the medial or lateral forefoot of the Formthotics orthotics, this may be done using glue or adhesive tape.

Important notes or things to watch out for?

Commonly, a lateral (or forefoot valgus) wedge will yield the most improvement in the Windlass Mechanism Test and Forefoot Stability Test.

Step 5: In-shoe testing

It is important to check the patient’s stance and gait to assess the functional effects of Formthotics orthotics while the patient is wearing them in their shoes.

Questions to think about are whether the patient finds them comfortable? Are there areas on their foot that might feel as though they will rub? Is there enough room in the shoes for both their feet and the Formthotics insoles? It is important the patient feels comfortable leaving with their Formthotics insoles, or they may be unlikely to use them.

How do you do it?

Ask the patient to take a short walk to see how the Formthotics orthotics feel within the shoe. You may also ask them to perform some of the 6 Tests to see if there is an improvement in the test results that were collated without Formthotics. Tests we’d recommend at this stage include forefoot stability, star excursion, single leg balance and knee bend tests.

Important notes or things to watch out for?

It is important the patient feels comfortable leaving with Formthotics in their shoes, otherwise it is likely they will not use them.

Step 6: Ongoing patient management

While the end point of treatment occurs when the patient can perform their desired daily activities without pain or restrictions to mobility, it is important to continually assess the patient’s orthotics. Booking a review 6 or 12 months after the initial treatment to discuss whether the orthotics are still working or if any changes to the patient’s health might require adjustment to the orthotics.

How do you do it?

Start with a review of existing orthotics. Look at the indentations of toe or metatarsal head pressures on the orthotics. Have a discussion with the patient about whether they feel the orthotics are working or not. Depending on the review it may be necessary to complete the 6 Tests again.