If your practice has decided to stick with a traditional casting method, it is important to follow a strict set of casting rules/procedures in order to receive a high-quality, accurate, well-fitting device.
Regardless of utilizing a plaster casting method or an STS sock casting method, it is critical that the practitioner places patients' feet in subtalar neutral position.
Subtalar Neutral Position.
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- Elevate the supine patient to shoulder level and title the exam chair. Encourage your patient to relax.
- Observe the patella as you dorsiflex the foot. The knee should remain in an upright position, perpendicular to the table. To compensate for external rotation, raise the corresponding hip with a towel or pillow. For internal rotation, elevate the opposite hip.
- With your arm, writs, hand and fingers in a straight line (much as if you were saluting), place the ulnar surface of your thumb in the sulcus of the fourth and fifth toes.
- Familiarize yourself with the foot and its range of motion. Move from supination to pronation, then back to the neutral position.
- When the angles formed by the lateral malleolus and its superior and inferior structures are equal, the foot is in the neutral position.
STS AFO Casting