VASYLI FOREFOOT POSTING
To manage forefoot varus with an orthotic addition, first measure the forefoot varus angle. This is where the plantar plane of the forefoot is inverted relative to the plantar plane of the rearfoot when the subtalar joint is in neutral.
If the angle of the forefoot varus is 4 degrees, the forefoot would be posted at 4 degrees under the plantar metatarsal area with the thickest part of the wedge proximal to the first metatarsal head.
VASYLI HEEL LIFTS AND MET RAISE
In certain circumstances, the patient may need the addition of a heel lift to reduce stress on the Achilles tendon or lower leg structures, or to address equinus conditions, for example. In the case of an anatomical limb-length discrepancy, a heel lift may be applied under the device on the short side.
These lifts are placed at the back and center of the device, extending forward until finishing under the tarsal area. They are available in thicknesses of 4mm, 6mm, and 8mm in small, medium, and large.
A combination of these lifts can be used to obtain higher thicknesses. However, it’s doubtful that a thickness of more than 8mm could be used in most modern footwear.
METATARSAL RAISE (MET DOME):
Some patients suffer from forefoot problems such as metatarsalgia, interdigital neuritis, or neuromas. Although some of these problems are controllable with the use of foot devices, occasionally the metatarsal area needs extra lift to further support the structure.
The metatarsal raise is placed on top of the device and its front lip fits flush on the end of the orthotic. It is usually placed in the center of the device to lift the middle 3 metatarsals, but it can be shifted slightly to the lateral or medial side of the device midline for extra support of the 4th metatarsal or 2nd metatarsal.