Vasyli Orthotic Additions
Vasyli Forefoot Posting
Firstly, measure the forefoot varus angle, i.e. 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 under the 1st metatarsal head.
If the foot has a forefoot valgus abnormality, measure the angle i.e. where the plantar plane of the forefoot is everted relative to the plantar plane of the rearfoot (ground) when the subtalar joint is in neutral.
If the angle of forefoot valgus is 6 degrees, the forefoot should be posted at 6 degrees under the plantar metatarsal area with the thickest part of the wedge under the 5th metatarsal head.
IMPORTANT: Forefoot Wedging techniques as noted above are based on an 'Ideal Rearfoot' with no deformity.
Vasyli Rearfoot Posting
When a 'Rearfoot Varus' is present, then occasionally extra wedging is needed to enhance the controlling aspect of the device you are using. A 'Rearfoot Varus' is defined as the combination of the Subtalar Neutral and Tibial Varum components which is the Neutral Calcaneal Stance Position.
1) Position the foot in the neutral calcaneal stance position (NCSP).
2) Wedge the rearfoot to the NCSP angle using the rearfoot wedge that is suitable.
VASYLI Rearfoot wedges have a 2 degree or a 4 degree inclination and are made from firm (red) density EVA for maximum effect and long-term wear. Wedging becomes important when dealing with any pronatory condition. Rearfoot wedging itself is necessary to change the timing of the pronatory phases and to help control the level of excessive pronation present in most of these conditions.
Most wedging occurs on the medial aspect of the calcaneus to increase inversion at the Subtalar Joint, and reinstate the structural integrity of the foot and alignment of the lower limb. Although the device helps to relieve the stress that pronatory disorders tend to cause, we have found that patients benefit greatly from having the orthotic device wedged at an appropriate angle to increase the level of effect.
For smaller sizes (SK, K, XS) the rear foot wedge (RVR) may require trimming. Align the wedge with the start of the arch profile (Fig A). Trim rear of wedge as shown in Figure B.
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, lower leg structures, Equinus conditions etc. In the case of a limb length discrepancy being present, a heel lift may be applied under the device on the short side.
These lifts are placed at the back and centre of the device extending forward until it finishes 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, but it would be 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 etc, 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 centre of the device, to lift the middle 3 metatarsals, but can be shifted slightly to the lateral or medial side of the device midline for extra support of the 4th Metatarsal or 2nd metatarsal.