Written by Northwest Podiatric Laboratory’s Medical Director, Timothy Messmer, DPM, and originally appearing in the Fall 2021 newsletter for AAWP (American Association for Women Podiatrists). Click here to learn more about AAWP and its mission to develop female podiatric physicians.


As podiatrists and their staff work through the daily flow of the office schedule, certain cases or situations might cause some pause.  For those of you in the typical podiatric practice, you know that the ‘orthotics’ patient can often be challenging.

Not only are no two patients’ feet exactly the same, but different pathologies often present with varying degrees of challenges.  Obtaining quality negative casts or digital scans in the patient with a significant equinus deformity can bring many difficulties.

We know from the anatomy as well as the clinical presentation, that patients with a tight Achilles tendon (whether it is isolated gastrocnemius or gastroc-soleus) present with the foot/ankle in a relatively plantarflexed position, and/or their deformity produces an excessive plantarflexory force when they are placed into proper position to cast or image the foot.

A few positioning tips (specific to supine casting technique) should help to ease the frustration that often is experienced in trying to obtain good quality plaster casts or digital images from these patients.

  •   Patients need to be reminded that relaxing is key to this working well!
  •   The knee should be flexed slightly with a bump/pillow under the knee or a step/raise (such as https://www.amazon.com/Step-Aerobic-Platform-Black-Risers/dp/B000BO8AAC ) under the calf being utilized.  (Both of these techniques will help to relax the proximal tightness by negating the pull of the gastroc muscle as it originates off the distal femur.)
  •   Hip position – asking the patient to lie flatter (fully supine with hip neutral) rather than sitting up in the treatment chair (with hip flexed) will help to reduce the tightness in the hamstrings, which is often seen coinciding with a tight Achilles tendon.
  •   You will also want to avoid asking the patient to ‘fight off’ the equinus by actively dorsiflexing their ankle, because this will invariably lead to firing of their tibialis anterior tendon and result in dorsiflexing the 1st metatarsal, leading to inversion of the forefoot and a ‘false FF varus.’

If you keep the above suggestions in mind when positioning your equinus patient for casting/scanning, you will make it much easier for both you and your patient to comfortably and reliably obtain high-quality images for the making of the best custom foot orthoses.



Northwest Podiatric Laboratory is an industry leader in custom foot orthotic and related technologies. Dennis Brown, a retired British soldier, elite athlete and natural-born inventor founded the company in 1964 and was joined by a biomechanics pioneer, Dr. Chris Smith, in 1974. With an exclusive blend of science, craftsmanship and innovation, the partners have built a company that utilizes proprietary production techniques and technology to produce orthotics with a unique shape and unparalleled performance. Northwest Podiatric Laboratory has helped over a million people suffering from foot pain to lead better, pain-free lives. Learn more at www.nwpodiatric.com.

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