CHAPTER CONTENTS 11

Introduction 231
Dressings and bandages 232
Clinical padded dressings 234
The mechanical basis of selection 235
Application of padded dressings 236
Design of padded dressings 237
Summary 246
Limiting foot and ankle movement 246
Taping 246
Casting 250
Replaceable orthoses 255
Replaceable padding 255
Insoles 258
Silicones and moulded thermoplastic
orthoses 260
Silicone moulds 260
Thermoplastics 262
Summary 263
Mechanical therapeutics
in the clinic
Michael Curran
INTRODUCTION
This chapter concerns foot problems that can be
managed either wholly or in part by orthotic
control at the time of consultation. Broadly, the
philosophy of orthotic care provision is that a
programme of temporary management is fol-
lowed until a ‘stock’ or ‘prescription’ orthosis is
considered more appropriate. The term ‘stock’ is
used in this chapter to refer to ready-prepared
orthoses. These are often prepackaged, such as
Frelon, Formthotics and Vasyli. Patient versions
of some of the aforementioned are now available
over the pharmacy counter.
There are certain criteria that should be con-
sidered when deciding whether to use mechani-
cal therapy, and these have been summarized in
Box 11.1. Alongside the use of orthoses, there is
also a role to be played by dressings and other
more substantial materials, and this role is dis-
cussed below. These materials can provide con-
siderable mechanical therapeutic benefit, even
though traditionally they are not considered to
be orthoses themselves.
Mechanical therapy can be provided without
laboratory prescription in one of five ways:
• dressings and bandages
• clinical padded dressings
• limiting foot and ankle movement
• replaceable orthoses
• moulded thermosetting and thermoplastic
orthoses.
Each of these five will be discussed in turn, and
for each technique, the function and method of