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1065 Tim
Shoe Size:
Foot Pain:
Previous Orthotic Use:
Surgery:
Diagnosis:
Surgery location:
Orthotic
Type
EVA - Standard
Width
Normal
Narrow
Wide
Material
EVA
Soft
Medium
Hard
Dual Density
Type
mm L
mm R
Digital Corrections
Total MLA Height
mm L
mm R
MLA Position
Standard
L
R
Proximal
L
R
Mid
L
R
Lateral Contact
L
R
Contact
L
R
Anatomical Contact
L
R
Heel Cup Height
8mm
L
R
12mm
L
R
16mm
L
R
Nil / Low
L
R
Lat Clip
L
R
Heel Cup Width
Standard
L
R
Inc Lat
L
R
Dec Lat
L
R
Shell Width
Standard
L
R
Narrow
L
R
Wide
L
R
Shell Profile
Standard
L
R
A Type Arch
L
R
MED/LAT Heel Skive
L
mm
Med
Lat
R
mm
Med
Lat
Lateral Arch
L
R
Cuboid Notch
L
R
Plantar Arch Grind
Standard
L
R
Narrow
L
R
Shell Modification
1st Med Head Cutout
Left
Right
Standard
Standard
Large
Large
Mortons
Standard
Standard
Large
Large
Standard
L
R
Narrow
L
R
Postings
Rearfoot
L
Var
Val
Int
Ext
1/4
1/2
R
Var
Val
Int
Ext
1/4
1/2
Forefoot
L
Var
Val
Extended to distal end of toes
R
Var
Val
Extended to distal end of toes
Heel
Heel Raise
mm L
mm R
Heel Pitch
mm L
mm R
Finishings
Additions
Left
Right
Met Dome Size
1
2
3
4
1
2
3
4
Met Pad Position
1
2
3
4
5
1
2
3
4
5
Met Bar Size
SML
MED
LEG
SML
MED
LEG
Arch Cookies
3mm PPT
3mm PPT
Heel Seats
3mm PPT
3mm PPT
Reverse
Mortons EXT
PMP Pad Cutout
1
2
3
4
5
1
2
3
4
5
Cushioning/Underlay
Poron
1.6mm
3.2mm
Poron SR
3.2mm
Notes
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