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Page 1: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

1 Head to Foot Ortho. 03 9870 2284

head to foot ortho.catalogue august 2017

& 03 9870 2284 ) [email protected]

Page 2: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

2Head to Foot Ortho. 03 9870 2284

Page 3: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

3 Head to Foot Ortho. 03 9870 2284

About Us

About Us

Head to Foot Ortho. (HTFO) is owned by clinicians who understand the demands of operating a healthcare business in Australia. HTFO has industry experience in wholesale distribution, public / private clinical service provision and business mergers and acquisitions.

HTFO is an ISO 9001:2015 quality certified company and we pride ourselves in giving exceptional levels of service, product knowledge and education to our customers. We’ll go the extra mile to assist you in achieving excellent patient outcomes; it’s something that we are passionate about.

We invite you to call us, utilise our clinical and technical expertise and experience the HTFO difference.

Our Service

Let’s talk with you about what you need … we can discuss how best to achieve what you require … before you see the client, during the consultation or once you’ve prepared your client plan.

Communication ensures that what we provide is what you require.

Our Products

HTFO offer orthotic products that are of the highest quality and reliability.

With over 20 years experience in healthcare provision, we can provide quality orthoses that meet your expectations.

Customer Service

We’re here to help - chat with one of our customer service team or ask for a clinician.

We look forward to assisting you.

Stephen Dickins and Tim Jarrott, Directors

& 03 9870 2284

7 03 9870 0248

) [email protected]

@ www.htfo.com.au

Quality ISO 9001

Page 4: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

4Head to Foot Ortho. 03 9870 2284

ContentsProducts Code Page No.

Outcome Measure Technologies Page

BTS G Walk GWAUN001, GWAOPT01, GWAOPT02 6

Pressure Guardian PG-Kit 2A, PG-03 8

Compression Garment Application

Ezy-As SAS-08017, SAM-06264, SAL-06264, UHA-07246 12

Custom made orthoses

Propulsion carbon pre-preg AFO custom made A41 14

Propulsion carbon pre-preg KAFO custom made K14 14

Propulsion AFO for partial foot amputation custom made A42 15

CROW - Charcot Restraining Orthotic Walker A29 16

Custom foot orthotics F05, F06 17

Custom foot orthosis with toe filler F05a, F06a 17

High cupping foot orthosis F07 18

Surgical shoe raise F15 18

Shoe float / flare F20 19

Shoe wedge F20 19

Carbon fibre stiffening modification to shoe F26 20

Rocker sole shoe modification F20 20

Ankle foot orthosis (AFO) custom made A09 21

Ankle foot orthosis (AF0) - jointed / hinged custom made A10 22

Bi-valved ankle foot orthosis (AFO) custom made A11 23

Weight relieving AFO custom made A14 24

Metal below knee caliper custom made A25 25

Knee ankle foot orthosis (KAFO) custom made K15 26

3 point knee extension orthosis K16 27

Dynamic knee extension orthosis custom made K29 27

Knee control orthosis (KC0) custom made K30 28

Low spinal brace (LSB) WB11-11/12/13/14/15/16/17 29

High spinal brace (HSB) WB12-11/12/13/14/15/16/17 30

3 point elbow extension orthosis E02 31

Dynamic elbow extension orthosis custom made E03 31

Forearm guard / fracture orthosis custom made E05 32

Rigid wrist / hand orthosis (WHO) custom made W03 32

Cranial helmet H05 33

Spinal jacket (plastic) custom made B15 33

You choose 34

Pre-preg carbon Proplusion range order form 36

Central fabrication technical instruction sheet 37 - 39

Key (guide only):

Costs: $ = < $100 $ $ = $100-$250 $ $ $ = $250-$500 $ $ $ $ = $500 - $1000 $ $ $ $ $ > $1000

Complexity: P= simple to use, PPP = more difficult to use, some help may be reqd to donn and doff

PPPPP= help needed to donn and doff

Page 5: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

5 Head to Foot Ortho. 03 9870 2284

Outcome Measure Technologies

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6Head to Foot Ortho. 03 9870 2284

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test SMAR T Accurate and reliable data

BTS G-WALK analyzes the walkingpattern applying a suite of specific protocols, validated through clinical studies. The key indexes are the result of a 3-years-long study which have been validated by the most advanced clinical centers in the world.

A G I L E

V E R S A T I L EQuick and accurate assessment of motor impairmentsWith BTS G-WALK the clinician can obtain all the most importantinformation: spatio-temporal

parameters, general walking kinematics, pelvis

kinematics.

P O W E R F U LSeveral analysis protocols available BTS G-WALK software includes the protocols to execute several tests, that can be integrated in the patient clinical chart:

- Walk- Timed UP and GO- Turn Test- 6 Minutes Walking Test- Indoor Running

ESSENTIAL

Intuitive and easy to use The actual test is very easy to perform and the resulting reports are automatically generated and supply immediate comparison with normal range results.

Applications

Orthopaedics:- to choose the most suitable movement aid (O&P applications) - to evaluate pre- and post-surgery strategies

Neurology:- for the definition of rehabilitation strategies and their follow-up- for the evaluation of disease progression and the e�ectiveness of medications Geriatrics:- elderly people fall prevention periodical check-ups

C L I N I C A L LY V A L I D A T E D A new approach to functional movement analysis The walk parameters are essential to assess orthopaedic andneurological patients. BTS G-WALK allows all specialists to select the most e�ective treatment and monitor its results.

Pocket wireless systembased on inertial sensorsPlaced on L5, BTS-GWALKallows to execute a functional analysis with objective, accurate and quantitative data. The sensor is placed around the waist with an ergonomic belt: the patient is totally free to walk, run and jump.

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test

Page 7: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

7 Head to Foot Ortho. 03 9870 2284

SMAR T Accurate and reliable dataBTS G-WALK analyzes the walkingpattern applying a suite of specific protocols, validated through clinical studies. The key indexes are the result of a 3-years-long study which have been validated by the most advanced clinical centers in the world.

A G I L E

V E R S A T I L EQuick and accurate assessment of motor impairmentsWith BTS G-WALK the clinician can obtain all the most importantinformation: spatio-temporal

parameters, general walking kinematics, pelvis

kinematics.

P O W E R F U LSeveral analysis protocols available BTS G-WALK software includes the protocols to execute several tests, that can be integrated in the patient clinical chart:

- Walk- Timed UP and GO- Turn Test- 6 Minutes Walking Test- Indoor Running

ESSENTIAL

Intuitive and easy to use The actual test is very easy to perform and the resulting reports are automatically generated and supply immediate comparison with normal range results.

Applications

Orthopaedics:- to choose the most suitable movement aid (O&P applications) - to evaluate pre- and post-surgery strategies

Neurology:- for the definition of rehabilitation strategies and their follow-up- for the evaluation of disease progression and the e�ectiveness of medications Geriatrics:- elderly people fall prevention periodical check-ups

C L I N I C A L LY V A L I D A T E D A new approach to functional movement analysis The walk parameters are essential to assess orthopaedic andneurological patients. BTS G-WALK allows all specialists to select the most e�ective treatment and monitor its results.

Pocket wireless systembased on inertial sensorsPlaced on L5, BTS-GWALKallows to execute a functional analysis with objective, accurate and quantitative data. The sensor is placed around the waist with an ergonomic belt: the patient is totally free to walk, run and jump.

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test

Wireless Digital Gait Analysis System

Tests are easy to perform, provide immediate results, are clinically validated

and easy to interpret

Your pocket gait analysis laboratory

Included tests:- Walk - Timed UP and GO - Turn Test - 6 Minutes Walking Test - Indoor Running- Free Test

Part Number Description Specification & Inclusions

GWAUNO01 BTS G-WALK ® HARDWARE: 1 x Wireless inertial sensor, 1 x belt (+ extension), 1 x transport bag, 1 x Bluetooth Dongle, 1 x USB cableSOFTWARE: BTS G-Studio - 1 licence = 5 users

GWAOPT01 BTS Secure / annual fee Annual software subscription, free software updates and technical support

GWAOPT02 Warranty extension - 3 years 1 year included + 2 additional

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8Head to Foot Ortho. 03 9870 2284

PressureGuardian™ provides you with instantaneous pressure measurement inside the client’s footwear.

Measure, Modify, Succeed

Measure and improve your outcomes for the high risk foot with ...

Simultaneous Multi-Sensor Readings

Patient Report

Benefits:R Static and dynamic pressure readings on-the-spotR Immediate data to verify your interventionR Show your client what is being achievedR Simple documentation for insurance clients

Let’s talk- call our clinical team today.

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9 Head to Foot Ortho. 03 9870 2284

Maximise outcomes for the high risk foot.

CASE STUDY

28 days(actual patient

results with chronic 2yr

ulcer)

‘In the High Risk Foot setting, Pressure Guardian provides invaluable pressure loading information to enable us to more accurately offload our

neuropathic patients. It grants us immediate feedback with which to better evaluate the efficacy of our orthotic devices prior to application.’

Podiatrist, High Risk Foot Clinic, Melbourne

Simultaneous Multi-Sensor

Readings

Graphed Data of Static & Dynamic

Pressure

Four Report Options

Patient Report

Part Number Description Specification & Inclusions

PG-Kit 2A Pressure Guardian System

1 Pressure Guardian Module, 1 x Module Charger, 1 x Module Retainer Cuff, 1 x Quad Lead Cable, 1 x Single Lead Cable, 1 x Calibration Jig, 1 x 5 Pack of 8” Sensors, Warranty, 12 months, Software, Free iOS Mobile Apple App.

PG-03 Replacement pack 5 sensors (8”)

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10Head to Foot Ortho. 03 9870 2284

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11 Head to Foot Ortho. 03 9870 2284

Compression Garment Application

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12Head to Foot Ortho. 03 9870 2284

Product Code Description

SAS-08017 Ezy-As Applicator/Small (Red)

SAM-06264 Ezy-As Applicator/Medium (Yellow)

SAL-06264 Ezy-As Applicator/Large (Blue)

UHA-07246 Ezy-As Handle Attachment

Page 13: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

13 Head to Foot Ortho. 03 9870 2284

Custom Made Orthoses

Page 14: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

14Head to Foot Ortho. 03 9870 2284

What it does: It also stabilises the ankle providing medial-lateral ankle support and improving standing balance. Great for active clients who require a smooth and efficient gait pattern.

Fabrication options:• Low profile or PTB style• High or low profile inner boot• Varying posterior strut stiffness• Firm or flexible toe plate

When to use it: The dynamic strut stores energy to allow for more efficient ambulation. Provides stabilisation of the ankle, subtalar and mid-tarsal joints. This design limits plantar-flexion allowing toe clearance through the swing phase of gait and controls tibial motion during stance. Call us to discuss.

How to measure it / size it: • Cast or scan the body segment required – we’ll

modify it for you.• See page 36 for technical information.

A custom fabricated, dynamic response, pre-preg carbon fibre Ankle-Foot-Orthosis (AFO). Its primary function is to provide sagittal plane ankle stability and motion control for conditions like dorsi-flexor and plantar-flexor weakness.

Propulsion Carbon Pre-preg AFO – custom made

What it does: It stabilises the knee providing medial-lateral and anterior-posterior support while eliminating knee hyperextension or knee buckling. Controls genu varum or valgum moments at the knee while keeping the knee joint stable.

When to use it: Knee and ankle instability, either specific or coupled, such as conditions like poliomyelitis, stroke, traumatic injury or other neurological conditions. Call us to discuss.

A custom fabricated, dynamic response, pre-preg carbon fibre Knee-Ankle-Foot- Orthosis (KAFO). Its primary function is to provide sagittal and coronal plane knee / ankle stability and motion control.

Propulsion Carbon Pre-preg KAFO - custom made

Order code: A41 Cost: $ $ $ $ $ Complexity: PPPPP

Order code: K14 Cost: $ $ $ $ $ Complexity: PPPPP

How to measure it / size it: • Cast or scan the body segment required – we’ll

modify it for you.• See page 36 for technical information.

Fabrication options:• Low profile or PTB style• High or low profile inner boot• Varying posterior strut stiffness• Posterior offset, polycentric or lock knee joint

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15 Head to Foot Ortho. 03 9870 2284

What it does: The dynamic strut stores energy to allow for more efficient ambulation. This design provides a longer toe lever for a patient with a partial foot amputation, returning their third rocker to gait. The longer toe lever also offers improved balance throughout all phases of gait.

When to use it: The orthosis is specifically design for trans-metatarsal and mid-tarsal amputation levels, restoring the lost foot lever and improving pressure distribution within the ankle-foot complex.

A custom fabricated, dynamic response, pre-preg carbon fibre Ankle Foot Orthosis (AFO). This device is designed for client with a partial foot amputation.

Propulsion AFO for Partial Foot Amputation – custom made

Order code: A42 Cost: $ $ $ $ $ Complexity: PPPPP

Fabrication options:• As per Propulsion AFO• Firm or soft toe filler

How to measure it / size it: • Cast or scan the body segment required – we’ll

modify it for you.• See page 36 for tecnhincal information.

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16Head to Foot Ortho. 03 9870 2284

CROW - Charcot Restraining Orthotic Walker

What it does: The CROW functions by offering total contact support about the foot / ankle region with the option to provide specific unloading to areas that require it. CN deformities often cause the foot to change shape; the resulting stress on the foot can cause ulceration. By distributing pressure equally throughout the leg and foot, the CROW removes excessive forces and gives the foot time to heal. It can be removed for wound care and washing, and is durable.

Fabrication options:• Thermoplastic shells• Carbon fibre back / thermoplastic front

When to use it:Patients with Charcot Neuroarthropathy will benefit from the stabilisation offered by the CROW, as will those with recalcitrant mid and forefoot ulceration. The CROW has an external walking sole that does allow ambulation.

How to measure it / size it: • Cast or scan the body segment required.• The cast ankle position will be the finished ankle position in the CROW -

so make make sure its correct when you cast (or ask us to correct it).

Order code: A29Cost: $ $ $ $ $Complexity: PPPPP

The Charcot Restraint Orthotic Walker, or CROW, is a stable boot designed to accommodate and support a foot with Charcot neuroarthropathy (CN). The CROW consists of a fully enclosed ankle/foot orthosis with a rocker-bottom sole.

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17 Head to Foot Ortho. 03 9870 2284

What it does: Custom foot orthoses stablise and control the alignment of the foot and ankle complex, provide plantar pressure re-distribution and support to the structure of the foot.

Fabrication options:• Semi-rigid - EVA - you choose the density - soft,

medium or firm. See page 37.• Rigid – polymer or carbon fibre• Full length or ¾ length• Localised reliefs• Metatarsal domes / bars

When to use it: • Patients with alignment abnormalities such as pes

plano valgus• Biomechanical deficiencies including excessive foot

pronation • Injuries to the foot and ankle • Plantar pressure re-distribution for diabetic feet

How to measure it / size it: • Cast or scan the body

segment required.• Take impressions of

client’s foot: - Plaster slipper cast

Custom made foot orthoses are specially-made devices designed to support the structure of the foot. Worn in conjunction with supportive footwear, they may be used to treat foot pain caused by abnormal motion, to treat injuries such as tendonitis or plantar pressure wounds and provide some knee stability.

Custom foot orthotics - pair or single

What it does: A custom foot orthosis with toe filler supports the alignment of the foot and ankle complex, provides plantar pressure re-distribution and assists in filling the toe box of the shoe when a partial foot amputa-tion has occured.

Fabrication options:• Semi-rigid – EVA – you choose the density – soft,

medium or firm• Full length localised reliefs• Metatarsal domes / bars

When to use it: Partial foot amputation, in particular including the great (1st) toe or multiple lesser toes (As the amputation site becomes more proximal (e.g. transmetatarsal) then it may be important to consider a device that assists in control of the ankle and compensates for the loss of propulsion).

How to measure it / size it: • Cast or scan the body

segment required. • Take impressions of

client’s foot: - Plaster slipper cast

A custom made foot orthosis with toe filler is a specially-made device designed to support the structure of the foot and accommodate for the loss of foot length and leverage in a partial foot amputee.

- Foam impression box - Fibreglass slipper cast

• Modify the cast to suit your requirements, or instruct us and we’ll do it for you

Custom foot orthosis with toe filler (partial foot amputee)

Order code: F05a (pair), F06a (single) Cost: $ $ $ $ $ Complexity: PPPPP

- Foam impression box - Fibreglass slipper cast

• Modify the cast to suit your requirements, or instruct us and we’ll do it for you

Order code: F05 (pair), F06 (single) Cost: $ $ $ $ $ Complexity: PPPPP

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18Head to Foot Ortho. 03 9870 2284

What it does: These orthoses provide maximal alignment correction to the foot and ankle complex. Control of the rearfoot is achieved through containment of the calcaneus in conjunction with medial longitudinal arch support.

Fabrication options:• Plastic - polypropylene, co-polymer, polyethylene• ¾ length, full length • Padding as requested

When to use it: • Patients with correctable significant alignment

abnormalities such as pes plano valgus associated with hypermobility in a child.

How to measure it / size it: • Cast or scan the body

segment required.• Take impressions of the

clients foot / feet using a cast method

• Ensure that the cast

High cupping custom made foot orthoses are a rigid style device with deep heel cup and high trim lines. Designed to provide maximum alignment control e.g. UCBL or SMO.

High cupping foot orthosis

What it does: A surgical shoe raise increases the height of a shoe by an amount determined by the prescriber.

Fabrication options:• Supply the shoe of your choice – preferably a

supportive shoe with fastening system• Specify the height of the raise and the side (left or right)• Full length raise OR raise with gradual taper to the toes

OR heel only raise• A part internal raise may help to reduce the size of the

external raise

When to use it: Patients with leg length discrepancies, for example after total hip replacement surgery.

How to measure it / size it: • Measure the patients leg length left vs right in supine

position - ASIS to medial malleolus / umbilicus to medial

malleolus• Confirm the amount by standing the patient on a

simulated raise.• Seek patient feedback on the height and check level

of iliac crests in standing

A surgical shoe raise is a modification made to the sole of shoe to increase the height of the shoe.

has adequate depth to encapsulate the calcaneus

• Modify the cast to suit your requirements, or instruct us and we’ll do it for you

Surgical shoe raise

Order code: F07 Cost: $ $ $ $ $ Complexity: PPPPP

Order code: F15 Cost: $ $ $ $ $ Complexity: PPPPP

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19 Head to Foot Ortho. 03 9870 2284

What it does: A shoe float increases the width of the sole of the shoe, typically on one side. This assists in providing stability to the shoe when alignment issues are present.

Fabrication options:• Supply the shoe of your choice – preferably a

supportive shoe with fastening system• Specify (left or right) and medial or lateral.• Specify the float width.• Heel only or full length of the shoe

When to use it: A float / flare is a very helpful addition when attempting to increase stability for an ankle that is significantly valgus (medial float) or varus (lateral float). Often used in conjunction with other orthotic options (e.g. custom foot orthosis or ankle foot orthosis) the float will control the point of application of the ground reaction force.

How to measure it / size it: • Larger float = greater control• Call us to discuss your requirements

A shoe float / flare is a modification conducted to the sole of shoe to increase the base of support on either the medial or lateral side of the shoe (or both).

Shoe float / flare

What it does: A shoe wedge will create a varus (medial wedge) or valgus (lateral wedge) force on the foot / ankle complex and more proximal joints.

Fabrication options:• Supply the shoe of your choice – preferably a

supportive shoe with fastening system• Specify, L or R, the height of the wedge, medial or

lateral

When to use it: Patients with alignment issues that are significant and correctable (e.g. correctable pes plano valgus = medial shoe wedge). (Typically used in conjunction with other orthotic options such as custom made foot orthoses).

How to measure it / size it: • Simulate the wedge by standing the patient (with

shoes on) and placing firm material under the medial or lateral side of the shoe.

• Adjust the height based on correction achieved and patient feedback.

A shoe wedge is a modification conducted to the sole of shoe to increase the height of the medial or lateral side and therefore change the angle of the shoe.

Shoe wedge

Order code: F20 Cost: $ $ $ $ $ Complexity: PPPPP

Order code: F20 Cost: $ $ $ $ $ Complexity: PPPPP

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20Head to Foot Ortho. 03 9870 2284

What it does: A carbon fibre stiffening modification reduces the flexibility of the sole of shoe, preventing unwanted flexion of the forefoot during gait.

Fabrication options:• Supply the shoe of your choice – preferably a

supportive shoe with fastening system.• Specify the side (left or right).

When to use it: • Overuse injuries of the foot such as stress fractures.• Partial foot amputees will typically benefit from a

stiffening modification to their shoe to replace the lost leverage post amputation.

• Useful when offloading the forefoot of a diabetic foot ulcer, reducing the force and time spent weightbearing through the forefoot.

How to measure it / size it: • Supply the shoe - must be structurally sound.

A carbon fibre stiffening plate is inserted into the sole of the shoe permanently, ensuring the existing space in the shoe is not compromised.

Carbon fibre stiffening modification to shoe

What it does: A rocker sole changes the timing of pressure distribution on the plantar aspect of the foot and assists in creating a smooth rollover during gait.

Fabrication options:• Supply the shoe of your choice – preferably a

supportive shoe with fastening system.• Specify the height of the rocker (e.g. 10mm / 15mm /

20mm) and the side (left or right).• Consider a raise to the opposite shoe to ensure even

leg length.

When to use it: Patients with ankle arthrodesis / fusion or degenerative changes in the ankle joint benefit from the features of a rocker in decreasing stress and movement required at the talo-crural joint. A useful adjunct when offloading plantar forefoot pressure areas, the rocker assists with reducing time spent in the forefoot region of the shoe.

How to measure it / size it: • Consider the overall stability of your patient. • Talk to one of our clinicians about the best rocker type

and height for your patient.

A rocker sole modification is an adjustment that is conducted to the sole of shoe to increase the rolling action of the shoe without the need for the shoe and foot to flex.

Rocker sole shoe modification

Order code: F26 Cost: $ $ $ $ $ Complexity: PPPPP

Order code: F20 Cost: $ $ $ $ $ Complexity: PPPPP

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21 Head to Foot Ortho. 03 9870 2284

Ankle foot orthosis (AFO) custom made

What it does: A custom AFO is used to control motion and alignment of the foot and ankle complex and influence biomechanics of the knee. The materials used and the design / trimlines of the AFO will influence the final characteristics, depending on your prescription criteria. • Call one of our clinicians to discuss your patient and we can assist in choosing the correct style and materials.

Fabrication options:• Plastic – polypropylene, co-polymer or polyethylene

- Select your pattern of transfer paper or colour • Carbon fibre lamination• Solid or flexible (leafspring) design

When to use it:• Patients who require control of the foot ankle complex to assist with static positioning (e.g. bed resting AFO for

stroke patient) or to maximise function and stability in gait. • To assist in the control of dorsiflexion and / or plantarflexion weakness during gait and general control of ankle

alignment.• Immobilisation may also be required to assist with symptomatic relief for conditions such as significant osteoarthritis

of the ankle joint.

How to measure it / size it: • Cast or scan the body segment required.• Cast in a neutral / corrected alignment - or in the specific position required for your client.• Clearly identify bony prominences or other areas of concern on the cast.• Modify the cast to suit your requirements, or instruct us and we’ll do it for you.• Mark the final trimlines of your AFO on the cast.

A custom made ankle foot orthosis (AFO) is a specially designed orthosis that encompasses the foot, ankle and lower leg. AFO’s are among the most commonly prescribed lower limb orthoses. They are custom made for each individual and designed to assist with control of muscle weakness, joint instability and high muscle tone.

• Strap size and location as requested• We’ll fabricate to any point that you like – mould only /

moulded and trimmed off / fully finished for fit.

Order code: A09Cost: $ $ $ $ $Complexity: PPPPP

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22Head to Foot Ortho. 03 9870 2284

Ankle foot orthosis (AFO) – jointed / hinged custom made

What it does: A jointed AFO is used to control motion and alignment of the foot and ankle complex and influence biomechanics of the knee. The jointed AFO allows motion control in the saggital plane, whilst stabilising moblity in the frontal plane, to assist in the control of dorsiflexion and / or plantarflexion weakness during gait and general control of ankle alignment. • Call one of our clinicians to discuss your patient and we can assist in choosing the correct style and materials.

Fabrication options:• Plastic – polypropylene or co-polymer

- Select your pattern of transfer paper or colour • Carbon fibre lamination• Choose your joint design

- Tamarack joint, dynamic positioning joint or other• Plantarflexion block, dorsiflexion block or free motion

When to use it:• Patients who require control of the foot ankle complex to maximise function and stability in gait. • To assist in the control of dorsiflexion and / or plantarflexion weakness during gait and general control of ankle

alignment, especially in a neurological setting - for example, control of an equinovarus ankle post stroke.

How to measure it / size it: • Cast or scan the body segment required.• Cast in a neutral / corrected alignment - or in the specific position required for your client.• Clearly identify bony prominences or other areas of concern on the cast.• Modify the cast to suit your requirements, or instruct us and we’ll do it for you.• Mark the final trimlines of your AFO on the cast.

A jointed custom made ankle foot orthosis (AFO) is a style of AFO that incorporates a mechanical ankle joint to allow pre- determined and controlled movement of the ankle whilst preventing unwanted movement and providing stability.

• Dorsiflexion assist – specify the strength required (low, medium, strong)

• Strap size and location as requested• We’ll fabricate to any point that you like – mould

only / moulded and trimmed off / fully finished for fit

Order code: A10Cost: $ $ $ $ $Complexity: PPPPP

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23 Head to Foot Ortho. 03 9870 2284

Bi-valved ankle foot orthosis (AFO) custom made

What it does: A bi-valved AFO is used to control motion and alignment of the foot and ankle complex and influence biomechanics of the knee. The anterior shell allows complete containment of the leg to maximise control and stability whilst spreading the forces over a broad surface area.

Fabrication options:• Plastic – typically polypropylene posterior shell with

polyethylene anterior shell (padded) - Select your pattern of transfer paper or colour

• R-wrap style (thin polypropylene anterior and posterior circumferential shells)

• Carbon fibre lamination• Jointed or fixed ankle

When to use it:Patients who require maximum control of the foot ankle complex and total contact support of the tibial region. For example a patient with a tibial fracture who is being managed conservatively or needs supplemental support post-operatively. Neurological patients with high tone or dystonic movement patterns may benefit from the additional control of an anterior tibial shell.

How to measure it / size it: • Cast or scan the body segment required.• Cast in a neutral / corrected alignment - or in the specific position required for your client.• Clearly identify bony prominences or other areas of concern on the cast.• Modify the cast to suit your requirements, or instruct us and we’ll do it for you.• Mark the final trimlines of your AFO on the cast

A bi-valved custom made ankle foot orthosis (AFO) is a style of AFO that incorporates an additional anterior shell to increase control and pressure distribution compared to that of a standard AFO. An anterior shell can also be incorporated into a jointed AFO.

• Plantarflexion block, dorsiflexion block or free motion• Dorsiflexion assist – specify the strength required

(low, medium, strong)• Strap size and location as requested• We’ll fabricate to any point that you like – mould

only / moulded and trimmed off / fully finished for fit.

Order code: A11Cost: $ $ $ $ $Complexity: PPPPP

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24Head to Foot Ortho. 03 9870 2284

Order code: A14Cost: $ $ $ $ $Complexity: PPPPP

Weight relieving AFO custom made

What it does: This style of AFO incorporates a bi-valved shell proximally to provide maximal loading of the mid-proximal tibia. Through the use of specific cast modifications or by adding a metal upright ‘split stirrup’ section distally, weight relief of the foot and ankle can be achieved whilst allowing weightbearing through the limb.

Fabrication options:• Call us to discuss your weight relief requirements and we’ll help you with the best design for your client.• Plastic – typically polypropylene posterior shell with polyethylene anterior shell (padded)

- Select your pattern of transfer paper or colour • Carbon fibre lamination• +/- metal upright split stirrups into footwear• Strap size and location as requested• We’ll fabricate to any point that you like – mould only / moulded and trimmed off / fully finished for fit

When to use it:Hind and midfoot offloading of the foot and ankle either in the short term (e.g. calcaneal fracture or plantar heel ulceration) or long term to provide pain relief and stability.

How to measure it / size it: • Cast or scan the body segment required.• Discuss casting position with one of our clinicians to achieve the desired offloading • Clearly identify bony prominences or other areas of concern on the cast• Modify the cast to suit your requirements, or instruct us and we’ll do it for you• Mark the final trimlines of your AFO on the cast • Provide the shoe if a metal upright split stirrup section is required

A custom made weight relieving AFO that provides circumferential containment of the lower limb and control proximally of the calf to allow weight relief of the ankle and hindfoot.

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Metal below knee caliper custom made

What it does: A metal upright caliper provides control of the foot ankle complex and allows for adjustable correction of varus or valgus deformities and the opportunity to provide ankle control / assist if required.

Fabrication options:• Single (medial or lateral) or double upright• Free motion or limited motion• Dorsiflexion assist• Medial (controls valgus) or lateral (controls varus) T-strap • Velcro closure or buckle closure

When to use it:A major advantage of this style of orthosis is the minimal contact with the lower limb. Patients with ankle instability or significant mal-alignment of the foot and ankle into varus or valgus may benefit from this style of device. Particularly useful when fluctuating oedema, poor skin condition or pressure intolerance would preclude the use of a more rigid style plastic / carbon fibre AFO. Adjustable on a day-to-day basis.

How to measure it / size it: • Take a tracing of the patients leg whilst in a supine position • Mark the height of the ankle joint • Mark and measure the total height of the caliper (finished

height should be 3-5cm below the fibula head)• Provide a calf circumference measurement • Provide the shoe NB - Please call our team to discuss tracing / measurement requirements.

A metal below knee caliper incorporates a calf shell, medial and / or lateral metal upright and an attachment into the sole of a shoe. Typically used with a T-strap to provide correction to a valgus or varus alignment concern.

Options: • Round ferrule

- single upright (medial or lateral) - double upright - T –strap (medial or lateral)

• Square ferrule - Single upright (medial or lateral) - Double upright - Free motion - Limited motion - Dorsiflexion assist - Double action - T-strap (medial or lateral)

Please call us to discuss the most appropriate option for your patient.

Order code: A25Cost: $ $ $ $ $Complexity: PPPPP

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26Head to Foot Ortho. 03 9870 2284

Order code: K15Cost: $ $ $ $ $Complexity PPPPP

Knee ankle foot orthosis (KAFO) custom made

What it does: A custom KAFO is used to control motion and alignment of the knee, foot and ankle and influence biomechanics during gait. The materials used and the design / trimlines of the KAFO will influence the final characteristics, depending on your prescription criteria. • Call one of our clinicians to discuss your patient and we can assist in choosing the correct style and materials.

Fabrication options:• Plastic – polypropylene or co-polymer: select your

pattern of transfer paper or colour • Carbon fibre lamination• Metal / leather option• Anterior or posterior thigh and tibial sections• Solid, flexible or jointed ankle section

When to use it:• Patients who require control of the lower limb to maximise function and stability in gait or allow for safe and effective

weightbearing. • Flaccid lower limb weakness such as occurs with Poliomyelitis or increased muscle tone post spinal cord injury

may require stabilisation of both the foot / ankle complex and the knee. Significant alignment issues including knee hyperextension or genu varum / valgum will sometimes be best controlled with a device such as a custom KAFO.

How to measure it / size it: • Take a cast, scan or tracing of the clients lower

limb from proximal thigh to toesCast in a neutral / corrected alignment at both the foot / ankle and knee

• Clearly identify bony prominences or other areas of concern on the cast

A custom made knee ankle foot orthosis (KAFO) is a specially designed orthosis that encompasses the thigh, knee, lower leg, foot and ankle. Knee ankle foot orthoses are made for each individual and designed to assist with control of muscle weakness, joint instability and high muscle tone.

• Modify the cast to suit your requirements, or instruct us and we’ll do it for you

• Mark the final trimlines of your KAFO on the cast

• Knee joint choice – e.g. drop lock, cable operated locks, posterior offset, free motion, stance phase control

• Strap size and location as requested• We’ll fabricate to any point that you like – mould only

/ moulded and trimmed off / fully finished for fit • Check fit options available at various stages of

production

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Order code: K16 Cost: $ $ $ $ $ Complexity: PPPPP

What it does: The 3 point knee extension orthosis utilises a medial and lateral upright connected to a calf and thigh band. A padded strap then passes over the knee and allows the patient or carer to pull the strap tight and create an extension force on the knee. The tension of this strap can be adjusted to tune the amount of knee extension force created.

Fabrication options:• Custom made to suit the length and circumference of

your patient

When to use it: A flexion contracture / stiffness has developed at the knee joint that is preventing full extension. Typically used after an orthopaedic procedure, such as a total knee replacement, when joint range of motion is not restored to full range.

How to measure it / size it: • Measure the total length of the device – long lever

arms are most effective• Measure the circumference at the distal and proximal

end of the orthosis• Provide the knee angle of the patient

A custom made orthosis that is designed to provide an adjustable extension force to the knee.

3 point knee extension orthosis

What it does: The dynamic knee extension orthosis is a very effective way of providing an extension (and/ or flexion) force to the knee joint. The custom made thigh and calf sections spread the force over broad surface areas allowing for excellent tolerance to the load and therefore high compliance. The dynamic joint is simple and intuitive to use and highly adjustable.

Fabrication options:• Thermoplastic – select your colour and thickness

preference • Fully lined

When to use it: The dynamic knee extension orthosis can be used when a flexion contracture / stiffness has developed at the knee joint that is preventing full extension. This orthosis is an effective and tolerable way to provide a corrective force over long period of time.

How to measure it / size it: • Cast or scan the body segment required.• Mark knee joint and areas of interest.• Modify the cast or send to us and we’ll modify it for

you.

A custom made knee orthosis designed to provide a dynamic, constant and adjustable extension (and/or flexion) force to the knee. This orthosis is designed using custom moulded, padded, polymer thigh and calf sections with a dynamic knee joint incorporated into the design.

Dynamic knee extension orthosis custom made

Order code: K29 Cost: $ $ $ $ $ Complexity: PPPPP

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28Head to Foot Ortho. 03 9870 2284

Knee control orthosis (KCO) custom made

What it does: A KCO allows for controlled motion and alignment of the knee during gait. The materials used and the design / trimlines of the KCO will influence the final characteristics, depending on your prescription criteria. • Call one of our clinicians to discuss your patient and we can assist in choosing the correct style and materials.

Fabrication options:• Plastic – polypropylene or co-polymer

- Select your pattern of transfer paper or colour • Carbon fibre lamination• Anterior or posterior thigh and tibial sections• Padding where required• Knee joint choice – e.g. drop lock, cable operated locks, posterior offset, free motion, stance phase control• Strap size and location as requested

When to use it:• Knee joint stability either in the sagittal plane (flexion / extension) or frontal plane (varus / valgus) to assist with

correction of deformity. • Significant alignment issues including knee hyperextension or genu varum / valgum

How to measure it / size it: • Cast or scan the body segment required.• Cast in desired position.• Clearly identify bony prominences or other areas of concern on the cast.• Modify the cast to suit your requirements, or instruct us and we’ll do it for you.• Mark the final trimlines of your KCO on the cast.

A custom made knee control orthosis (KCO) is a specially designed orthosis that encompasses the thigh, knee and lower leg. The KCO is designed primarily to assist with control of muscle weakness or joint instability at the knee where a ‘foot section’ is not required in the final orthosis design.

Order code: K30Cost: $ $ $ $ $Complexity: PPPPP

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Low spinal brace (LSB)

What it does: The LSB provides control of the lumbar spine in the sagittal plane, preventing unwanted flexion and extension and limit-ing lateral flexion and rotation.

Fabrication options:• Custom made to suit your patient

- Height and circumference measurements required

• OR Select a pre-made spinal brace kit - Choose your height , all straps are fully

adjustable and can be trimmed to length• A waterproof / hydrotherapy option is also available

When to use it:Patients who require immobilisation of the lumbar spine (L2 – L5 levels) post injury or post surgery. Patients with chronic low back pain may also benefit from the support of this orthosis.

How to measure it / size it: • Measure the height of your patient and select the

appropriate size frame (see right)• If you would like a custom made option, take 3

circumference measurements: below chest, waist and hips and provide the finished height of the orthosis.

A low spinal brace (LSB) is a lightweight, padded aluminium frame spinal orthosis that provides control and immobilisation to the lumbar spine. This orthosis can be easily shaped to suit the individual anatomy of the patient and Velcro straps allow for adjustment and easy donning / doffing.

Guidelines for LSB / HSB height selection

Patient height LSB Height

Order Code

Less than 5ft (< 153cm)

11” WB11-11

5ft 1 – 5ft 3 (154 – 160cm)

12” WB11-12

5ft 4 – 5ft 6 (161cm – 169cm)

13” WB11-13

5ft 7 – 5ft 9 (170cm – 175cm)

14” WB11-14

5ft 10 – 6ft (176cm – 183cm)

15” WB11-15

6ft 1 – 6ft 3 (184cm – 191cm)

16” WB11-16

Greater than 6ft 4 (> 192cm)

17” WB11-17

Order code: See height selection chartCost: $ $ $ $ $Complexity: PPPPP

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30Head to Foot Ortho. 03 9870 2284

High spinal brace (HSB)

What it does: The HSB provides control of the thoracic and lumbar spine in the sagittal plane, preventing unwanted flexion and exten-sion and limiting lateral flexion and rotation.

Fabrication options:• Custom made to suit your patient

- Height and circumference measurements required• OR Select a pre-made spinal brace kit

- Choose your height - All straps are fully adjustable and can be trimmed

to length• A waterproof / hydrotherapy option is also available

When to use it:Patients who require immobilisation of the mid – low thoracic and lumbar spine (T7 – L5 levels) post injury or post surgery. Patients with chronic postural issues such as thoracic kyphosis may also benefit from the correction and control that this orthosis offers.

How to measure it / size it: • Measure the height of your patient and select the

appropriate size frame (see right)• If you would like a custom made option, take 3

circumference measurements: below chest, waist and hips and provide the finished height of the orthosis.

A high spinal brace (HSB) is a lightweight, padded aluminium frame spinal orthosis that provides control and immobilisation to the thoracic and lumbar spine. This orthosis can be easily shaped to suit the individual anatomy of the patient and Velcro straps allow for adjustment and easy donning / doffing.

Order code: See height selection chartCost: $ $ $ $ $Complexity: PPPPP

Guidelines for LSB / HSB height selection

Patient height LSB Height

Order Code

Less than 5ft (< 153cm)

11” / 19” WB12-11

5ft 1 – 5ft 3 (154 – 160cm)

12” / 20” WB12-12

5ft 4 – 5ft 6 (161cm – 169cm)

13” / 21” WB12-13

5ft 7 – 5ft 9 (170cm – 175cm)

14” / 22” WB12-14

5ft 10 – 6ft (176cm – 183cm)

15” / 23” WB12-15

6ft 1 – 6ft 3 (184cm – 191cm)

16” / 24” WB12-16

Greater than 6ft 4 (> 192cm)

17” / 25” WB12-17

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31 Head to Foot Ortho. 03 9870 2284

Order code: E02 Cost: $ $ $ $ $ Complexity: PPPPP

What it does: The 3 point elbow extension orthosis utilises a medial and lateral upright connected with a forearm and upper arm band. A padded strap then passes over the elbow at the point of the olecranon and creates an extension force on the elbow. The tension of this strap can be adjusted to tune the amount of force created.

Fabrication options:• Custom made to suit the length and circumference of

your patient

When to use it: The 3 point extension orthosis can be used when a flexion contracture / stiffness has developed at the elbow joint that is preventing full extension. Typically used after orthopaedic trauma where immobilisation in flexion has been required and joint range of motion is not restored to full range.

How to measure it / size it: • Measure the total length of the device – long lever

arms are most effective• Measure the circumference at the distal and proximal

end of the orthosis• Provide the elbow angle of the patient

A simple custom made orthosis that is designed to provide an adjustable extension force to the elbow.

3 point elbow extension orthosis

What it does: The dynamic elbow extension orthosis is a very effective way of providing an extension (and/or flexion) force to the elbow joint. The custom made forearm and upper arm sections spread the force over broad surface areas allowing for excellent tolerance to the load and therefore high compliance.

Fabrication options:• Co-polymer plastic – select your colour and thickness

preference • Fully lined

When to use it: The dynamic elbow extension orthosis can be used when a flexion contracture / stiffness has developed at the elbow joint that is preventing full extension. Either after an orthopaedic procedure or as a result of increased muscle tone resulting from a neurological condition.

How to measure it / size it: • Cast or scan the body segment required.• Clearly mark any bony prominences, the elbow joint

position and other areas of interest.• Modify the cast or send to us and we’ll modify it for you.

A custom made elbow orthosis that is designed to provide a dynamic, constant and adjustable extension (and/or flexion) force to the elbow. This orthosis is designed using custom moulded, padded, polymer forearm and upper arm sections with a dynamic elbow joint incorporated into the design.

Dynamic elbow extension orthosis custom made

Order code: E03 Cost: $ $ $ $ $ Complexity: PPPPP

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32Head to Foot Ortho. 03 9870 2284

What it does: A forearm guard / fracture orthosis provides complete circumferential protection and stabilisation to the length of the forearm.

Fabrication options:• Plastic – select your colour and thickness preference

- Co-polymer - Polyethylene - UMHW – high impact strength

• Fully lined

When to use it: The forearm guard is typically used for protection upon return to work or sporting activity after a forearm fracture.

How to measure it / size it: • Cast or scan the body segment required.• Take a cast of the patients forearm from wrist to elbow• Clearly mark any bony prominences and other areas

of interest• Mark the proximal and distal height of the orthosis on

the cast and the opening position• Modify the cast or send to us and we’ll modify it for you

A custom made thermoplastic orthosis that provides circumferential support and protection to the forearm, excluding the wrist and elbow joint.

Forearm guard / fracture orthosis custom made

What it does: A custom WHO provides stabilisation and immobilisation of the wrist (and fingers if required) whilst allowing easy donning and doffing.

Fabrication options:• Plastic – select your colour and thickness preference

- Co-polymer - Polyethylene

• Fully lined if required• Fingers included or excluded• Thumb included or excluded

When to use it: The custom WHO is used to support the wrist and hand for treatment of stable fractures and soft tissue injuries where immobilisation is required. This orthosis is also prescribed for static positioning of the wrist / hand to prevent contracture e.g. post stroke.

How to measure it / size it: • Cast or scan the body segment required.• Clearly mark any bony prominences and other areas of

interest• Mark the proximal and distal length of the orthosis on

the cast and the opening position• Modify the cast or send to us and we’ll modify it for you

A custom made thermoplastic orthosis that provides circumferential support and immobilisation to the wrist +/- fingers.

Rigid wrist / hand orthosis (WHO) custom made

Order code: E05 Cost: $ $ $ $ $ Complexity: PPPPP

Order code: W05 Cost: $ $ $ $ $ Complexity: PPPPP

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33 Head to Foot Ortho. 03 9870 2284

What it does: The custom helmet provides protection or in the case of an infant allows for cranial remoulding.

Fabrication options:• Co-polymer or polyethylene plastic

- Select your colour and thickness preference - Select a transfer paper pattern

• Fully lined • Chin strap if required

When to use it: Custom made helmets are used to protect patients who are at high risk of falls or post surgery – e.g. craniotomy. For infants a custom made helmet can be used to influence the shape of the head as a child grows (for instance in the treatment of plagiocephaly).

How to measure it / size it: • Cast or scan the head• Clearly mark the ears, front centre and other areas of

loading / relief. • Mark the desired trimlines on the cast.• Modify the cast or send to us and we’ll modify it for you.• Please call if you need a cranial remoulding helmet.

A custom made helmet is a plastic, fully padded helmet that is moulded to suit the shape of an individual patients head.

Cranial helmet

Order code: H05 Cost: $ $ $ $ $ Complexity: PPPPP

A custom made plastic spinal orthosis is a moulded body jacket that provides circumferential control and containment to the thoracic and lumbar spine. Fully padded this orthosis creates an intimate fit and therefore maximal control.

What it does: The plastic spinal orthosis provides maximum control of the lumbar and thoracic spine in all planes, restricting motion and allowing for a corrective force to be applied where required.

Fabrication options:• Plastic – polyethylene or co-polymer

- Select your colour choice or transfer paper pattern• Anterior opening• Bi-valved• You choose the design• Fully lined as requested

When to use it: Used for treatment of adolescent scoliosis, support and immobilisation of spinal fractures or long term postural control where a high degree of support is required.

How to measure it / size it: • Cast or scan the body segment required. • Mark clearly the proximal and distal trimlines• Identify the opening position on the cast

Spinal jacket (plastic) custom made

Order code: B15 Cost: $ $ $ $ $ Complexity: PPPPP

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34Head to Foot Ortho. 03 9870 2284

What it does: Your choice ...

Fabrication options:• You tell us what you want and we’ll make it for you.• Call one of our clinicians and discuss your design

ideas, we’ll help turn this into a reality.

When to use it: It’s up to you….

How to measure it / size it: • Cast or scan the body segment required. • We’re here to assist with your unique design ideas.

Cost: ? ? Ease of use: ? ?

You decide ... HTFO can fabricate many other custom designed orthoses as you require.

You choose

?

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35 Head to Foot Ortho. 03 9870 2284

Please use the following measurement / order forms for all custom products, or supply your own instruction sheet as preferred.

Measurement and Order forms

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36Head to Foot Ortho. 03 9870 2284

FABRICATION INSTRUCTIONS TYPE OF BRACE AFO (Low profi le trim lines) AFO (PTB trim lines) KAFO (Posterior off set knee joints) KAFO (Polycentric adjustable knee joints) KAFO (Drop lock knee joints) Partial Foot Prosthesis with carbon fi ller Partial Foot Prosthesis with cloud fi ller CAST CORRECTIONS

Leave as casted Correct to 90 degrees** POSTERIOR STRUT

Flexible Moderate FirmTOE PLATE Flexible FirmPATIENT’S ACTIVITY LEVEL K-1 K-2 K-3 K-4ENCOMPASSING

1st Metatarsal 5th Metatarsal ANKLE STRAP Medial Lateral

Order Date: Date Needed: PO#:

BILLING INFORMATIONFacility: Contact Name:

Address: City: State: Postcode:

Phone: Fax: Email:

SHIPPING INFORMATION Same as BillingFacility: Contact Name:

Address: City: State: Postcode:

Phone: Fax: Email:

PATIENT INFORMATIONLast Name: First Name:

Male Female Age: Weight: Height: LT RT BIL

Diagnosis:

Special Instructions:

INNER BOOT Low Profi le High Profi le ADDITIONS Pad Footplate (Spenco) Pad Footplate (Firm Puff )

SHOE SIZE

SHOE SENT WITH CAST? Yes No FOOT LENGTH(While weight bearing on sound side)

HEEL HEIGHT 3/8” 1/2” 3/4” Other

**WE WILL NOT ACCEPT JOBS WITHOUT PATIENT’S WEIGHT OR HEIGHT ON THE FORM.

CUSTOM PRE-PREGORDER FORM

Fibular height

MEASUREMENT / CASTING INFORMATION

LAB USE ONLY Intake Date Shipped Date Serial Number Tracking Number Technician

Calf circumferenceFinished AFO height

CUSTOM PRE-PREG ORDER FORM

FABRICATION INSTRUCTIONS TYPE OF BRACE AFO (PTB trim lines) AFO (Low profi le trim lines) KAFO (Posterior off set knee joints) KAFO (Bail lock knee joints) KAFO (Drop lock knee joints) Partial Foot Prosthesis with carbon fi ller Partial Foot Prosthesis with cloud fi ller Chopart Partial Foot Prosthesis CAST CORRECTIONS

Leave as casted Correct to 90 degrees in shoe** Correct cast to 2 degrees of Plantar Flexion**

POSTERIOR STRUT Flexible Moderate Firm

TOE PLATE Flexible FirmPATIENT’S ACTIVITY LEVEL K-1 K-2 K-3 K-4ENCOMPASSING

1st Metatarsal 5th Metatarsal

Order Date: Date Needed: PO#:

BILLING INFORMATIONFacility: Contact Name:

Address: City: State: Postcode:

Phone: Fax: Email:

SHIPPING INFORMATION Same as BillingFacility: Contact Name:

Address: City: State: Postcode:

Phone: Fax: Email:

PATIENT INFORMATIONLast Name: First Name:

Male Female Age: Weight: Height: LT RT BIL

Diagnosis:

Special Instructions:

ANKLE STRAP Valgus control Varus controlINNER BOOT Low Profi le (Standard) High Profi le ADDITIONS Pad Footplate** (Spenco) Pad Footplate** (Firm Puff / EVA)

SHOE SIZE (Required information)

SHOE SENT WITH CAST? Yes No FOOT LENGTH(While weight bearing on sound side)

HEEL HEIGHT 3/8” 1/2” 3/4” Other

(**Additional fabrication charge)WE WILL NOT ACCEPT JOBS WITHOUT PATIENT’S WEIGHT OR HEIGHT ON THE FORM.

CUSTOM PRE-PREGORDER FORM

MEASUREMENT / CASTING INFORMATION

LAB USE ONLY Intake Date Tracking Number Modifi ed Date Technician Shipped Date

Fibular heightFinished AFO height

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37 Head to Foot Ortho. 03 9870 2284

Central Fabrication - TECHNICAL INSTRUCTION SHEET

Business Name: ………………………………………………………............................. Order #: ..................................

Clinician: …………………… Email: ...............……………….……………………… Ph: ..........................................

Patient Name: ………………………………………. H: ……........…. W: ...................... Date Reqd: / / Foot Orthoses: Pair o / Single o

Length: Full Length o 3/4 length o Style: Semi-rigid (EVA) o Rigid o UCBL o SMO o

Density: Firm o Medium o Soft o

Covering: EVA – Purple o Blue o Brown o Black o Red o Green/blue o Blue/white o

Plastazote o Other: ..……......…………………………..

Left:

Domes: Mild o Mod o Large o

Wedges: Medial o Lateral o 3mm o 6mm o

Poron: Int heel o Ext heel o Forefoot o Other ……….…

Transfer paper pattern: ..................................................................................................................................... (for UCBL or SMO)

Special Instructions: ………………....……………………………………………………………………………................

Footwear Mods:

Left:

Raise: ……mm Full w/taper o Full w/no taper o Heel only o

Float: …………mm Lat o Med o Heel only o

Wedge: ……….mm Lat o Med o Heel only o

Rocker: ….........mm Full o Forefoot o

Carbon stiffener: Left o Right o

Special Instructions: …………….…………………………………………………………………………………...............

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

Right:

Domes: Mild o Mod o Large o

Wedges: Medial o Lateral o 3mm o 6mm o

Poron: Int heel o Ext heel o Forefoot o Other …………

Right:

Raise: ….. mm Full w/taper o Full w/no taper o Heel only o

Float: …………mm Lat o Med o Heel only o

Wedge: ……….mm Lat o Med o Heel only o

Rocker: ….........mm Full o Forefoot o

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38Head to Foot Ortho. 03 9870 2284

Central Fabrication - TECHNICAL INSTRUCTION SHEET

Business Name: ………………………………………………………............................. Order #: ..................................

Clinician: …………………… Email: ...............……………………………………… Ph: ..........................................

Patient Name: ………………………………………. H: ……........…. W: ...................... Age: .......... Date Reqd: / /

Ankle Foot Orthoses: Left / Right / Bilateral

Material: 4mm PP o 5mm PP o 4mm PE o 5mm PE o Carbon lamination o Other: ..................................................

Copolymer: o Thickness ………….mm

Style: Fixed o Leafspring o Artic with stop o Artic w/out stop o Bivalved o CROW o

Colour …………….. Foot Length: Full o Foot length………… / shoe size ……..…(or tracing required) / ¾ length o

Height of finished AFO: ………………. Ankle strap: Attach lat o Attach med o Slotted o - med / lat / med-lat

Foam lining: o Specific location …………………………………………………….Thickness…......…………….....…..

Transfer paper pattern: ..................................................................................................................................................................

Special Instructions: ………………………………………………………………………………………………………...

……………………………………………………………………………………………………………………………..

BK / AK Calliper: Left / Right / Bilateral

BK o AK o Medial upright o Lateral upright o Double upright o

Round ferrule o Square ferrule o Fixed ankle o Ltd motion o DF assist o Other: .........................................................

Knee joint type ………………………………

Medial T-strap o Lateral T-strap o Buckle o Velcro o Knee spider o

Special Instructions: ………………………………………………………………………………………………………...

Knee / Knee Ankle Orthoses: Left / Right / Bilateral

Type: Knee orthosis o KAFO o 3 point knee extension o (tracing / measurements required) Bivalved Plastic o

Materials: 4mm PP o 5mm PP o 4mm PE o 5mm PE o Carbon Lamination o Copolymer o Other: .........................

Thickness …..........mm Colour .......................................…

Foam lining o Specific location ………………………………………..

Knee: Fixed knee o Hinged knee o Joint type ……………………….

Ankle: Fixed ankle o Leafspring o Jointed ankle – type………………………. o Posterior stop …...….......……… o

Foot: Full Length foot o ¾ length foot o

Special Instructions: ….......………………………………………………………………………………………………..

...……………………………………………………………………………………………………………........................

...……………………………………………………………………………………………………………........................

Page 39: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

39 Head to Foot Ortho. 03 9870 2284

Central Fabrication - TECHNICAL INSTRUCTION SHEET

Business Name: ………………………………………………………............................. Order #: ..................................

Clinician: …………………… Email: ...............……………………………………… Ph: ..........................................

Patient Name: ………………………………………. H: ……........…. W: ...................... Date Reqd: / / Spinal Orthoses:

Low spinal o High spinal o Circumferences: Chest …………….. Waist ……………… Hips ……………….

Brace Height: ……………………………

Boston o 5mm PE o Other Plastic ………………………. Thermofoam lining o Yes No

Special Instructions: …………………………………………………………………………………………….................

Wrist Orthosis: Left / Right

4mm PE o Copolymer o Other……………………………. Thickness ………….mm Colour ………….…............…..

Thumb included o Dorsal opening o Other opening: ….................................................................................................……

Foam lining o Specific location ……………………………..………….………………………………………………….

Special Instructions: …………………………………..…………………………………………………………...............

Elbow Orthosis: Left / Right / Bilateral

4mm PE o 5mm PE o Copolymer o Thickness ………….mm Colour ……………………………………………….

Fixed o Hinged o Joint type ………………………. Medial / Lateral …………………………………………………..

Special Instructions: ………………………………………………………………………………………………………...

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………..

Page 40: catalogue august 2017 - Orthotics Catalogu… · • Low profile or PTB style • High or low profile inner boot • Varying posterior strut stiffness • Firm or flexible toe plate

40Head to Foot Ortho. 03 9870 2284

Testimonial: ‘We are very happy with the central fabrication service provided by Head to Foot Orthotics. The team consistently produces work of high quality. They are always willing to accommodate our needs to produce the best orthoses for our clients. The communication has been excellent. I would confidently recommend this service.’

J.M. - Orthotist , > 15 years experience

& 03 9870 2284

7 03 9870 0248

) [email protected]

39 Centre Way, Croydon, 3136, Victoria

@ www.htfo.com.au