• L _____ mm R _____ mm ( Max. 10 mm )

  • EXAMINATION FINDINGS

  • UCBL!!!

  • Sport Flex!!! All Sport!!! Casual Ultra Flex!!! Active Diabetic!! Dress Flex!!! Pump Flex!!!

    Arch Profile Non-weight bearing High !L !R Med !L !R Low !L !R

    Arch Profile Weight bearing High !L !R Med !L !R Low !L !R

    Pronation ! Mild !L !R Moderate !L !R Severe !L !R

    Gait Attitude ! In-toe (adducted)

  • ! Straight ! Out-toe (abducted)

  • Supination ! Mild !L !R Moderate !L !R Severe !L !R

  • SPECIALTY DEVICES

  • ACCOMODATIONS

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  • Gait Plate!!! !Induce toe In ! Induce toe Out

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  • ALTERNATE SHELL MATERIAL

  • SPECIFIC TOP COVER REQUEST

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  • ! White Polypropylene 2 mm ! White Polypropylene 3 mm ! Carbon Flex 2 mm

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  • !Blue ETC 1/8 !Black ETC 1/8 !Vinyl 1/16 !Vinyl 1/8 !Star Suede 1/16” Black !Star Suede 1/8” Blue !Ultrahyde 1/16 !Ultrahyde 1/8 !Suede - $15.00 !Leather - $20.00 !Neoprene - $10.00

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  • Arch Fill - Soft!! Arch Fill - Firm!!

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  • SUPPLIES

  • Extra Foam Padding - Full Length

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  • !Order Forms !Footwear Catalog !Shipping Labels

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  • Bio Foam ( See current price list )

  • UNDERLAY

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  • SPECIAL INSTRUCTIONS

  • SHOE SELECTION

  • SHOE SELECTION

  • SHOE SELECTION

  • Size: _____________________________ Color:

    Size: _____________________________ Color:

    Size: _____________________________ Color:

    Width: _________________ !with orthotic !Shoe onlyWidth: _________________ !with orthotic !Shoe only

    Width: _________________ !with orthotic !Shoe only

  • Lab Copy( Keep bottom copy for records )

  •  / /

  • Gait analysis and Biomechanical Evaluation: Our examination reveals the following imbalances to be contributing to the above problems:

  • Prognosis: The custom orthotics are a medical necessity and must be worn on a day-to-day basis, for an indefinite period of time. Wearing custom orthotics will alleviate the symptoms caused in the foot, hip, and low back. The orthotics, the feet and gait should be monitored to watch for change in prescription or breakdown of the device.

    Casting Technique: Non-weight bearing 3D volumetric cast in subtalar neutral. This data is scanned by technicians. Copolymer plastic is formed over the positive to create a custom orthotic for the patient’s specific correction and symptomatic needs.

    Manufacturing Laboratory: The Orthotic Group Inc. Markham ON.

    Fee: See accompanying invoice. No part of these fees are covered by OHIP.

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  • Orthotics

    • Device designed to provide high levels of control with design features allowing maximum shock absorption. Best suited for casual, workplace and active footwear which allow depth for device.
    • High control level
    • Semi rigid poly pro shell with arch fill
    • Full length puff top covering with nyplex bottom cover

    • Sleek low profile orthotic allowing mild biomechanical control for use in women's high heel shoes.
    • Carbon shell
    • Narrow tapered grind design
    • 1/16 starsuede top covering

    Trilaminate shell, designed to provide soft cushioning and enhanced support. Ideal device for sensitive clients who require gentle support. Full fitting casual footwear suggested. Not recommended for dress or athletic footwear due to bulk and design.

    • For the diabetic patient who's primary fitness activity is walking. Ideal device for the type 2 patient who requires stability, support and pallation during their daily activities.
    • 2mm carbon flex shell
    • Poron arch fill
    • Poron 1/8 and plastizote top covering

    • Orthotics constructed utilizing a semi-flexible shell design to provide motion control and comfort for children. Suited for athletic footwear and casual day to day youth footwear.
    • Carbon Flex
    • Sport ETC top covering

  • Adult - Naot, Finn Comfort Youth - Geox

  • WOMEN’S

  • MEN’S

  • YOUTH

  • UCBL

    • Specialty device for children and adults with flexible flat feet requiring maximum control and correction. Rigid device with medial and lateral phlanges and comfort eva top covering.
    • RCH or polypro shell design
    • Raised medial and lateral phlanges
    • Puff top covering

    • Designed to meet the needs of active clients requiring motion control, and shock absorption. This is an ideal device for athletic activities and workplace footwear for individuals who perform long periods of standing or walking.
    • 2mm carbon shell
    • Poron arch fill
    • Sport ETC top cover
    • Nyplex bottom covering

    • Specifically constructed to meet the needs of patients who require increased motion control in a lightweight resilient device. Fits most athletic footwear types.
    • 2mm or 3mm poly pro shell
    • Full length sport etc coverings

  • WOMEN’S

  • WOMEN’S

    • Orthotics designed for patients who require support and flexibility in their day to day activities. Fits most shoes with the exception of narrow dress style footwear. An excellent product for clients who require one pair of orthotics for use in both athletic or casual footwear.
    • 2mm or 3mm carbon flex shell
    • Full length supreme etc covering

    For Him, or Her, low profile device for use in slip on or lace dress shoes, designed to promote enhanced biomechanical control with reduced bulk.

    • 2mm carbon shell
    • 1/16 starsuede top covering
    • Narrow orthotic grind

  • Atlas orthotic lab

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