Table 5 All accepted statements from the Delphi survey on prescription of customised FOs for symptomatic flexible pes planus in the adult

Inverted cast pour [heel in an inverted position]

The focus of treatment is increased rearfoot control (e.g. excessive rearfoot eversion/varus)

88.3

2

The STJ is medially deviated (frontal plane dominance)

70.8

2

There is tibialis posterior dysfunction

79.1

2

There is a high supination resistance

81.8

3

Neutral cast pour [heel in a vertical position]

To reflect the foot position accurately

75.0

2

When rearfoot control is adequately addressed in this position

91.7

2

When inversion cannot be tolerated

81.8

3

Medial heel (Kirby) skive

When there is medial deviation of the STJ axis

91.6

2

When additional rearfoot control required

100.0

2

With tibialis posterior dysfunction

75.0

2

With high supination resistance

86.3

3

Allows increased control without bulk

86.4

3

Greater anti-pronation force required at sustentaculum tali

86.4

3

To increase the calcaneal inclination in the sagittal plane as well as some inversion in frontal plane

81.8

3

No rearfoot post

When footwear accommodation is a concern

75.0

2

Extrinsic rearfoot post

To increase stability of device

91.6

2

Extrinsic rearfoot post (inverted)

To increase rearfoot control (medially deviated STJ, high supination resistance)

79.2

2

In tibialis posterior dysfunction

90.9

3

Minimal arch fill

To ensure foot posture captured is appropriately maintained

75.0

2

To achieve full amount of correction (when foot ROM allows)

79.1

2

Maximum arch fill

In the presence of range of motion limitations

72.7

3

When there is a severe flat foot deformity (e.g. weight bearing medial cuneiform)

86.4

3

Medial flange

In the presence of large midfoot transverse ROM (talus and/or navicular)

82.6

2

With tibialis posterior dysfunction

75.0

2

When increased medial control is required (midfoot support)

81.8

3

No forefoot post

In the presence of forefoot supinatus when the supinatus can be reduced

72.7

4

Intrinsic forefoot post

In the presence of forefoot valgus

70.8

2

To balance forefoot to rearfoot misalignment

79.2

2

When the inverted rearfoot position offers sufficient support to the symptomatic pes planus foot

72.7

3

With severe forefoot supinatus or osseous varus

90.9

3

Extrinsic forefoot post

In severe midfoot collapse or fixed inverted forefoot deformities

77.3

3

Forefoot post balanced to perpendicular

Standard practice outside of fixed forefoot deformities

75.0

2

To encourage the forefoot to be parallel with the supporting surface (offers stability)

81.8

3

Maintains rearfoot to forefoot balance

95.4

3

1^st MTPJ cut out

In the presence of a plantar flexed 1^st ray

72.7

3

Plantar fascial groove

When the plantar fascia is tight

83.3

2

When the plantar fascia is prominent (bowstrings)

91.7

2

When the plantar fascia is irritated or painful

100.0

3

To minimise risk of irritation

81.8

4

Metatarsal dome

When forefoot pain exists (e.g. neuroma, bursitis, hyperkeratosis, metatarsalgia)

87.5

2

In the presence of digital deformities (claw/hammer toes)

83.4

2

If previously had success with a metatarsal dome

81.8

3

Cuboid filler

Symptomatic lateral column or midfoot (e.g. subluxed cuboid)

90.9

3

Heel aperture

In the presence of plantar calcaneal bursitis

79.0

4

A rigid, semi-rigid and flexible device

Patient weight/size (increased weight = increased rigidity required)

91.7

2

Degree of control required (increased control = increased rigidity required)

87.5

2

Activity levels (increased activity = increased rigidity required)

77.3

3

Perceived tolerance of patient to rigidity

90.9

3

Footwear limitations

72.7

3

Available ROM/joint integrity

81.8

3

Longevity required from device

72.7

3

Stability is gained with maximum rigidity

72.7

3