If your practice has decided to stick with a traditional casting method, it is important to follow a strict set of casting rules/procedures in order to receive a high-quality, accurate, well-fitting device.
Regardless of utilizing a plaster casting method or an STS sock casting method, it is critical that the practitioner places patients’ feet in subtalar neutral position.
Subtalar Neutral Position.
Elevate the supine patient to shoulder level and tilt the exam chair. Encourage your patient to relax.
Observe the patella as you dorsiflex the foot. The knee should remain in an upright position, perpendicular to the table. To compensate for external rotation, raise the corresponding hip with a towel or pillow. For internal rotation, elevate the opposite hip.
With your arm, wrists, hand and fingers in a straight line (much as if you were saluting), place the ulnar surface of your thumb in the sulcus of the fourth and fifth toes.
Familiarize yourself with the foot and its range of motion. Move from supination to pronation, then back to the neutral position.
When the angles formed by the lateral malleolus and its superior and inferior structures are equal, the foot is in the neutral position.