Formthotics Medical System
Practical guidance for the patient in front of you. Assess, choose, fit and review with a clear purpose.
A companion to practical training. This does not replace training or the manufacturer’s Instructions for Use (IFU), and is not a treatment protocol.
Assess
Ask what the patient wants to do more comfortably, then use history, examination and a repeatable task to decide whether an orthotic trial is suitable.
“I want to walk the dog for 30 minutes without having to stop.”
Patient goal → possible measure for reviewBefore selecting a device
Clarify the working diagnosis, relevant history, skin and footwear. Consider circulation and protective sensation when indicated. Explain the trial, alternatives and uncertainty.
Concerning trauma, infection, skin breakdown or neurological change needs appropriate assessment. A hot, swollen foot in a person with diabetes needs urgent specialist assessment.
The six tests
These findings support reasoning alongside the history and wider examination. No single test dictates a prescription.
(Foot Morphology and Motion Test)
Observe joint range, symptoms and asymmetry with the foot supported. Compare with weight-bearing findings.
Non-weight-bearing morphology gives a baseline for comparison with standing movement.
A non-weight-bearing position does not establish how the foot functions in gait. Interpret it alongside the other tests; agreement between examiners can vary.
Observe the barefoot foot and lower limb in standing and walking. Compare the pattern with the patient’s goal.
A relevant pattern may emerge when movement, symptoms and the chosen task are considered together.
An alignment difference can be present without symptoms. Appearance alone does not identify a cause or justify correction.
Estimate the effort needed to initiate supination with a consistent technique. Compare with the wider assessment.
Manual resistance can inform a trial, which is then judged by the fitted response.
Manual resistance is one observation. It does not specify an exact orthotic force, density or wedge prescription.
Gently lift the hallux. Observe arch response, effort and symptoms; compare under the same conditions.
The response can be compared before and after a suitable trial alongside the patient’s function.
Diagnostic validity is limited. A response to this test does not establish a diagnosis or guarantee that a modification will help in normal activity.
Observe trunk, pelvis, knee and foot during a comfortable bend. Compare control and symptoms.
Whole-limb movement adds context to the patient’s functional task.
A movement pattern alone cannot identify which structure is responsible or show that an orthosis is required.
Choose a safe stance or reach task. Compare control, symptoms and effort with similar support.
A repeatable task can help assess response and monitor change at review.
Balance reflects several influences. One better attempt does not establish the cause of difficulty or prove lasting benefit.
A low arch or high manual supination resistance, on its own, is not a reason to prescribe a medial wedge.
Choose
Match support, cushioning and shoe space to the assessed aim. Confirm the choice in the patient’s actual footwear.
Dual density
Compare the construction, then check the fitted response.
Balanced support & cushioning
A medium base with a softer top layer.
Check in the trialComfort, useful support and room for both layers.
Original Dual MediumFirmer underlying support
A semi-rigid base with a softer cushioning top.
Check in the trialTolerance of firm contact, local pressure and the chosen task.
Original Dual HardSupport & durability
A high-density base with a softer upper layer.
Check in the trialWhether the construction and profile suit the aim and shoe.
Original Dual UltraThese are product comparisons, not a prescribing rule. Body mass or a single test result does not determine a model.
Use the size chart as a starting point. Check the device against the foot and inside the actual shoe: heel seated, toes uncrowded, no bunching and enough depth. Check the removable factory liner before adding another layer.
Compare the actual thickness, profile and density. A single layer may suit the available space or a planned modification; dual models can also accept appropriate additions.
Consider when sensitive contact or prominent areas make accommodation a priority. Soft provides mild functional support; X-Soft is the most accommodative option.
Check in practice Check local pressure, comfort and whether the material remains effective under the patient’s loading.
A useful starting comparison when the assessment does not point towards either extreme.
Check in practice Check whether the fitted device improves the intended activity.
Consider when a more supportive feel is appropriate and tolerated during everyday or sporting use.
Check in practice Check arch contact, comfort and the response to the chosen task.
Consider when resistance to repeated loading and firm underlying support are priorities.
Check in practice Check focal pressure and tolerance of firm contact beneath the foot.
Consider when the support and durability of the higher-density construction suit the aim. Single and dual models are available.
Check in practice Compare the actual model and fit. Hard and Ultra describe different product properties, not a universal progression.
The material
Formthotics are 3D-milled from proprietary plant-based Formax Foam. Controlled heat moulding lets the device conform to the foot and shoe in minutes. The closed-cell foam resists moisture absorption and is designed to be lightweight and easy to clean.
Fit & check
The patient, orthotic and shoe must work together. Check fit and comfort before heat, during moulding and again in motion.
Remove the existing removable liner where appropriate. Check device size and placement. Trim at the toes if needed; keep the heel intact. Look for bunching, crowding and pressure.
With the Formthotics V20, use the approved three-minute heating cycle and current model instructions. Check comfortable warmth. Fasten the shoe and hold the fitting stance for about 30 seconds.
Ask the patient to walk briefly. Check toe room, heel hold, focal pressure, rubbing, comfort and stability. A new or painful pressure point calls for reassessment.
Repeat a relevant task in the same shoe and conditions. Keep, adjust, remove or reconsider the device based on the response—not on appearance alone.
See the technique
The manufacturer’s existing demonstration. Follow the current instructions for your model and heating equipment.
The six steps support the same assess → choose → fit → review journey. Rearfoot and forefoot changes are considered when the clinical aim and patient response support them.
Check in-shoe fit at the initial appointment and after every change.
Additions
Establish the response to the correctly fitted and moulded orthosis. Consider an addition when there is a clear clinical aim and a way to judge its effect.
What am I changing? What do I expect to improve? What would make me remove it?
Some patients need an adjustment period before modification. Open an addition below for placement and reassessment guidance.
A targeted change to rearfoot loading.
Consider a trial when changing rearfoot loading could improve the clinical aim. A medial wedge may be relevant where additional resistance to pronation is intended. A lateral wedge needs a clear reason for loading in the opposite direction.
Attach beneath the rearfoot of the orthosis. The thicker edge is medial for a medial wedge and lateral for a lateral wedge. Begin with a modest modification and repeat the same task.
Check symptoms, stability and any new pressure elsewhere. New lateral-border discomfort after medial wedging prompts reassessment.
Standard wedges are available in medium and firm material. The shaped 3D Tri-Plane wedge has its own fit and alignment; select it for a reason.
Product details
Additional contact beneath the medial arch.
Consider when extra medial-arch contact or support is a specific objective after the initial fitting. Foot shape alone does not establish the need.
Position beneath the arch of the orthosis and match the pad to the individual contour. Check the size and transitions so it does not create a pressure ridge.
Ask the patient to distinguish comfortable support from a focal lump. Reposition, reduce or remove the pad if contact becomes intrusive.
Product details
Redistribution of pressure-related forefoot loading.
Consider for assessed pressure-related forefoot symptoms where moving load away from a painful area is the aim. Include the diagnosis and footwear in the decision.
Locate the metatarsal heads and transfer their position to the orthosis. Begin with the dome prominence just proximal to the heads, then adjust to the individual response. Attach the UK product beneath the orthosis for more diffuse contact.
Reassess walking, push-off and toe-box space. Increased focal pressure, tingling or a distinct lump calls for review of position, size or suitability.
A study in older adults supports careful proximal placement. It used other dome products and measured pressure, so it does not establish one position for every patient.
Product details
Heel elevation for a defined clinical purpose.
Consider a selective trial where elevation has a clear purpose, such as modifying a dorsiflexion-related symptom. An assessed leg-length discrepancy is a separate indication with its own reasoning.
Secure beneath the heel of the orthosis or within the shoe as directed for the product. Choose height and unilateral or bilateral fitting to match the aim. The UK 4 mm and 6 mm options are product sizes, not automatic prescription doses.
Check heel retention, shoe-counter contact, forefoot pressure and the target activity. Agree when to continue, adjust or remove the raise.
For Achilles symptoms, use selectively alongside rehabilitation. A 2025 trial in midportion Achilles tendinopathy found a small benefit over sham that did not reach its predefined clinically important difference. It did not support heel lifts as primary management.
Product details
A specific change to forefoot support or loading.
Consider when assessment identifies a particular forefoot loading or support requirement. Distinguish a flexible presentation from a fixed position and state which area needs support.
Choose medial or lateral orientation beneath the orthosis, with a smooth transition. The reversible wedge can be used in either orientation. Direction and amount follow the assessed aim.
Reassess push-off, first-ray and hallux function, comfort and any new pressure beneath adjacent metatarsal heads.
Practise placement under supervision. A forefoot posture measurement alone does not determine the modification.
Product details
A modification that extends towards the midfoot.
Consider where a longer area of support is relevant to the clinical aim, or an addition needs shaping for a rearfoot or forefoot application.
Use the longer wedge as appropriate, or cut it for the intended application using suitable equipment and training. Check orientation, contour and smooth transitions.
Compare the same functional task and inspect for edge pressure, crowding or new symptoms. More material does not automatically improve the result.
Medium and firm versions are available. Change material, height or position separately where practical so the response is easier to interpret.
Product details
Keep the same footwear and task when comparing a change.
Name the symptom or activity and record a baseline.
Check fitting, moulding, comfort and the initial response.
Mark the position and secure it appropriately. Change one feature where practical.
Compare symptoms and function. Check for new pressure or instability.
Document side, position, size, material and response. Agree the next step.
Where medium and firm versions exist, compare compression under load, maintenance of the intended shape and contact tolerance. Change material, height and position separately where practical.
Immediate improvement supports a monitored trial. Continued benefit during normal use determines whether the modification remains appropriate.
Review
An orthotic trial includes wear advice, a route back if something is wrong, and a planned review of the original goal.
Agree a gradual wear plan around the patient’s activity and tolerance. Check which shoes they will use and what a comfortable adjustment may feel like. There is no single timetable for everyone.
New or worsening pain, blistering or bruising needs the patient to stop using the device and contact the clinician for reassessment.
Agree review timing for the presentation and risk. Compare the original goal, symptoms, comfort and actual wear. Changes in footwear, activity or symptoms may need an earlier review.
At review
| Problem | What to check | Next step |
|---|---|---|
| Arch discomfort or a rubbing edge | Skin, focal pressure, device seating, profile and wear history. | Reassess fit and suitability. Stop use for new or worsening pain or skin injury; make any adjustment within training and the IFU. |
| Heel slipping or toes crowded | Device size, heel seating, removable liner and available shoe depth. | Recheck the foot-device-shoe fit. Compare appropriate footwear or a lower-volume option, then re-test. |
| New discomfort after an addition | The last change: side, position, size, material and intended effect. | Reduce or remove the recent addition and reassess the same task. Do not keep a change that creates new symptoms. |
| No useful improvement | Actual wear, footwear, original goal and wider assessment. | Reconsider the trial and wider care plan. More material is not an automatic next step. |
A useful record
Before they leave
“We’re trying this to help you walk more comfortably. Tell me how it feels in the shoes you actually wear. We’ll review what helps and change the plan if needed.”A patient-conversation prompt
Explain the aimAgree what you hope will improve and acknowledge that the response is individual.
Invite honest feedback“How comfortable is it? What might make it difficult to wear?”
Connect the wider careExplain how the trial fits with agreed exercise, load and footwear advice.
Agree the route backConfirm the wear plan, review date and when to stop and contact you sooner.
Practice cases
These are illustrative prompts, not diagnoses or prescriptions. Choose a goal, a trial and a way to tell whether it helped.
An adult has pain on first steps and after longer walks. Their aim is to resume a 30-minute daily walk.
An adult has discomfort beneath the forefoot. Their usual work shoes have limited room.
Support improves walking comfort, but the patient finds firm contact intrusive.
After a rearfoot modification, the patient notices new lateral-border discomfort.
Knowledge check
Eighteen short questions on assessment, density selection, additions, fitting and follow-up. Each answer explains the clinical reasoning.
Loading the questions…
Quick reference
Keep the sequence simple, then adapt it to the person in front of you.
Supporting clinical references:
