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| 1. Outline medial and lateral malleoli with a water soluble marker. Place dot at central apex of each malleolus to highlight axis location. |
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| 2. Palpate subtalar joint to locate neutral position and desired casting position. |
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3. Observe casting position by suspending foot from 4/5 sulcus. Position STJ in neutral and dorsiflex the ankle to 90 degrees to fully pronate and lock the MTJ.
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 B. Casting |
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| 1. Apply dampened strip of plaster above level of malleoli. Leave anterior aspect of ankle exposed to facilitate removal of cast. |
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| 2. Apply 1 or 3 strips of plaster onto foot similar to traditional orthotic casting. |
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3. Assume casting position and reduce supinatus by pressing down on the 1st ray at the level of the medial cuneiform - 1st metatarsal joint. Ensure that the ankle is dorsiflexed to 90 degrees.
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Right foot (posterior view): With (left) and without (right) supinatus reduced.
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| 4. Remove cast being careful not to splay the ankle section during removal of cast. |
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| 5. Cast Evaluation: It should be noted that if structural forefoot varus is present, the cast will not sit in calcaneus vertical. |
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