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| 1. Outline the medial and lateral malleoli with a water soluble marker. Place a dot at the central apex of each malleolus to landmark axis location. |
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| 2. Palpate subtalar joint to identify neutral position and desired casting position. |
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| 3. Observe casting position by suspending foot from the 4th & 5th toes. Position the 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. Adhere protective plastic strip/tube with masking tape. |
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| 2. Apply masking tape around ankle and transfer landmarks. |
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| 3. Apply wet sock (soak in water for approx 20 seconds). Pull sock off toes to prevent flexion of the digits. |
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| 4. Assume casting position and reduce supinatus by pressing down on the 1st ray at the level of the medial cuneiform-1st metatarsal joint. |
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| 5. Allow cast to dry for 3-5 minutes. Using blunt-nosed scissors, cut down strip/tube to level of 1st metatarsal head and remove with care. |
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| 6. Cast Evaluation: It should be noted that the cast will not sit in calcaneus vertical if structural forefoot varus is present. |
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