Casting A New Light On Orthotic Prescription and Manufacturing with Neil Smith


vfas2Professional Achievements
Winning on the New Inventors
Getting the VFAS into Temple University Podiatric Hospital where 2 years of research have just been completed.
Presenting the VFAS at The Biomechanics Summer School in Manchester with Dr Simon Spooner
Presenting the VFAS at the PFA in Boston
Being interviewed on 2GB by Dr. Graham on the VFA


In 2007 you won the New Inventor Awards as part of the popular ABC television program with your presentation of your Vertical Foot Alignment System. In the ten years since how has your perception related to orthotics and orthotic prescription changed?

My perception hasn’t changed about correcting the foot’s alignment with the VFAS since the New Inventors…and can’t believe it’s been ten years! My perceptions have changed regarding, forces, loads, ZOOS (Zones Of Optimum Stress, a term coined by Dr. Simon Spooner), Supination Resistance and how they effect the orthotic prescription, irrespective of the technique you use to capture the foots shape. If you apply the right amount of force to damaged tissue and offload those damaging forces…job done! I guess that’s why OTC’s are so popular. If it works and you put the tissues in their ZOOS, all good!

The Vertical Foot Alignment System is a unique way of casting clients; why do you believe it is so important to cast people weight-bearing?

There are so many ways to capture the foots shape for a custom orthotic: Non-WB (using plaster bandage for suspension, supine, prone, 4th and 5th loading…), Semi-WB, WB (uncorrected), Foam Boxes (MASS, Semi-WB and WB), laser scanning which is accurate to a thousands of a millimeter! Scan with an I-Pad or mobile phone and send the image to get a 3D printed orthotic and there’s also Amfit and Orthema (and others) which have the pins that come up to meet the foot and fabricate orthotics from that profile…the list is endless.

The one thing they have in common…they are all modified! Some less than others, but
still modified, so the orthoses applies forces to the plantar foot to offload the damaging forces. By aligning the feet WB on the VFAS, the practitioner has total control over the forces applied to the Rear, Mid, and F/F on the Lateral and Medial sides. It captures the elongation of the foot, fatty tissue spreading, bony prominences and how much mobility the foot has, so you can only do to the foot, what the foot is capable of doing. What I mean by this, is if the foot doesn’t have the ROM, for whatever reason, you’ll see and feel this when you’re taking the mould. You can’t put a round peg in a square hole!

There’s a tipping point for all feet and if you go past this point the foot will slide off the orthotic. If you try and make the foot do something it can’t do because the corrections you choose are trying to force the foot into a position it’s not capable of getting to, it will either feel really uncomfortable or the foot will just slide off because of that tipping point, which can be uncomfortable anyway. When you align the feet WB you can see that tipping point and balance those forces out between the Rear, Mid and F/F, which have a real Kinematic effect on the feet, ankles, knees and hips, into the back. When you stand on an orthoses made from the VFAS, you should feel like you’re foot’s “in it” and not “on it” and feel taller because of the Kinematic change it has on the foots posture.VFAS.jpg

Different practitioners tend to have a stance when it comes to the best kind of footwear to accompany an orthotic. Some prefer a neutral/cushion shoe, while others chose a more controlling option. Where do you stand on the issue?

I always go for the Neutral option when it comes to shoes as long as it’s not too soft. If the orthotic is doing its job and you have a shoe that’s extra firm on the Medial heel and under the MLA, it can over correct and the foot can become laterally unstable. I think at the best of times shoes give most practitioners headaches.

There is a progressive move toward the scanning of feet instead of casting to limit mess and cost to a business. Is the VFAS compatible with these advances in technology? 

There’s no doubt that plaster will be phased out. It does take a great mould of the foot (especially on the VFAS), but it’s too messy and has to go. I’ve been working with low temperature heating thermoplastics for the last couple of years and all of the VFAS moulds will be done this way, hopefully by the end of the year. No mess and the patient will feel what the orthotics is going to feel like straight away. I’m putting a system in place where you can add pre-glued cookies to the Heel, Cuboid, MLA, F/F and Mets so the patient will have something instantly so once you know the shape is right and the patient is happy, just scan the moulds (which I call Foot Aligners), fill the script out on-line and send me the information over the internet to have a direct milled orthoses or positive mould and have it made the traditional way and vacuum form the materials over the positive to be made.

Is the use of the Vertical Foot Alignment System appropriate for all clients? Given the various types of conditions a patient may present with are contraindications for the use of the device. 

There will always be contraindications with any technique you use and it’s no different for the VFAS. Anyone (mainly kids) less than 30 Kg’s is probably too light, people with spasticity or severe balance issues and if your too old and frail. On a whole, it’s pretty rare and the oldest I’ve had on the VFAS is 97, the youngest is 7 and the heaviest was  ~170Kg’s. If I were going to take a cast for an orthoses, I’d use impression foam and use MASS technique (Semi-WB) and slightly modify the severity out of the MLA by modifying it with plaster.

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