CK,

On a somewhat different note, but with the theme of serial orthoses, I have 
used a serial treatment method for fabrication of orthoses following 
calcaneal fractures.  These feet are often quite edematous for many months 
(or more) following the initial immobilization and/or surgical treatment of 
their injuries.  Casting for any type of orthoses during a period of 
excessive edema will result in a device which will ultimately not fit 
appropriately.  I have used aliplast and nicoplast formed in a semi weight 
bearing impression as a temporary device for these patients.   I seem them in 
3 week intervals and find by that time that the device is too large as the 
foot's swelling has decreased.  On followup after series of these (usually 2 
or 3) temporary devices, the device is usually found to fit, an indication 
that the reduction in swelling has stopped.  They are then casted for 
permanent devices at that time.  After 20 years of experience with this 
approach, I find it invaluable to manage this otherwise difficult to treat 
class of injuries.  

Regards,
Howard Dananberg


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