…or cuboid notch or cuboid pad or cuboid raise or cuboid elevation or Denton modification or Feehery modification or … it comes by many names. As well as having many names it is used for many reasons. There are lots of reasons and explanations given for what the purpose of it is and I not totally sure on any of them.

Some use it for cuboid syndrome, some use it to stop the foot sliding off the orthotic laterally, some use it to facilitate the movement of the center of pressure towards a high gear propulsion, some use it for … etc

The reason I raise this now is that it has recently been pointed out to me that things like a cuboid notch may not be placed in the right place. It got me thinking.

The cuboid does not “drop” and need to be supported in the sagittal place which is theoretically what a cuboid notch or pad does. Because the cuboid is part of the calcaneocuboid joint, as it “drops” it also everts (rotates). This could be interpreted as that if a cuboid notch or pad is indicated, then not only should it lift up the cuboid, it probably should also try to invert it. This means that our cuboid notch’s need to be moved more medially (but still on the lateral side of the foot orthotic shell), so they can try to invert the cuboid bone as well.

I know my anecdotal clinical experience has been I have had some awesome results and equally have had some absolute disasters where the cuboid notch has made the pain worse, so its mixed. I certainly do use adhesive felt padding on the foot as a treatment direction test to see if the design feature is indicated on a foot orthotic.

I now wonder if my dismal failures with this were becasue when I used the cuboid notch to lift up the cuboid, I was increasing the eversion force on the bone when I need to lift it up and increase the inversion force on the bone. All my cuboid pads are not being moved a little medially now, so lets wee what happens.

We call them “thongs” in Australia. The Archies footwear come with an arch support built into them. We sell Archies in our clinic in Melbourne and they sell well. Pretty much everyone who tries on a pair buys them They are that comfortable. What is useful about the Archies is that they can be used by those who need or have foot orthotics but want to occasionally wear this style of footwear.

The other great thing about these is that can be modifiable. I sometime get on the tools and make what I call a MOSI Archie modification for those with a more medially located subtalar joint axis. I made this video on the technique.

I also occasionally answer a question online about them!

I talk a lot during the Clinical Biomechanics Boot Camps about many different design features that get used in foot orthotics such as the MOSI, the Kinetic Wedge and the Cluffy Wedge to name just a few. They are all useful features and have their places depending on what affect you are wanting.

For example, the Cluffy Wedge is deigned to hold the hallux in a slightly dorsiflexed position. This tenses up the windlass mechanism in the foot and brings on that windlass effect earlier. That is only going to be useful if you want to or need to bring it on earlier. If the windlass mechanism is functioning fine, then the Cluffy Wedge is probably not going to make any difference. That does not stop some clinicians using it as a ‘cure all’ and using it in in most orthotic prescriptions. The Cluffy wedge or a similar foot orthotic modification is indicated when it indicated and not indicated when its not indicated.