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Biomechanics > 10) Orthotic Prescription Writing > Flashcards

10) Orthotic Prescription Writing Flashcards

(75 cards)

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1
Q

Factors to be considered

A
  • Foot type
  • Physiological (not chronological) patient age
  • Type of activity
  • Nature of the chief complaint
  • Biomechanical examination
  • Shoe style
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2
Q

Cavus foot

A
  • Generally requires softer materials

- Possibly an inverted pouring position for varus heel

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3
Q

Planus foot

A
  • Generally requires more “control”

- Rigid/semi-rigid materials

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4
Q

Children commonly require

A
  • Rigid/semi-rigid materials
  • Well tolerated
  • Hypermobility is a common complaint
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5
Q

Elderly patients

A
  • Traditionally cannot tolerate rigid materials as well
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6
Q

Sports

A
  • Some element of flexibility in the orthosis
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7
Q

Nature of the chief complaint

A
  • Hypermobility?
  • Shock absorption needs?
  • Painful lesions?
  • Proximal plantar fasciitis?
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8
Q

Biomechanical examination

A
  • Limb length inequality
  • FF/RF malalignment
  • Transverse plane abnormality
  • Pes planus/cavus
  • Tibial influence
  • RCSP/NCSP
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9
Q

Dress shoes

A
  • Thinner, more rigid materials generally utilized (i.e. TL, graphite)
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10
Q

Athletic shoes

A
  • More orthotic “friendly”
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11
Q

Specialized shoes

A
  • Thinner, more rigid materials generally utilized (i.e. TL, graphite)
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12
Q

Orthoses prescription form contents

A
  • Negative cast pouring position
  • Orthotic plate choice
  • Forefoot balancing
  • Rearfoot posting
  • Top covers/forefoot extensions
  • Special additions/modifications
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13
Q

Miscellaneous positive and negative cast modifications

A
  • Blake inverted cast technique
  • Kirby medial heel skive technique
  • Plantar fascial accommodation
  • Pronated cast technique
  • Forefoot supinatus
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14
Q

Blake inverted cast technique

A
  • A positive cast modification indicated for excessive subtalar joint pronation
  • Especially good for runners
  • Technique inverts heel of positive cast without inverting the forefoot
  • Must include plantar fascial groove
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15
Q

Advantage of Blake inverted casting technique

A
  • Inverts foot without raising arch height
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16
Q

Blake inverted technique measurements

A
  • 5 degrees Blake inversion = 1 degree Rootion inversion

- 15, 25, 35, 45 degrees increments

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17
Q

Kirby medial heel skive technique

A
  • A positive cast modification indicated for excessive STJ pronation
  • Reduces dorsiflexory force upon the first ray
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18
Q

Kirby medical heel skive technique measurements

A
  • 2-6 mm generally utilized

- Requires minimum 16 mm heel cup

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19
Q

Kirby medical heel skive technique advantage

A
  • Reduces pronation without inverting foot and increasing arch height
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20
Q

Plantar fascial accommodation

A
  • Indicated when a prominent plantar fascia is present (5 mm standard)
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21
Q

FF supinatus must be

A
  • Casted out
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22
Q

Pronated cast technique is indicated for

A
  • Tarsal coalition (peroneal spasm)
  • Rigid pronated foot
  • STJ arthritis
  • Rearfoot valgus
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23
Q

Pronated cast technique

A
  • Negative cast taken with STJ held in maximally pronated position
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24
Q

Children’s orthosis

A
  • Whitman-Roberts plate: high medial flange/lateral clip

- Heel stabilizers

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25
Orthosis Rx
- Lateral ankle instability - Interdigital (Morton’s) neuroma - Posterior tibialis tendon dysfunction - Sesamoiditis - Hallux elevatus - Hallux limitus
26
Morton's extension (special addition/modification)
- Firm material to build up directly plantar to the hallux (“bring the ground up to the toe”) - Not connected directly to the orthotic plate
27
Morton's extension indication
- Hallux elevatus
28
Rigid forefoot extension
- Rigid material is extended directly plantar to the first MTPJ and is connected to the orthotic plate (is an extension of)
29
Rigid forefoort extension indications
- Painful hallux limitus/rigidus (Kirby heel skive also helpful) - First MTPJ arthritis - Unstable MTPJ (s-p turf toe injury)
30
Hallux limitus is a structral/funtcional deformity with arthritic changes due to
- Long first metatarsal - Trauma - Excessive pronation with resulting metatarsus primus elevatus
31
Functional hallux limitus
- Control STJ pronation - Unload first ray - First metatarsal cut-out - Kirby medial heel skive - Reverse Morton’s extension
32
Metatarsal raise (bar, pad)
- Elevation of soft material positioned just proximal to the metatarsal heads (distal aspect of orthotic plate)
33
Metatarsal raise (bar, pad) indications
- Metatarsalgia | - Interdigital neuroma
34
Orthosis Rx: Metatarsalgia
- Metatarsal raise | - Forefoot accommodation
35
Sesamoiditis
- Inflammation of the sesamoid(s)
36
Orthotic Rx: Sesamoiditis
- Metatarsal raise | - Forefoot accommodation
37
Orthotic Rx: s-p sesamoidectomy
- Raise of soft material directly plantar to the first metatarsal head
38
Lateral ankle instability
- Rehab/braces >>> orthosis - High (> 16 mm) heel cup - Lateral flare to rearfoot post
39
Lateral ankle instability orthoses reduce the instability by
- Increasing the stability of the forefoot (i.e. forefoot balancing)
40
Posterior tibialis tendon dysfunction
- Common esp. in obese females
41
Devices for tibialis posterior tendon dysfunction
- U C B L - Arizona brace - Richie brace - 6 mm kirby medial heel skive - 2 – 4 degree inverted cast
42
Cuboid subluxation
- Midfoot pain: “I can walk on my heel or on my toes, but not heel to toe” - Cuboid pad: 1/8 inch foam/felt
43
Heel spur syndrome is also known as
- Proximal plantar fasciitis
44
Heel spur syndrome
- Achilles and plantar fascial stretching is most essential - Injectable/oral medication - OTC arch support initially
45
Plantar fascial strain
- Promoting first ray plantarflexion is most essential to reduce strain upon the plantar fascia - Valgus forefoot post/extension - First ray cut-out and forefoot accomodation - Varus forefoot wedging (posting) increases strain upon the plantar fascia
46
Peripheral neuropathy
- Plastizote insole
47
Controlling excessive STJ/MTJ pronation
- Use rigid/semi-rigid materials - Deep ( > 14 mm heel cup) - High medial flange - Flat (0 degrees) motion - Medial extension to the rearfoot post - Inverted orthosis - Kirby medial heel skive technique
48
Controlling excessive supination
- Lateral flare to the rearfoot post - High lateral heel cup - Korex (1/8 in) valgus wedge plantar to 4 & 5 metatarsal heads
49
Dispensing orthosis
- Proximal to the metatarsal heads - Contour the patient’s arch with only a small (1/8 – ¼ inch) separation - Heel should fit entirely within the orthotic heel cup - Almost as wide as the patient’s foot
50
Dispensing orthosis evaluation
- Bisect the patient’ heels and observe them standing in the orthosis - Observe walking with/without - Success = resupination
51
Advisories with dispensing orthosis
- Address any areas of irritation, heel slippage, etc. - Advise patient Orthosis is a brace and may require a period of acclimation (1 hr increase each day) - Return to clinic in 2 -4 weeks
52
Troubleshooting orthotic problems
- Heel slippage - Heel cup irritation - Arch irritation - Lateral instability - Supinatus pain - Anterior edge irritation - Orthosis “squeaking”
53
Heel slipping
- Grind rearfoot post to contact point - Pad tongue of shoe - Heel counter pads - Orthotic / shoe incompatibility
54
Anterior edge irritation
- Anterior edge of orthotic plate too long (grind) - Forefoot balance platform applied too proximal - Inadequate skive of anterior edge of orthotic plate
55
Heel cup irritation (lateral)
- Inadequate plaster addition to lateral heel | - Inadequate skive of heel cup
56
Orthosis "squeaking"
- Corn starch powder/cover under orthosis | - Excessive movement within shoe?
57
Lateral instability of orthosis
- Overzealous correction (inversion)
58
Arch irritation
- Inadequate plaster arch addition - Absence of fascial accommodation (?) - Overzealous correction
59
Supinatus pain
- First metatarsal pain | - Re-cast for new orthotic device
60
Arch support
- Direct pressure against the medial arch
61
Functional orthosis
- Controlled pronation through simultaneous contact of the medial aspect of rearfoot post and medial aspect of the anterior edge of orthotic plate
62
Movement in RF varus (stages of gait cycle)
- Heel contact = Rearfoot inverted - FF loading/midstance: Excessive STJ/MTJ pronation limited - Propulsion: MTJ resupination results in STJ resupination
63
Correction of RF varus
- If RFV > 8 degrees, post rearfoot 8 degrees inverted with 5 degrees of motion
64
Good response seen in RF varus correction with these conditions
- Plantar keratomas - Retrocalcaneal exostosis - Lateral ankle instability - Postural fatigue
65
Variable response seen in RF varus correction with these conditions
- Tailors bunions (symp) - Adductovarus fifth hammertoes (symp) - Both depend on 5th ray stability
66
5th ray is unstable if
- High ( > 8 degrees) 4 – 5 intermetatarsal angle - Large (> 1 cm) range of motion - Abduction present upon range of motion
67
Orthosis with RF valgus will be beneficial only if
- Talus does not contact the ground prior to reaching STJ end range of motion
68
Good response seen in FF varus correction with these conditions
- Postural fatigue | - Hallux abductovalgus
69
Variable response seen in FF varus correction with these conditions
- Tailors bunions (symp) - Adductovarus fifth hammertoes (symp) - Both depend on 5th ray stability
70
Marginal response seen in FF varus correction with these conditions
- Plantar keratomas
71
Problem associated with orthosis for FF varus
- Pronation off the orthotic
72
FF supinatus considerations
- Heel contact: inverted - Midstance: excessive STJ/MTJ pronation limited - Propulsion: MTJ supination results in STJ resupination - Casting out vs. not casting out
73
FF valgus considerations
- Heel contact: excessive STJ supination is limited - Forefoot loading/midstance: excessive MTJ supination is limited - Propulsion: forefoot (MTJ) pronation limited
74
Good response seen in FF valgus correction with these conditions
- Postural fatigue - Plantar keratomas - Lateral knee strain - Hallux abductovalgus (symp) - Tailors bunions (symp) - Adductovarus fifth hammertoes (symp)
75
Plantarflexed first ray deformity response of symptoms
- Marginal to poor | - Forefoot has two planes, so plate contact is reduced

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