12) Custom Molded Footwear Flashcards
(49 cards)
1
Q
Custom molded/extra depth shoes indications
A
- Neuropathy
- Severe deformities
- Unstable gait
2
Q
Footwear plays a key role in prevention of
A
- Plantar ulceration contributing to a reduction in lower extremity amputation in the diabetic and neuropathic population
3
Q
A successful footwear plan includes
A
- Patient Compliance
- Regular footwear Checks
- Proper footwear selection based on foot risk category
4
Q
Custom molded shoes steps
A
- Negative cast taken of patients foot and ankle (Orthotist or Podiatrist)
- Plaster or fiberglass “system”
- Customized shoe constructed
- Plastizote insole
- Rocker sole or bar
5
Q
Extra depth shoes (depth inlay shoe)
A
- Not a customized shoe
- No negative cast necessary
- Lace-up oxford shoe which has extra depth
- Plastizote insole (+/- custom molded)
- +/- rocker bar
6
Q
Risk factors for wounds (5)
A
- History of a wound
- Loss of protective threshold (5.07 filament)
- Deformity
- Poor glycemic control (Diabetes)
- Any medical condition which gives rise to neuropathy. i.e. Diabetes
7
Q
Risk category 0
A
- Has disease that can lead to insensitivity
- Has protective sensation
- NO plantar ulcer
- Well Fitting Shoe
8
Q
Risk category 1
A
- Extra-depth shoes
- Heat-molded soft insert
9
Q
Risk category 2
A
- Extra-depth shoe
- Rigid rocker soles
- Custom molded orthoses
10
Q
Risk category 3-5
A
- Extra depth or custom molded shoes
- Custom molded inserts
- Custom Molded AFO orthoses with a rigid rocker
11
Q
Rocker bar or sole indications
A
- Metatarsal phalangeal joint arthritis (hallux limitus, rigidus)
- Status – post Keller bunionectomy, first MTPJ fusion
- Forefoot ulceration
- Neuropathy
- Rocker bar vs. rocker sole
12
Q
Forefoot disorders treated with forefoot rocker
A
- Hallux rigidus
- Sesamoiditis
- Gout
- Met head fractures
- Diabetic ulcers
13
Q
Contraindications of forefoot rocker
A
- Balance issues
14
Q
Disorders treated with double rocker
A
- Charcot midfoot
- Midfoot ulcer
15
Q
Contraindications of double rocker
A
- Balance issues
16
Q
Forefoot disorders treated with negative heel rocker
A
- Hallux rigidus
- Sesamoiditis
- Dorsiflexion contractures
- Met head fractures
- Diabetic ulcers
17
Q
Contraindications of negative heel rocker
A
- Tight gastrocs
- Equinus
18
Q
Direct mold off-loading insert
A
- Soft and molded inserts are effective in reducing foot pressure in patients with high risk feet
- Molding multi-density Plastazote material directly to the patients foot is an effective design for reducing pressure over long periods of use
19
Q
Foot and ankle bracing selection should be determined by
A
- Patient factors
- Purpose
20
Q
Patient factors in determining foot and ankle bracing
A
- Patient’s pathology or dysfunction
- Patient’s activity level
- Patient goals
- Age
- Footwear
21
Q
Purposes for determining foot and ankle braces
A
- Control motion
- Support motion
- Restore motion
22
Q
Supra-malleolar orthosis (SMO) indications
A
- Severe pronatory forces
- Ankle joint frontal plane instability
23
Q
Case: posterior heel ulceration with forefoot amputation
A
- Cast for accommodative appliance
24
Q
Charcot restraint orthopedic walker (CROW boot) inlay
A
- Plastizote #1 inlay
25
Supportive motion bracing functions
- Support natural motion of foot and ankle
- Reinforce the structure of the foot and ankle from the outside in
- Help relieve painful joint movement
- Limit ROM
26
Restorative motion bracing indicators
- High activity Level
- Nerve impairment
- Joint immobility
- Good muscle strength
- Good muscle and tendon flexibility
- Physical therapy
27
Restorative motion bracing functions
- Restore dynamic gait function
28
Ankle-foot orthosis (AFO)
- Controls foot and ankle movement
- Composed of thermoplast (polypropylene)
- “Old” style AFO constructed of leather and steel
- Intrinsic (modern) and extrinsic (old) types
- Fixed, hinged and dynamic types
- Richie brace (fixed) may serve as an AFO
29
Ankle-foot orthosis (AFO) indications
- Drop foot deformity
- Other paralytic/neuromuscular conditions
- Ankle joint arthritis
- Unstable gait
- Severe foot deformity
30
Types of ankle-foot orthosis
- Fixed (90 degrees)
- Hinged
- Dynamic: dorsiflexion – assist (spring loaded)
- Tension-band (everts / inverts foot)
31
Dynamic-assist (spring) hinged AFO: Requirements
- Dropfoot deformity
- Stable knee
- Ankle joint dorsiflexion (knee extended) 90 degrees minimum
32
Hinged AFO prescription
- Dropfoot deformity with stable knee
33
Fixed AFO prescription
- Dropfoot deformity with unstable knee
34
Leaf – spring AFO prescription
- Weak anterior and posterior leg
35
Hinged AFO with plantarflexion stop prescription
- Toe walking (uncompensated ankle equinus)
36
AFO in equinus with heel lift prescription
- Fixed ankle equinus
37
Tension band AFO prescription
- Foot/ankle in flexible varus/valgus
38
Arizona brace
- An AFO with frontal plane support of the foot
| - More ankle support than an AFO
39
Arizona brace used for
- Great for rigid, pronated foot in the presence of dropfoot or anterior weakness.
- Charcot foot: Arizona brace with depth-inlay shoe
40
Supportive motion bracing indicators
- Moderate to high activity
- Painful dysfunction caused by overuse
- Conservative option before surgery or not a surgical candidate
- Physical Therapy
41
Arizona brace/Richie brace indications
- Severe rigid pes planus (ie. Charcot foot): Arizona brace
| - Severe flexible pes planus: Richie brace (AKA custom stirrup orthotic)
42
Multi-purpose bracing(KAFO) knee ankle foot orthosis indications
- Duchene muscular dystrophy
- Friedrich’s ataxia
- Neuromuscular/spino-cerebellar degeneration with muscular weakness/flaccid paralysis
- Proximal femoral fractures
- Total hip replacement
43
Tone-reducing ankle-foot-orthosis (TRAFO/DAFO) indications
- Muscle spasticity (Cerebral palsy, CVA)
| - Pressure and prolonged stretch over muscles and tendons
44
Tone-reducing ankle-foot-orthosis (TRAFO/DAFO)
- Pediatric brace
| - Effectively improve control and function through biomechanical and neurophysiological effects
45
Prosthetic K levels
- Defined by Medicare based on an individual's ability or potential to ambulate and navigate their environment
- Once determined, prosthetic components covered by Medicare can be determines
- K0-K4
46
SACH foot
- Most basic prosthetic foot available in United States
- Heel is composed of a foam wedge that provides cushioning in the heel section during heel strike
- Commonly used on pediatric or geriatric amputees
47
Single axis foot
- Includes bumpers, which control ankle’s ROM
48
Dynamic response foot
- Dynamic elastic response imitates the energy return characteristics of a normal ankle
- Reduces energy expenditure and improves gait
49
Multi-axial foot
- Multiple components at the ankle
| - Provide maximum amount of motion on all planes
