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Movement Disorders > Orthotics > Flashcards

Orthotics Flashcards

1
Q

Don’t forget…

A

to review the different ways to tie shoes!

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2
Q

Mechanisms behind patients with patello-femoral pain syndrome being helped by orthotics

A
  1. reduction in obligatory IR of the LE
  2. reduction in dynamic Q-angle
  3. reduction in laterally-directed soft tissue forces acting on knee
  4. reduction in patellofemoral contact pressures as a result of improved contact with femur
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3
Q

Indiciations for foot orthotics

A
  • plantar fasciitis
  • ITBS
  • hallux rigidus
  • midfoot OA
  • balance issues
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4
Q

Tissue stress theory

A
  • Kirby

- orthotics attempt to minimize excessive stress/symptoms

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5
Q

Foot morphology theory (root) and sagittal plane facilitation theory (dananberg)

A

Kostka says “do not focus on these too much)

  1. foot morphology theory - focuses on subtalar joint neutral position (rearfoot and forefoot in neutral alignment)
  2. Sagittal place facilitation theory - ankle equinus and functional hallux limitus
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6
Q

First 3 principles of orthotic management

A
  1. “normal” alignment of structures distal to proximal
  2. Allow adaptation to ground surfaces without compromise of anatomical structures because of either hypermobility or hypomobility
  3. Protect compromised soft tissue structures from excessive stress (e.g. plantar fascia, posterior tibialis)
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7
Q

“Normal” alignment of structures distal to proximal

A
  • metatarsals heads contracting ground (directly or indirectly)
  • relative neutral forefoot to midfoot orientation
  • relative neutral rearfoot to leg orientation
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8
Q

Principles 4-6 of Orthotic Management

A
  1. provide a stable BOS
  2. provide a rigid lever mechanism for forward propulsion
  3. do not compromise force absorption mechanisms
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9
Q

Foot orthotic options

A
  • off-the-shelf orthotics
  • in-house orthotic systems (quick fabrication or time consuming fabrication)
  • orthotic labratories
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10
Q

Examples of off the shelf orthotics

A
  • power step
  • superfeet
  • dr. scholl
  • sof sole
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11
Q

Quick in-house orthotic systems

A
  • resin activated by luke-warm water
  • molded in “subtalar neutral”
  • extrinsic posting (rearfoot or forefoot post)
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12
Q

Time consuming in-house orthotics

A
  • blank molded with foot in “subtalar neutral”

- cork grinded to provide hindfoot and/or forefoot posting (i.e. medial or lateral)

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13
Q

Orthotic labratories

A
  • based on mold (either plaster cast or foam impression)
  • limited adjustablity
  • turn around time typically 1-2 weeks
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14
Q

Casting techniques

A
  • plaster cast (gold standard, functional orthotics)

- impression foam (polystyrene)

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15
Q

Plaster cast technique

A
  • NWB (subtalar neutral) with patient in prone position

- may also plantarflex 1st ray during molding in presence of significant forefoot varus and/or hallux rigidus

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16
Q

Impression foam pros/cons

A
  • quicker and cleaner than plaster casting

- best for accomodative molds (bony prominence, callus, fibrous tissue mass)

17
Q

Full weightbearing impression

A
  • foot in its compensated position
  • captures static standing foot deformities
  • best for accomodative orthotics (someone who has just had sx or a diabetic)
18
Q

Semi-weightbearing impression

A
  • with patient seated, clinician applies downward force at teh knee and metatarsal heads
  • may distort flexible foot deformities
19
Q

Non-weight bearing impression

A
  • requires practice

- minimizes distortion of intrinsic foot deformities

20
Q

General guidelines

A
  • cast or mold in neutral position
  • medial rearfoot posting for excessive calcaneal eversion
  • medial forefoot posting for excessive forefoot varus
  • 1st ray cut out for plantarflexed 1st ray
  • lateral hindfoot/forefoot posting for medial knee Oa/forefoot valgus
21
Q

Full length vs. 4/3 length

A
  • full length allows for more control, but is difficult to fit in every shoe
  • 3/4 length is less control, but fits into more shoes
22
Q

Rigid orthotic

A
  • control
  • excessive pronator
  • not always tolerated
23
Q

Semi-rigid orthotic

A
  • combines control and shock absorption

- active persons/athletes

24
Q

Soft orthotic

A
  • accommodative problems (diabetic)

- attempts to increase contact area in efforts to reduce pressure

25
Q

General guidelines for posting

A
  • used to further modify the positive cast (intrinsic) or the orthotic (extrinsic)
  • intrinsic post - modifications made to the shape of the positive impression
  • extrinsic post - providing an external “build-up” to the orthotic
26
Q

Rearfoot posting

A
  • commonly used for abnormal hindfoot pronation

- medial instrinsic or extrinsic post

27
Q

Forefoot posting

A
  • used to correct either varus or valgus deformities through a medial or lateral wedge respectively
  • varus: medial
  • valgus: lateral
28
Q

Heel cups/pads

A
  • for plantar fasciitis
  • increases contact areas
  • extra padding to help absorb forces
29
Q

Metatarsal pads

A
  • morton’s neuroma

- attempt to splay apart metatarsals

30
Q

Heel lifts

A
  • achilles tendonitis
  • ankle equinus
  • limb length inequality
  • 3/8”: limit inside shoe
31
Q

Distal leg varum causes the hindfoot to…

A

evert in order to bring the medial aspect of the foot to the ground

32
Q

Review rearfoot leg angle graph

A

-comparing subtalar joint neutral, relaxed stance, and SLS on orthotic prescription lab handout

33
Q

Longitudinal arch angle

A
  • staggered stance with equal weightbearing
  • good indicator of arch angel during walking and running
  • pronated (150 degrees)
  • see picture
34
Q

Forefoot to rearfoot alignment

A
  • good reliability with visual estimation

- poor reliability with use of goni

35
Q

1st ray position and mobility

A
  • position: plantarflexed (below the other 4), neutral, DF
  • mobility: rigid (doesn’t even reach the level of the other 4), normal (anything in between), hypermobile (goes beyond the other 4)
  • poor reliability for both measures
36
Q

REview the foot posture index?

A

maybe?

Movement Disorders (8 decks)

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