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Orthotics > Foot Orthotics > Flashcards

Foot Orthotics Flashcards

1
Q

What is a foot orthotic?

A

 A device that is placed in a person’s shoe to reduce or eliminate pathological stresses to the foot or other portions of the lower kinetic chain.
 A device used to support the foot, improve function, and improve the alignment of the foot and/or lower extremity

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2
Q

Function of the foot during gait

A

Provide base of support
Mobile adaptor
Shock attenuation
Accommodation of transverse plane
motion
Provide rigid support

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3
Q

Talocrural joint axis

A

Through malleoli
 Lateral malleolus is inferior & posterior to medial malleolus

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4
Q

Talocrural joint PF

A

with adduction

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5
Q

talocrural joint DF

A

with abduction

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6
Q

Subtalar joint OKC pronation

A

Calcaneus
 Everts
 Abducts
 DFs

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7
Q

Subtalar joint OKC supination

A

Calcaneus
 Inverts
 Adducts
 PFs

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8
Q

CKC Pronation

A

o Calcaneus everts
o Talus adducts and PF’s
o Leg internally rotates
o Knee flexes

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9
Q

CKC Supination

A

o Calcaneus inverts
o Talus abducts and
dorsiflexes
o Leg externally rotates
o Knee extends

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10
Q

Mid-Tarsal Joint Axes

A

Longitudinal Axis:
- Pronation/Supination (Eversion/Inverson)
Oblique Axis
- PF/DF
** In WB’ing, MTJ follows the STJ (Oblique axis)

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11
Q

Tarsometatarsal Joints

A

 Keep MT heads on the
ground
 STJ Pronation
 MTJ Pronates with STJ

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12
Q

TMT Joint - Supination Twist

A

 1-2nd MT DF 2° GRF
 4-5th MT PF 2° flexor mm

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13
Q

Stance phase includes:

A

– Initial Contact
– Loading Response
– Mid-stance
– Terminal Stance
– Toe-off

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14
Q

Swing phase includes:

A

 Initial Swing
 Mid-Swing
 Terminal Swing

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15
Q

3 Functional Goals of the Foot

A
  1. Get both calcaneal condyles on the ground
  2. Get MT heads on the ground
  3. Provide rigid level for toe off
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16
Q

What position is the STJ in at heel strike?

A

supination

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17
Q

initial contact is with…

A

the lateral condyle of calcaneus

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18
Q

What occurs after initial contact?

A

STJ pronation to get medial condyle of calcaneus on ground

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19
Q

How do you get metatarsal heads on the ground?

A

STJ pronates, giving forefoot mobility to adapt
to surface

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20
Q

Provide rigid lever for toe off - mid stance:

A

STJ moves toward neutral, increasing the
stability of the forefoot

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21
Q

provide rigid level for toe off - terminal stance/toe off:

A

STJ is supinated to provide rigid foot

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22
Q

when does maximum supination occur?

A

just prior to toe off

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23
Q

motion during gait cycle

A

 Foot is in supination prior to loading response
 STJ pronation occurs until 50% of gait cycle
 Re-supination initiated during mid-stance, by 60% of gait
 Supination (max stability) just prior to toe off

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24
Q

what is subtalar joint neutral

A

Point at which the talus is neither pronated nor
supinated, relative to the navicular

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25
Q

reliability of subtalar joint neutral

A

Intrarater – Fair
– Interrater – Poor
– Both can improve with training/experience

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26
Q

Usefulness of subtalar joint neutral

A

– Consistent starting point
– Intrinsic foot deformities
– Neutral position of the joint

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27
Q

What is “functional” neutral position (resting standing foot position)

A

– Knees extended
– Arms at sides
– Feet 6 inches apart
– Comfortable amount of toe-out

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28
Q

What does “functional” neutral position do?

A

More closely approximates the position of the subtalar joint during gait

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29
Q

Compensations

A

A change in the structure, position, or function of one part to neutralize an abnormal force or a
deviation in structure, position, or function of
another part

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30
Q

Functions of a foot orthotic

A

 Distribute WB forces evenly on the plantar surfaces of the foot
 Reduce excessive stresses to the proximal structures from pronation/supination
 Reduce the magnitude and rate of excessive pronation
 Balance intrinsic foot deformities

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31
Q

Indications for Foot orthotics

A
  • LE/Spine symptoms
  • PT goals achieved or pt plateaus
  • Course of therapy completed
32
Q

Intrinsic abnormalities require

A

more controlling orthotic

33
Q

extrinsic abnormalities require

A

more accommodative orthotic

34
Q

Foot orthotic requirements

A

 Conforms to the contours of the foot
 Rigid enough to control pronation, but flexible enough to allow normal motion
 Capable of being adjusted with precision
 Durable
 Comfortable
 Does no harm
 Cost-effective
 Lightweight

35
Q

normative angle of inclination values

A

Newborn: 150
Adult: 125
Geriatric: 120

36
Q

“Normal” subtalar joint neutral

A

Rearfoot: 0-3° varus
Forefoot: calcaneus perpendicular to MT line

37
Q

Osseous Deformity

A

rotation within the calcaneus

38
Q

Shell

A

“frame of the eye glasses”

39
Q

posts

A

“lens”
Intrinsic
Extrinsic

40
Q

Shell - Soft

A

– Goal: pressure relief, shock attenuation
– Material: soft foams
– Extrinsic posts
– Indications: DM, hyposensitivity, pes cavus, supinatory foot

41
Q

Semi Rigid Shell

A

– Goal: Motion control, shock absorption
– Material: cork, leather, low-temp plastics
– Posts: intrinsic or extrinsic
– Indications: motion control

42
Q

Rigid Shell

A

– Goal: CONTROL
– Material: heat-moldable plastics
– Casting required
– Posting: intrinsic
– Indications: control of excessive pronation

43
Q

Posting Functions

A

 Control motion, bring ground to the foot
 Maintain abnormal joint relationships
 Prevent compensation/reduce abnormal motion
 Enhance muscle activity

44
Q

Intrinsic Posting

A

 Within the shell of the orthotic
 Forefoot posting is almost always intrinsic
 ↓’d bulk so better fit in shoe
 have to be conservative (50%) difficult to adjust
 $$$ custom made

45
Q

Extrinsic Posting

A

 Most orthotics have extrinsic rearfoot
posting
 Stronger
 Easier to adjust
 Less arch pressure
 More bulk in shoe

46
Q

Varus Post

A

on medial side of foot

47
Q

forefoot posting - varus post

A

on medial side of foot

48
Q

forefoot posting - valgus post

A

on lateral side of foot
** forefoot only

49
Q

0 degree post

A

extrinsic post without angulation (LIFT)
– Large FF varus, no RF abnormality

50
Q

Bar post

A

runs straight, flat across
– Usually extrinsic
– Rigid plantarflexed 1st ray
 Bar post under rays 2-4

51
Q

Posting determination - rear foot

A

– Approximately 50%
of varus
– Maximum 6º

52
Q

posting determination - forefoot

A
  • approximately 40%
  • maximum 8 degrees
53
Q

posting determination - age

A

more conservation with increasing age

54
Q

posting determination - weight

A

more aggressive with increasing weight

55
Q

last thing that determines posting

A

activities

56
Q

Accommodative orthotic (soft shell)

A

 Allows significant amount of flexibility
 Supinatory foot type
 Improve shock absorption
 Distribute forces t/o foot
 “Bias” – controls motion and lets foot come to ground more easily

57
Q

What are accommodative orthotics used for?

A

 Congenital malformations
 ROM problems
 Insensate feet
 Diabetic/Rheumatoid feet
 Illness, old age, unhealthy feet
 rigid PF’d 1st ray

58
Q

Biomechanics Orthotic (Rigid/semi- rigid)

A

 Increased rigidity of shell
 Semi-rigid or Rigid
 Durometer – indication of flexibility/rigidity
– Higher number = more rigid
– weight, activity, desired control

59
Q

what are biomechanics orthotics used for?

A
  • anything else
  • pronatory foot problems
60
Q

Biomechanics orthotic requirements

A

– Conform exactly to contours of the foot
– Sufficiently rigid to maintain contours with use
– Control abnormal motion
– Allow normal motion to occur in proper sequence
– Stand up to stress and wear
– Capable of being adjusted with precision

61
Q

Dual Density

A

 Usually semi-rigid shell
 Provides control of excessive pronation
 Softer, accommodating material on top
 Allows shock attenuation
 Best of both worlds
 Easier for patients to break in
 Top cover can be replaced

62
Q

considerations for selection

A

 Patient condition: Acute/chronic
 Pronatory v. supinatory
 Intrinsic/extrinsic
deformities
 Patient’s footwear
 Type of stress you are
trying to reduce
 Type of material
 Customized v. over-the-
counter
 Cost
 Fabrication time

63
Q

Patient information

A

 Bring shoes in
 Goals and limitations of orthotics
 Not likely an immediate cure
 may need adjustments

64
Q

break in period

A

 Break-in period may vary
 Day 1 - 1-2 hrs
 Increase total wear time by 1-2 hours/ day
 Break-in period will depend on type of orthotic
 More rigidity = longer break-in periord
 Tolerate ~ 6-8 hrs/ day prior to wearing for sports
 Sports: begin 1/3 of time and increase by 1/3’s
 Stop if symptoms increase or new sx arise

65
Q

Longevity

A

 Depends on usage, body weight, and material
 Long-term use - evaluate ~ 1-4 years
 Semi-rigid ~ 1-2 years
 Soft orthotics 6 months to one year (max)

66
Q

Purchasing new shoes

A

 Wait until they have orthotic
 Don’t show it to the clerk
 Find an appropriate shoe/fit
 Then place orthotic in shoe to
determine if a larger size is
needed

67
Q

Dress shoes

A

 Difficult to wear orthosisbecause of narrow shank and shallow heel
 Dress orthotics are available
 As heel height increases, function of the orthotic decreases
 Maximum heel height = 2 in

68
Q

Diabetes - typical changes

A

 Intrinsic Muscle Weakness
 Toe deformities (hammer/claw toes)
 Prominent MT heads
 Fat pad atrophy

69
Q

Diabetes - Shoe Considerations

A
  • Wide toe box
  • Good plantar contact
  • Straight last
70
Q

Orthotic considerations for diabetes

A

 Decrease plantar pressures
– Total contact
1st & 5th MT heads
Talus
Navicular
** Usually accommodative or dual-density

71
Q

RA shoewear

A

 Probably straight last
 Good heel counter
 Wide toe box

72
Q

RA - Hallux rigidus

A
  • rocker-bottom shoe or MT bar
73
Q

Trouble shooting - primary cause

A

shoe gear

74
Q

trouble shooting - sudden recurrence of complaints

A

– Worn post
– Orthotic fatigue
– Gouging of shoe insole by post
– Physiological changes in the patient

75
Q

trouble shooting - medial foot callus

A

– Not fully controlling foot – pronating against orthotic
– Excessively high post

76
Q

trouble shooting - lateral foot callus

A

– It’s a good thing
– Actually keeping foot in appropriate position

77
Q

trouble shooting - postural complaints

A

– Usually due to not following break-in schedule
– Decrease wearing time
– If symptoms aren’t elimated over time, re-evaluate your patient and/or orthotic

Orthotics (9 decks)

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