foot orthotics Flashcards
(99 cards)
1
Q
what is a foot orthotic
A
- device that is placed in a shoe to reduce or eliminate pathological stresses to the foot or other portions of the lower kinetic chain
- device used to support the foot, improve function, and improve alignment of the foot and/or lower extremity
2
Q
functions of foot during gait
A
- provide base of support
- mobile adapter
- shock attenuation
- accommodation of transverse plane motion
- provide rigid support
3
Q
talocrural joint axis
A
through malleoli
- lateral malleolus is inferior and posterior to medial malleolus
4
Q
talocrural PF
A
adduction (inv)
5
Q
talocrural DF
A
abduction (Ev)
6
Q
subtalar joint open chain calcaneus pronation
A
everts, abducts, DFs
7
Q
subtalar joint open chain calcaneus supination
A
inverts, adducts, PFs
8
Q
closed chain pronation
A
- calcaneus everts
- talus adducts and PFs
- leg internally rotates
- knee flexes
9
Q
closed chain supination
A
- calcaneus inverts
- talus abducts and DFs
- leg externally rotates
- knee extends
10
Q
mid-tarsal joint longitudinal axis
A
pronation/supination
(eversion/inversion)
11
Q
mid-tarsal joint oblique axis
A
PF/DF
12
Q
tarsometatarsal joint purpose
A
keep MT heads on the ground
13
Q
TMT joint supination twist
A
- 1-2nd MT DF secondary to GRF
- 4-5th MT PF secondary to flexor muscles
14
Q
stance phase components
A
- initial contact
- loading response
- mid-stance
- terminal stance
- toe-off
15
Q
swing phase components
A
- initial swing
- mid-swing
- terminal swing
16
Q
goal #1 of foot
A
get both calcaneal condyles on the ground
17
Q
at HS, STJ is in ______
A
supination
18
Q
initial contact with lateral or medial condyle of calcaneus
A
lateral condyle
19
Q
what has to occur to get medial condyle to ground
A
STJ pronation
20
Q
goal #2 of foot
A
get metatarsal heads on ground
21
Q
what has to occur to give forefoot mobility to adapt to surface
A
STJ pronates
22
Q
goal #3 of foot
A
provide rigid lever for toe off
23
Q
what happens to STJ during midstance
A
moves toward neutral, increasing the stability of the forefoot
24
Q
what happens to STJ during terminal stance/toe off
A
STJ is supinated to provide rigid foot
25
max pronation or supination prior to toe off?
max supination
26
foot is in _____ prior to loading response
supination
27
STJ _____ occurs until 50% of the gait cycle
pronation
28
_____ initiated during mid-stance, by 60% of gait
re-supination
29
pronating or supinating foot during heel contact and foot flat?
pronating foot
30
pronating or supinating foot during neutral, heel lift, and toe off?
supinating foot
31
functional neutral standing position
- knees extended
- arms at sides
- feet 6 inches apart
- comfortable amount of toe-off
32
compensation definition
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
33
foot orthotic functions
- distribute WB forces evenly on the plantar surfaces of the foot
- reduce excessive stresses to the proximal structures from pronation/supination
- reduce magnitude and rate of excessive pronation
- balance intrinsic foot deformities
34
orthotic indications
- LE/spine symptoms
- PT goals achieved or patient plateau
- course of therapy completed
35
what kind of orthotic for an intrinsic abnormality
controlling orthotic
36
what kind of orthotic for an extrinsic abnormality
accommodative orthotic
37
foot orthotic requirements
- conforms to contours of the foot
- rigid enough to control pronation, but flexible enough to allow normal motion
- capable of being adjusted with precision
- durable
- comfortble
- does no harm
- cost-effective
- lightweight
38
examples of extrinsic abnormalities
- coxa valga/vara
- tibial varum/valgum
- femoral anteversion/retroversion
- tibial torsion
- leg length discrepancies
- equinus deformity
39
what is the angle of inclination
angle between neck and shaft of femur
40
what is coxa valga
- increased angle of inclination
- increased compression at hip
41
coxa valga compensations
- genu varum (increased medial compression at knee; increased stress on popliteus, LCL, lateral hamstrings/gastroc/ITB)
- tibial varus > rapid pronation > posterior tib tendinitis > complain of medial leg symptoms
42
what is coxa vara
- decreased angle of inclination
- increased joint stability
- increased stress on femoral neck
43
coxa vara compensations
- genu valgum (lateral knee joint compression, medial knee gapping, VMO weakness, pes anserine, medial capsule)
- forced pronation (pain in arch of foot, medial malleolus, PT tendinitis at insertion)
44
what is tibial varum
- distal tibia deviated inward towards midline of body
- excessive inversion at heel strike
- calcaneus everts farther than normal
45
what is tibial valgus
- distal tibia deviated outward away from midline
- tend to contact ground with medial aspect of calcaneus
46
what is the angle of anteversion
angle between neck and shaft of femur in horizontal plane
47
what is femoral anteversion
- increased angle of anteversion
- shaft of femur faces medially
- rest of limb in alignment
- heel strike with pronated foot
- forefoot varus compensation
48
what is known as pigeon toed
femoral anteversion
49
what is femoral retroversion
- decreased angle of inclination
- feet point laterally
- contact more laterally > excessive pronation during loading response
50
what is tibial torsion
- external rotation
- contact with external rotation > quick pronation
51
what do you usually complain of with tibial torsion
PF symptoms
52
compensations for long leg
- rearfoot pronation
- knee flexion or hyperextension
- genu varum/valgum
- hip abduction
- pelvic tilt
53
compensations for short leg
- supination
- excessive PF
54
equinus deformity
- need 10 DF at end of mid-stance
- if DF inadequate, will pronate through STJ and mid-tarsal joint
- early heel rise if rigid
55
examples of intrinsic foot deformities
- subtalar varus
- forefoot varus/valgus
- forefoot valgus deformity
- PF 1st ray
56
normal subtalar joint neutral
- rearfoot: 0-3 deg varus
- forefoot: calcaneus perpendicular to MT line
57
what is subtalar varus
- inversion deformity of calaneus secondary to incomplete de-rotation during development
58
what is an osseous deformity
rotation within the calcaneus
- associated with subtalar varus???
59
what is forefoot varus
forefoot is in an inverted position relative to the calcaneal bisection, secondary to lack of de-rotation fo talus
60
what is forefoot valgus
forefoot in in an everted position relative to the calceaneal bisection
61
forefoot valgus deformity compensation
will occur through the rearfoot; rearfoot will be more supinated during mid-stance
62
orthotic components
shell and posts
63
soft shell goals and material
- pressure relief and shock attenuation
- soft foams
64
soft shell posts
extrinsic posts
65
soft shell indications
DM, hyposensitivity, pes cavus, supinatory foot
66
semi-rigid shell goal and material
- motion control and shock absorption
- cork, leather, low-temp plastics
67
semi-rigid shell posts
intrinsic or extrinsic
68
semi-rigid shell indications
motion control
69
rigid shell goal and materials
- CONTROL
- heat-moldable plastics; casting required
70
rigid shell posting
intrinsic
71
rigid shell indications
control of excessive pronation
72
posting functions
- control motion, bring ground to foot
- maintain abnormal joint relationships
- prevent compensation/reduce abnormal motion
- enhance muscle activity
73
intrinsic posting
- within shell of orthotic
- forefoot posting is almost always intrinsic
- decreased bulk to better fit in shoe
- difficult to adjust
- expensive
74
extrinsic posting
- most orthotics have extrinsic rearfoot posting
- stronger
- easier to adjust
- less arch pressure
- more bulk in shoe
75
varus post location
medial side of foot
76
valgus post location
lateral side of foot
77
0 deg post
- extrinsic post without angulation (LIFT)
- large FF varus, no RF abnormality
78
bar post
- runs straight, flat across
- usually extrinsic
- rigid PF 1st ray (bar post under rays 2-4)
79
rearfoot posting determination
- approximately 50% of varus
- max 6 deg
80
forefoot posting determination
- approximately 40%
- max 8 deg
81
age and weight posting determination
- more conservative with increasing age
- more aggressive with increasing weight
82
accommodative orthotic (soft shell)
- allows significant amount of flexibility
- supinatory foot type (improve shock absorption, distribute forces to foot, controls motion and lets foot come to ground more easily)
- congenital malformations
- ROM problems
- insensate feet
- diabetic/ rheumatoid feet
- illness, old age, unhealthy feet
- rigid PF 1st ray
83
biomechanical orthotic (rigid/semi-rigid)
- increased rigidity of shell
- durometer- indication of flexibility/rigidity (higher number = more rigid)
- pronatory foot problems
84
biomechanical orthotic requirements
- conform exactly to contours of 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
85
dual density
- usually semi-rigid shell
- provides control of excessive pronation
- softer, accommodating material on top
- allows shock attenuation
- easier for patients to break in
86
patient considerations for selection of orthotics
- patient condition
- pronatory vs supinatory
- intrinsic/extrinsic deformities
- patients footwear
- types of stress you are trying to reduce
- type of material
- customized vs over the counter
- cost
- fabrication time
87
orthotic break in period
- day 1: 1-2 hrs
- increases total wear time by 1-2 hours/day
- more rigidity = longer break in period
- tolerate 6-8 hrs/day prior to wearing for sports
- sports: begin 1/3 of time and increase by 1/3's
88
orthotic longevity
- long term use: evaluate 1-4 yrs
- semi rigid: 1-2 yrs
- soft orthotics: 6 months to 1 year max
89
dress shoes and orthotic
- as heel height increases, function of orthotic decreases
- max heel height = 2 in
90
diabetes typical foot changes
- intrinsic foot weakness
- toe deformities (hammer/claw)
- prominent MT heads
- fat pad atrophy
91
diabetes shoe considerations
- wide toe box
- good plantar contact
- straight last
92
diabetes orthotic considerations
- decrease plantar pressures (total contact: 1st and 5th MT heads, talus, navicular)
93
best orthotic for diabetes
accommodative or dual-density
94
rheumatoid arthritis shoewear
- straight last
- good heel counter
- wide toe box
95
what kind of orthotic for RA with hallux rigidus
- rocker-bottom shoe or MT bar
96
primary cause of orthotic issues
shoe gear, worn post, orthotic fatigue, gouging of shoe insole by post, physiological changes in the patient
97
medial foot callus causes
- not fully controlling foot- pronating against orthotic
- excessively high post
98
lateral foot callus good or bad
good because it means you're actually keeping foot in pronated position
99
orthotic postural complaints reasons
- not following break in schedule
- as a result you need to decrease wearing time
