O - Foot Orthoses

Question 1

what is an orthosis

Answer 1

device used to assist, resist, facilitate, stabilize, or improve ROM and functional capacity

Question 2

what is a foot orthosis

Answer 2

custom or stock orthosis used to treat foot

Question 3

what is a custom foot orthosis

Answer 3

device derived from 3D representation of pt’s foot

via plastic cast, foam box, scanning

Question 4

what are custom foot orthosis categories

Answer 4

rigid
semi-rigid
soft/flexible

functional/biomechanical
accommodative

Question 5

what dictates the type/category of orthosis

Answer 5

type of material used

Question 6

what type of materials are used for custom foot orthoses and what are each of its functions

Answer 6

soft/flexible = shock absorbing
hard/rigid = motion controlling

Question 7

what are the guiding principles behind custom orthotic devices

Answer 7

exams identify deficits contributing to development of path

varying features of orthosis can modify foot mechanics to dec pain and improve function

Question 8

custom vs prefabricated orthotics in pts w plantar fasciitis

Answer 8

similar benefits

Question 9

a lit review demonstrated effectivness of custom foot orthoses in what patholgies (4)

Answer 9

stress fx/reactions
foot pain
PFPS
soft tissue running related injuries

Question 10

what does literature say about custom vs prefabricated orthotics overall

Answer 10

evidence showing both work and there are a lot of similarities in material

may be hard to justify time, effort and cost needed for custom as a result

Question 11

balanced foot orthotic:

what is it
what type of orthotic
what models/theories is it based on

Answer 11

uses posts at RF and/or FF to control abnormal motion

biomechanical

• podiatric model
• root theory
• STJ neutral theory

Question 12

total contact foot orthotic

what is it
what type of orthotic

Answer 12

provides total plantar surface contact including medial longitudinal arch

accommodative

Question 13

what 2 orthotics fall under the foot orthosis theory

Answer 13

balanced foot
total contact foot

Question 14

balanced foot vs total contact foot orthotic

how are they cast
functions

Answer 14

balanced foot orthotic:
* foot cast in off-weight STJN position
* STJ functions around neutral
* control abnormal motion w posts/wedges at RF/FF

total contact:
* foot cast in resting position
* normal function doesn’t overload tissues
* med and lat long arches stabilized thru total plantar surface contact

Question 15

what are 2 reasons as to why foot orthotics work

Answer 15

• impact lower limb kinematics
• shock attenuation

Question 16

how much motion control is considered clinically significant when orthotics impact lower limb kinematics

Answer 16

individualized - a subtle number may be enough to dec load on tissues and dec the pt’s sx

Question 17

how do foot orthoses help w shock absorption

Answer 17

dec loading rate and vertical impact force

Question 18

do foot orthotics help w NM control

Answer 18

limited/no evidence

can help w controlling RF which improves postural ocntrol

Question 19

how does PFPS present

Answer 19

ant knee pain w:
* squatting
* stair climbing
* running

Question 20

PFPS

what potential risk factors have been identified

Answer 20

weakness prox (hip) and distal (foot)

Question 21

PFPS

what are specific potential risk factors in the kinetic chain (6)

Answer 21

excessive foot pronation
dec knee flex angle
inc hip IR during jump land
dec quad/HS strength
inc hip ER strength
increased navicular drop

inc hip ER strength may be compensatory
inc navicular drop is a component of excessive pronation

Question 22

PFPS

how could excessive pronation lead to PFPS

Answer 22

tibial IR leads to femoral IR
inc contact pressure on lateral facets of patella

Question 23

PFPS

how would foot orthoses help to treat PFPS

Answer 23

foot orthoses may dec pain by limiting foot pronation and lower limb rotation

Question 24

PFPS

what did a study reveal when looking at PFPS in runners and their:
* hip ABD and ER strength pre/post run
* arch heigh pre run
* LE kinematic data pre/post run

Answer 24

arch height didn’t change
runners w PFPS displayed weaker hip ABDs which was more pronounded at end of runners

top down study

Question 25

# PFPS what did a study find when examining ROM of TC, ST, knee during walking&running after an foot orthotic intervention

Answer 25

was helpful for walking not w running * control GRF w walking, but once you start running w higher impact - not so helpful ## Footnote during walking it was able to dec knee motion in frontal plane during contact & midstance --> but motion was inc w running

Question 26

# PFPS what did a study find when comparing outcomes in the following groups: 1. foot orthoses + PT 2. PT 3. foot orthoses 4. flat inserts

Answer 26

foot orthoses > flat inserts no diff b/w 2 and 3 no diff b/w 1 and 2 **practicioners may seek to hasten recovery by prescribing prefabricated orthoses**

Question 27

# PFPS what did a study find with prefabricated orthoses and runners w PFPS

Answer 27

did produce significant overall improvement * pts w inc midfoot mobility (aka pronation) were more likely to have more success w the orthotic

Question 28

# plantar foot pain what does the CPG say about foot orthotic and plantar foot pain

Answer 28

clinicians should use orthotics (custom or prefab) to support med arch and cushion heel esp in individuals who respond positively to antipronation taping techniques | improve function for short and long term periods ## Footnote aka start w antipron tape --> see how they respond and then talk about orthoses if it helps

Question 29

# plantar foot pain what did a study find when comparing customized to prefabricated orthotics

Answer 29

no significant difference, will benefit from either one

Question 30

# plantar foot pain what improvements were seen in plantar foot pain after 2 weeks of an orthotic intervention (2)

Answer 30

healing foot alignment improving ## Footnote used to prescribe orthoses for forever, this is now something that may be more temporary

Question 31

# plantar foot pain what did a study find about custom vs prefab in duration of improvement of sx

Answer 31

short term improvement in pain and function * temporary use while they heal, work to improve other components

Question 32

# plantar foot pain what did a systematic review find about the clinical effectiveness of foot orthoses in treatment and prevention of lower limb injuries

Answer 32

customized semi-rigid foot orthosses demonstrate mod to large benefits in treating and preventing plantar fasciitis ## Footnote semi-rigid prevent excessive amts of motion

Question 33

# plantar foot pain 4 what are non-custom foot orthotic options

Answer 33

vasyli freedom BFO superfeet powerstep

Question 34

# plantar foot pain vasyli orthotic: * characteristics * lifespan * function

Answer 34

lower density = less durable short lifespan (3-16mo) * temporary utilization able to modify RF and FF posts

Question 35

# plantar foot pain freedom BFO orthotic: * characteristics * lifespan * function

Answer 35

flexible lifespan 2-3mo wedge modifications ## Footnote inexpensive, temporarily try it out see if it works w/o huge cost if it doesn't

Question 36

# plantar foot pain superfeet orthotics * characteristics * function

Answer 36

come in different materials and durability insoles designed for various footwear and activity

Question 37

# plantar foot pain powerstep * characteristics * function

Answer 37

extrinsic 2deg post give some support and control motion

Question 38

# exercise related lower leg pain what are 5 possible reasons for pain b/w knee and ankle during exercise

Answer 38

1. medial tibial stress syndrome (MTSS) 2. chronic exertional compartment syndrome 3. stress fx 4. foot/ankle tendinopathy 5. nerve/vascular entrapment

Question 39

# exercise related lower leg pain what did studies find w foot/ankle position/mobility and exercise related lower leg pain

Answer 39

no association found no relationship found b/w foot type and orthotic use ## Footnote findings all over the place, hard to find good clinical direction

Question 40

# exercise related lower leg pain what did one study find with efficacy of orthotics and prevention of ERLP

Answer 40

orthotics more helpful for preventative/protection purposes ## Footnote dec amt of injuries occurring

Question 41

# stress fx what did studies show of the efficacy of orthotics

Answer 41

dec incidence of stress fx/reactions * orthoses help w shock attentuation * helpful w absorbing GRF, if hx of stress fx

Question 42

# stress fx what did a study show with the efficacy of orthoses in post tib stress fx

Answer 42

custom semi-rigid foot orthoses mod to larg benefits in treatign and preventing

Question 43

what are mr jims take homes on prescribing foot orthotics and PT

Answer 43

* not a lot of high level evidence to support * careful w interpretting low level studies * decision making guided by "expert" opinion and individual results * PTs are mvmt dysfunction experts, don't obsess over orthotics and think of things we can do for kinetic chain and impairments first ## Footnote he goes for footwear change first -> taping -> prefab before custom