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Assistive Tech > O - Foot Orthoses Principles > Flashcards

O - Foot Orthoses Principles Flashcards

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1
Q

what is a biomechanical orthosis

A

any device capable of controlling motion path in the foot/leg by maintaining the foot in or close to its neutral subtalar position

not trying to lock the foot at any point
want to help it move more efficiently

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2
Q

what are 5 characteristics of biomechanical orthoses

A
  1. conform to all contours of foot
  2. sufficiently rigid to maintain its contours and angular relationships
  3. control abnormal/excess motion and allow normal motion
  4. reasonably comfortable w gradually inc wearing time (breaking in period)
  5. capable of being worked on or adjusted
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3
Q

what are 4 goals of biomechanical orthoses

A
  1. minimize abnormal/excess motion
  2. encourage healing -> dec load on soft tissues and joints
  3. dec inflammation
  4. improve motion (normal mvmt patterns)
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4
Q

what are the 3 main components of biomechanical orthoses

A

shell/module
posts
top covers

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5
Q

what is the shell/module

A

off-weight neutral cast which conforms to plantar contours

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6
Q

what is the part of the biomechanical orthosis that will be fabricated

A

shell/module

via plaster cast, foam box, scanning

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7
Q

where is the shell/module on biomechanical orthoses

A

begins at heel and extends just prox to MT heads

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8
Q

what are 2 types of material that the shell/module can be made of and why

A

rigid - carbon graphite, polyethylene
* controls motion

soft - foam
* absorbs shock

depends on what the patient needs

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9
Q

what are posts and where are they placed

A

fills space created by a deformity and brings ground up to the foot so the foot can function better w/o going thru excessive amts of motion

placed at WB-ing sites (calcaneus, MTs)
* varus = medial wedge
* valgus = lateral wedge

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10
Q

what are the 2 main functions of the posts

A

stabilize the shell
provide motion control in frontal plane

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11
Q

what are the 2 main types of posts

A

extrinsic and intrinsic

doesn’t have to be one or the other, can be a mix in the orthosis

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12
Q

what type of post is the most common

A

extrinsic

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13
Q

what are extrinsic posts?
pros and cons

A

material added to plantar surface of shell

pros:
* easy to adjust
* excellent strength (can use different materials from shell)

cons:
* adds additional bulk in shoe

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14
Q

extrinsic posts

what is a bias

A

extrinsic post but made of softer material
* see in pts w hypopronated feet, looking for material to be a little softer

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15
Q

what are intrinsic posts?
pros and cons

A

positive plaster model of foot is modified to embody deformity and shell assumes the shape

pros:
* less bulk in shoe - shell assuming shape of deformity

cons:
* difficult to adjust (once it’s made, it’s made)
* material of shell determine strength (same material as the post)

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16
Q

extrinsic bar post vs single tip

A

bar post = goes all the way across
single tip = one side

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17
Q

what is the top cover

A

covers the dorsal surface of shell and is in contact w the pt

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18
Q

what are the 2 main functions of top covers

A

comfort
durability

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19
Q

what are the varying lengths the top cover could be

A

extends to MT heads, to the sulcus, or to toes

depending on pt comfort

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20
Q

why does mr jim prefer full length top covers

A

can trim it to what you want
* shifts less than the shorter ones
* could also be more comfortable depending on how sensitive the pt is

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21
Q

what are 4 examples of additions to orthoses

A

deep heel seat
1st ray cut out
flanges/clips
padding

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22
Q

additions: deep heel seat

what is it
function
con

A

normal is 6-8mm, deep is 12+mm
* deeper = wider

controls calcaneal position
* control excessive amts of calcaneal eversion

con - bulk in shoe

pedi pop could likely tolerate this the best, more aggressive of an intervention

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23
Q

additions: 1st ray cut out

what is it/who is it for

A
  • rigid PF 1st ray - cut out to compensate for that
  • flexible PF 1st ray - accomodate for this for MTP joint integ, hallux DF ROM
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24
Q

additions: 1st ray cut out

what is a 2-5 bar post and what is a con to this

A

allows 1st ray to stay in down position
* does same thing as the cut out

bar post is more bulky bc added material

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25
# additions: flanges/clips what are they 3 indications
extensions of shell and rearfoot posting 1. peds 2. ruptured tib post 3. soft tissue spill over
26
why is pediatrics an indication for flanges/clips additions
can tolerate more aggressive options
27
why is a ruptured tib post an indication for flanges/clips additions
foot won't be able to control pronation/maintain arch * flanges/clips gives pt ability to not have to compensate as much
28
why is tissue spill-over an indication for flanges/clips additions
can happen in other orthotics * this dec it
29
# additions: padding what is it / where is it
placed on shell and held in place by top cover * embedded between
30
# additions: padding 3 functions
shock absorption pain control pressure relief
31
# additions: padding 3 indications
interdigital neuroma heel spur sesmoiditis
32
where are the 4 locations of posting that you should know
RF valgus RF varus FF varus FF valgus
33
what is Hoke's Law
body **responds** to small increments of change body **reacts** to large increments of change
34
how does Hoke's law apply to orthotics
if we are too aggressive w the orthosis and post too much --> large change and the pt will react to that
35
biomechanical vs accomodative orthotics
biomechanical: (rigid) * change or control position/mvmt * goal: promote function near neutral position accommodative: (soft) * allow compensation * conforms to foot * dissipates forces * designed for comfort
36
what are 3 contraindications for biomechanical devices
acute path dec ROM incomplete eval
37
why is dec ROM a contraindication for biomechanical orthotics
biomechanical orthotics designed to control motion * anything additional to someone w less ROM will further dec motion
38
why is an incomplete eval a contraindication for biomechanical orthotics
need to assess entire kinetic chain
39
what are the 5 main lower kinetic chain concerns in the geriatric population
1. subtalar joint ROM 2. equinus influences limiting DF 3. pron/sup at midtarsal joints (general midfoot mobility) 4. abnormal (varus/valgus) influences at knees 5. hip ROM (lose hip ext, some rotation)
40
# geriatric population what does it mean if someone is chronologically old
large age in years but active and healthy
41
# geriatric population what orthotics are most appropriate for a chronically old pt pop
biomechanical device that is semi-flexible * would tolerate this well bc not a huge change accommodative device that uses more agggressive materials
42
# geriatric population what does it mean if someone is physiologically old
significant PMH and comorbidities sedentary, not doing a lot limited tolerance to change
43
# geriatric population what orthotics are appropriate for a physiologically old pt pop
accommodative device that is flexible w minimal posting * don't want to do too much change bc won't tolerate well * wouldn't do biomech bc wouldn't tolerate well additional shock absorption * add extra to dec GRF
44
# pediatric population what is the goal with orthotics in the pedi pt pop
objective is to establish normal osseous relationships w the foot allow normal development and foot function ## Footnote *need to be familiar w developmental stages
45
# pediatric population what should you have caution w when using orthotics in this pt pop
caution w early intervention that may prohibit natural derotation from a deformity ## Footnote born w lot of varus --> derotate w age and walking have a lot of pronation when little --> but will not be the same by 8-11yo
46
# pediatric population: neonate what developmental trends do you see at: hip, knee, ankle, and foot
**hip** = inc anteversion **knee **= inc varus bowing of tib **ankle:** * inc DF * minimal to no external mall position **foot: ** lot of compensated pronation * RF = 10deg varus in STJN * FF = 12-15deg varus
47
# pediatric population: 12mo what developmental trends do you see at: hip, ankle, foot
**hip:** fem anteversion 10-15deg **ankle:** * external mall position 10-15deg when lat mall is moving post and inf **foot: **inc pronation in standing & walking * RF and FF varus <10deg * relaxed calcaneal stance position 5deg eve
48
# pediatric population: 5yo what developmental trends do you see at: hip, ankle, and foot
hip: fem ant 10-15deg ankle: ext mall position 15-25deg foot: * RF varus 2-4deg * FF varus 0-2deg * relaxed calcaneal stance position 4deg eve
49
# pediatric population at what age do you see normal derotation of skeletal maturity
b/w 5-7yo
50
# pediatric population what is the take home point to know when intervening w orthotics in a pedi pop
under 7yo caution not to over correct and inhibit normal skeletal development and normal derotation
51
what type of orthotic is appropriate in the running population and what should you avoid
full length top cover that is cushioned semi-rigid orthosis avoid very rigid shell or posting materials * don't want to fx the shell bc all the impact and pounding of running ## Footnote think ab impact and loading response, the heel strike
52
what type of orthotic is appropriate in the aerobic population (ex: crossfit lol) and what should you avoid
cushion FF d/t inc WBing avoid excessive RF postin d/t abrupt direction changes
53
what type of orthotic is appropriate in the court sport population and what should you avoid
full length top covers possible lateral flange (if hx of lat ankle sprains) avoid aggressive RF posting ## Footnote basketball and volleyball sneakers have a lot of room to accommodate orthoses well
54
what type of orthotic is appropriate in the field sport population and what should you avoid
durable cover to withstand elements (ie playing in rain) avoid anything that will add bulk (ie intrinsic post) * need to dec bulk and width in cleats
55
what are red flags to watch for during the break in period of an orthotic
skin integ joint line pain
56
what does the break in period look like for an orthotic and what is normal
period of 2 weeks * inc wear 1-2hrs each day some achiness is normal bc changing their alignment
57
what law provides the basis for the break in period for orthotics
hoke's law if you walk around w new orthoses for 8-10hrs on first day, body will react * use gradual schedule --> body will respond
58
what is the typical cost for orthotics
self pay (insurance won't cover) * can cost upwards of 100s ## Footnote paying for materials, time/skill, lab cost
59
what is the life expectancy for biomechanical vs accomodative orthotics?
biomechanical - rigid materials * avg of 2-7yrs (he's seen up to 15yrs) accomodative - softer materials * 6-12 months ## Footnote depends on the density of the material it is made of
60
what is a factor that can shorten the life expectancy of biomechanical and accomodative orthotics
shorter in active/athletic population

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