POAT Unit 1: Footwear - The Groundwork for any LE Prosthesis and Orthosis (Adult and Peds)

Question 1

What is the Absolute Foundation for most LE orthotic and prosthetic interventions?

Answer 1

Well-designed shoes

• Each Part of the shoe can enhance or interfere with LE orthotic management

Question 2

What are the effects if a person has improper footwear?

Answer 2

There will be unwanted shearing ans pressures leading to skin breakdowns and structural damage to the foot over time

Question 3

With the Components of the Shoe, why is the Sole of the shoe important?

Answer 3

The Sole protects the plantar surface of the foot

• A thick sole protects the foot against irregularities in the walking surface. Although the sole must be durable, it must no be too rigid as to interfer with the toe rocker of the MTP hyperextension during Terminal Stance as preswing phases of gait

Question 4

What are some different areas of the Sole of the shoe?

Answer 4

• Welt: inside piece of the external sole
• Outsole: The portion that is most external
• Shank: The area that lies between the heel and the ball of the shoe. This is also the area that is most commonly fabricated to provide reinforcement and shape using material such as a spring steel, steel and leatherboard or wood strips between the welt and outsole. The purpose of the shank is to prevent collapse and the material between the heel and the ball of the boof to provide extra support

Question 5

What is the difference between the Midsole Insole and Outsole?

Answer 5

• The Midsole is the padded area between the Insole and Outsole that provides comfort, cushioning and shock absorption. It may also provide structural support
• The Outsole is the durable outermost portion of the sole that comes into contact with the ground and is treaded for traction. They are designed for specific patterns for functional needs
• The Insole is the portion that fits inside the shoe to provide additional cushioning and arch support

Question 6

With the Components of the Shoe, What is the “Upper” portion of the shoe?

Answer 6

The upper is divided into the vamp, tongue and rear quarter (covers dorsum of the foots)

• This holds the shoe together and secures the foot to the midsole. It provides stability and breathability to the shoe

Question 7

In Doc

With the Components of the Shoe, What is the “Toe Box” portion of the shoe?

Answer 7

The front part of the shoe which provides space for the distal forefoot and toes

Question 8

With the Components of the Shoe, What is the “Last” portion of the shoe?

Answer 8

This refers to teh overall shape of the sole and the footprint that the shoe is built around. It can be curved, semicurved or straight

Question 9

In Doc

With the Components of the Shoe, What is the “Ankle Collor” and “Heel Counter” portion of the shoe?

Answer 9

This is the rear portion of the “upper” that is designed to support the rear foot
- Often the top RAM of the heel counter is reinforced and padded for fit and comfort

Question 10

When considering shoe size, what is the minimum in inches for clearance between the longest toe and the end of the shoe?

Answer 10

1.5 inches

Question 11

What are Minimalist shoes designed for?

Answer 11

These shoes offer the concept of natural barefoot function

• These are designed to provide minimal cushioning and little external support

Question 12

What are Cushioning shoes (“Neutral”) designed for?

Answer 12

These are designed to provide external shock absorption only
- Not designed for “control”

Question 13

What are Stability shoes designed for?

Answer 13

These provide some external support of resistance to subtalor joint pronation
- STJ Medial control/protection

STJ = Subtalar joint

Question 14

What are Motion Control shoes designed for?

Answer 14

These extend pronation control into the Midtarsal joint
- Medial and Lateral STJ and MTJ protction

STJ = Subtalar joint

Question 15

What are Trail shoes designed for?

Answer 15

These shoes have a more protected “Upper” and enhanced Outersole traction devices

Question 16

What are three test to determine any shoe’s Functional Stability Characteristics?

Answer 16

• Torsional Rigidity
• Heel counter stiffness/rigidity
• Flexion Stability

Question 17

Test to determine any shoe’s Functional Stability Characteristics

What is the Torsional Rigidity Test?

Answer 17

This is performed by twisting the shoe around its long axis in opposite directions and evaluating the amout of resistance that the shoe provides to this

Question 18

Test to determine any shoe’s Functional Stability Characteristics

What is the Heel Counter Rigidity Test?

Answer 18

This is assed by squeezing the heel of the shoes, ankle and subtalar support in frontal plane provided by the heel counter is tested

Question 19

Test to determine any shoe’s Functional Stability Characteristics

What is the Flexion Stability Test?

Answer 19

This test the ease of flexion in the Mid part of the shoe and at the metatarsal heads area is assessed
- It is good for shoes to flex at the point of the forefoot rocker, but not to always flex without resistance in the midfoot area where support is needed

Question 20

Which would provide the greatest amount of stability against balance perturbations?
Which surface area would offer only a small base of support?

Ignore the quesion in pic

Answer 20

The 3rd shoe will provide the greatest amount of stability against perturbations and the 6th will offer a small BOS

Question 21

Using the pic, how much Upper stability, will a Canvas Upper provide?

Answer 21

Minimal Upper stability

Question 22

Using the pic, how much Upper stability, will a Mesh Upper provide?

Answer 22

Minimal Upper Stability

Question 23

Using the pic, how much Upper stability, will a Leather Upper provide?

Answer 23

Medium Upper Stability

Question 24

Using the pic, how much Upper stability, will a Reinforeced Leather Upper provide?

Answer 24

High Upper Stability

Question 25

With Shoe Modifications, what can be done with those patients with Leg-Length Discrepancies more than 3/8 inch or more?

Answer 25

A Full-length external lift can be mounted to the sole on the shorter limb to equalize leg length and reduce proximal stresses at the hips and spine

Question 26

With Shoe Modifications, what can be done with those patients with Leg-Length Discrepancies less than 3/8 inch?

Answer 26

The discrepancy can usually be accomodated with an orthotic heel wedge worn inside the shoe

Question 27

With Shoe Modifications, what can be done with those patients with Leg-Length Discrepancies as a result of a unilateral equinus deformity?

Answer 27

A heel wedge can be attached to the external surface of the shoe

Question 28

With Shoe Modifications, What are Heel Wedges used for?

Answer 28

Used to alter lines of stress to facilitate a more normal gait pattern - The most effective wedges range from 1/8 and 1/4 inches at their apex - Larger wedges tend to cause the foot to slide away from the wedge towards the opposite side of the shoe, drastically reducing the effectiveness of the modification

Question 29

With Shoe Modifications, how can heel wedging be useful for children and adults?

Answer 29

- For children it can help with rotational problems such as tibial torsion - For Adults it can accomoduate conditions such as a fixed valgus deformity of the calcaneus

Question 30

With Shoe Modifications, why are Medial Heel Wedges useful?

Answer 30

They are used when flexible valgus of the calcaneus are present. As the wedge elevates the medial heel, a resultaant varus tilt acts on the calcaneus, preventing excessive pronation of the foot

Question 31

With Shoe Modifications, why are Lateral Heel Wedges useful?

Answer 31

Used when flexible varus of the calcaneus present. Elevation of the lateral heel decreases the medial drive on floor contact at heel strike, tipping the calcaneus into valgus

Question 32

With Shoe Modifications, why are Full Heel Wedges useful?

Answer 32

Sometimes used in the presence of fixed or functional equinus deformity.

Question 33

With Shoe Modifications, What is the Goal of Heel Wedging?

Answer 33

To obtain a subtalar neutral position during the stance phase of gait

Question 34

With Shoe Modifications, what can Sole Wedges help modify?

Answer 34

Midfoot and forefoot positions

Question 35

With Shoe Modifications, why are Medial Sole Wedges useful?

Answer 35

This produces an inversion effect on the forefoot - This wedge is positioned along the medial aspect of the footwear, from a point just proximal to the fifth metatarsal head to the midline of the footwear. The apex of this wedge is the fifth metatarsal head

Question 36

With Shoe Modifications, why are Barton (Sole) Wedge useful?

Answer 36

Used in the presence of severe flexible pronation deformities, such as those seen in Pes Planus, when control of the midfoot is the goal. - This is usally made with 3/16 inch leather, extends along the medial side of the foot to the midtarsal joint and tapers laterally just anterior to the cuboid bone - This provides support to the navicular and helps invert the calcaneus

Question 37

# **In Doc** With Shoe Modifications, What are Metatarsal Bars and Rocker Bottoms?

Answer 37

This is a block of material (usually stacked pieces of leather or rubber) attached to the sole of the shoe - Its placement proximal to the metatarsal heads significantly reduces pressure at the metatarsal heads during the push-off phases of the gait cycle

Question 38

With Shoe Modifications, What are Curved Distal Edge of the Metatarsal bars useful for?

Answer 38

This is designed to follow the curve of the metatarsal heads. - Its commonly used to adapt shoes worn by patients with transmetatarsal amputations, fixed arthritic deformities, diabetes, forefoot deformities such as hallux rigidus and neuromas

Question 39

With Shoe Modifications, what do the placement of the metatarsal bar or rocker bottoms facilitate?

Answer 39

Push off by simulating forward propulsion in the absence of metatarsal flexibility

Question 40

With Shoe Modifications, why are Rocker Bottoms useful?

Answer 40

It redistributes body forces over the plantar surface of the foot while its bearing weight - It facilitates a smooth roll during the stance phase of gait while reducing sheer stress and trauma to the midfoot and forefoot - Its used patients who have any LE orthosis that limits forward progression of the tibia over the foot and toes durin the middle and late stance phases