Treatment Options

Question 1

Treatment options for an accessory navicular

Answer 1

Footwear: reducing pressure over navicular using horseshoe or donut pads, spot stretching
Orthoses: UCBL style if planovalgus foot type, pocket for AN
Other: reducing activity levels until pain subsides, taping, surgery

Question 2

Treatment options for Osgood-Schlatter’s disease?

Answer 2

Decrease tractional pull of patellar tendon on tibial tubercle. Reductions in activity, physio for tight muscles, orthoses to reduce excess leg rotation, knee brace

Question 3

Treatment options for Leg-Calves-Perth disease?

Answer 3

Minimizing femoral head deformity. Physio for tight musculature, reducing excess rotation through orthoses

Question 4

Treatment options for Kohler’s disease?

Answer 4

Abnormal pronation exacerbates this problem, so controlling this is important. Increased arch support through shoe mods, orthoses, footwear. Excavations for navicular

Question 5

Treatment options for Sever’s disease?

Answer 5

Decrease stress on achilles tendon. Physio if tight musculature present, footwear that doesn’t put pressure on the achilles tendon. Orthoses if biomechanical foot deformities are contributing to stress on achilles, shoe mods (heel lifts,sach heel)

Question 6

Treatment options for Freiberg’s disease?

Answer 6

Reducing pressure on affected MT head. Proper footwear fit (width and depth), orthoses to provide MT support or offloading, shoe mods (MT pad, excavations, rocker sole)

Question 7

Treatment options for a tarsal coalition?

Answer 7

Conservative treatments include anti inflammatories, activity modification, orthoses and shoe mods. Surgery required when these don’t work. Accommodative orthoses, stabilizing painful rearfoot movement, rigid material.

Question 8

Treatment options for a Clubfoot (talipes equinovarus)?

Answer 8

Multiple methods of correction (Kite, Ponseti, Copenhagen), however only effective when done early in childhood. Pedorthic treatments support remaining RF valgus, ankle equinus, and FF adduction. Footwear mods and styles can help as well.

Question 9

Treatment options for Plantar fasciitis/fasciosis?

Answer 9

DF night splint, lifts when LLD is present, forefoot rocker, footwear with arch support at home, stretching and strengthening of the fascia and calves, orthoses for biomechanical correction

Question 10

Treatment options for plantar fibromas?

Answer 10

Footwear with cushioned soles, orthoses to properly offload the area, physio for strength and stretching of plantar fascia, rest and reduction in activity. Surgery is last resort

Question 11

Treatment options for a calcaneal stress fracture?

Answer 11

Reduction in activity, especially if stress fracture came from the activity. Biomechanical issues contributing to greater stress on the area can be alleviated through orthoses, using SACH heel

Question 12

Treatment options for heel fat pad syndrome?

Answer 12

Modification of activities and rest will provide the best benefits. Gel heel cups to provide cushioning under the heel can be beneficial. Footwear with hard heels should be switched for something with more cushioning, like a running shoe.

Question 13

Treatment options for Baxter’s nerve entrapment?

Answer 13

Orthoses to reduce mechanical pressure over the medial ankle (reducing excessive pronation). reduction in activity

Question 14

Treatment options for a haglunds deformity?

Answer 14

Shoes with no heel counter, soft heel counters, modifying heel counters through stretching or removal of material. Treatments often focus on conditions associated with it, such as achilles tendinopathy. Surgery required for cases that dont respond to conservative methods

Question 15

Treatment options for retrocalcaneal bursitis?

Answer 15

With overuse, decreasing activity is the first point. Reducing friction of heel counter with shoe mods, or change in footwear. Orthoses can help if biomechanical factors appear to be contributing, raising up the heel to reduce tension. Stretching and strengthening of the gastroc soleus complex can help reduce tension over the achilles tendon insertion

Question 16

Treatment options for achilles tendinopathy?

Answer 16

Rest and modify activity. Orthoses to control excessive eversion can help, heel lifts as well. Physio for an eccentric exercise program seems to be the most beneficial. Neutral footwear appears advantageous compared to motion control footwear.

Question 17

Treatment options for tarsal tunnel syndrome?

Answer 17

Footwear with enough room around the heel counter to not squeeze the medial calcaneal nerves. Orthoses to help biomechanical issues of the rearfoot and midfoot. Surgery or injections can help as well if needed.

Question 18

Treatment options for PTTD?

Answer 18

Orthoses to correct biomechanical issues creating greater stress on the medial ankle. Stretching and strengthening are important in early stages, as function can still be restored.

Question 19

Treatment options for peroneal tendinopathy?

Answer 19

Controlling inversion through orthoses and footwear/ footwear mods. DF night splint could help as the peroneals are plantar flexors. Orthoses support lateral column

Question 20

Treatment options for cuboid syndrome?

Answer 20

Referral to manual therapy in conjunction with pedorthic treatment. Orthoses with soft cuboid padding and lateral column support appear to aid.

Question 21

Treatment options for a Lisfranc injury?

Answer 21

Pedorthic treatment minimal. Refer to physician if suspected. Depending on severity may need surgery, likely need an aircast boot to offload for a while. Shoes with stiff rocker sole can aid ambulation. UCBL orthotic supports MLA, accommodates deformity, decrease motion in painful joints

Question 22

Treatment options for a Morton’s foot (Morton’s syndrome)?

Answer 22

Orthoses with Morton’s extension under first MT head, rigid or semi rigid. Metatarsal pad to relieve pressure on second MT. Rocker sole footwear can reduce stress on metatarsals. Unresponsive or severe cases may require surgery.

Question 23

Treatment options for a Morton’s neuroma?

Answer 23

Can begin with neuroma or MT pad placed in footwear, proximal to MT heads. If custom orthoses seem necessary, they will typically control RF eversion. If narrow footwear is contributing, discuss footwear options with enough depth and width. Rocker sole can reduce MTP extension, which could relieve symptoms.

Question 24

Treatment options for MTPJ synovitis?

Answer 24

Stretching/strengthening calf muscles to reduce forefoot pressures during gait. Cushioned FF padding, rocker soled shoes, OTC or custom orthoses to offload where necessary. MT pads can be used, but require adequate depth and placement

Question 25

Treatment options for MTPJ capsulitis?

Answer 25

Reductions in activity early on. Stretching calves to reduce FF pressure in gait. Orthoses to offload area, use of first ray or MT pads. Footwear with rocker forefoot to reduce extension of teh MTPJ's.

Question 26

Treatment options for Flexor tenosynovitis?

Answer 26

If systemic inflammatory conditions are present, referral to physician may be necessary if they are not managing the condition well. Pedorthic management includes rigid rocker footwear, orthoses to accommodate excessive pronation and ankle equinus. Carbon plates inside footwear can be of use as well if footwear is not desired.

Question 27

Treatment options for a bunionette?

Answer 27

In absence of pain, patient education to maintain this. Talk about type of footwear, proper fitting footwear, mods to offload if needed. Mods include stretching, excavations, padding. Orthoses only needed if mechanics increase pressure to the area, using MT pads

Question 28

Treatment options for sesamoiditis?

Answer 28

Orthoses can offload 1st MTPJ by reducing pronation, or through cushioned materials. If extension of the hallux induces pain, a Morton's extension may be necessary. If plantar pressure induces pain, a MT pad placed proximally to the MT head can offload. Footwear with FF rocker and extra width. Excavations inside footwear.

Question 29

Treatment options for MTSS?

Answer 29

Orthoses aim to reduce excessive pronation. Footwear replacement if shoes are old and worn out. Common in runners, and runners should replace shoes more often. Footwear should have a stiffer midsole to resist torsion from pronation. Stretching calves can reduce pressures on ankle DF's. Referral to physio for this, as well as massage if necessary.

Question 30

Treatment options for compartmnet syndrome?

Answer 30

Orthoses to aid over pronation, through medial posting and MLA support. Footwear with stiffer midsole to resist torsion from pronation. Acute cases should be referred to physio for strengthening. Surgery needed for chronic and unresponsive cases.

Question 31

Treatment options for an LLD?

Answer 31

Physio referral if significant muscle imbalances are present. Massage to help release the tissue. Orthoses can help if over pronation of one side is leading to a functional discrepancy. Internal lifts for small LLD, external lift for large LLD. Imaging required for accurate lift measurement.

Question 32

Treatment options for IT band syndrome?

Answer 32

Excessive pronation or supination controlled through orthoses. Idea is to control internal rotation of the leg. FF varus common, orthoses can help with this as well. Footwear with firm heel counter and medial lateral torsion control. Supinated feet benefit most from a neutral shock absorbing shoe.

Question 33

Treatment options for PFPS?

Answer 33

Referral for physio for activity modification and strengthening, rest, orthoses for biomechanical contributions, patellar taping, knee bracing. Orthoses should control pronation to aid tibial internal rotation

Question 34

Treatment options for sciatica?

Answer 34

Impingement at L5 can lead to impaired function of tib ant and ext hallong. Orthoses can help control excessive motion in this case, as well as if foot drop begins to occur. In cases with neuropathy of the foot, education on hygiene of the foot is necessary.