12) Custom Molded Footwear Flashcards
Custom molded/extra depth shoes indications
- Neuropathy
- Severe deformities
- Unstable gait
Footwear plays a key role in prevention of
- Plantar ulceration contributing to a reduction in lower extremity amputation in the diabetic and neuropathic population
A successful footwear plan includes
- Patient Compliance
- Regular footwear Checks
- Proper footwear selection based on foot risk category
Custom molded shoes steps
- Negative cast taken of patients foot and ankle (Orthotist or Podiatrist)
- Plaster or fiberglass “system”
- Customized shoe constructed
- Plastizote insole
- Rocker sole or bar
Extra depth shoes (depth inlay shoe)
- Not a customized shoe
- No negative cast necessary
- Lace-up oxford shoe which has extra depth
- Plastizote insole (+/- custom molded)
- +/- rocker bar
Risk factors for wounds (5)
- History of a wound
- Loss of protective threshold (5.07 filament)
- Deformity
- Poor glycemic control (Diabetes)
- Any medical condition which gives rise to neuropathy. i.e. Diabetes
Risk category 0
- Has disease that can lead to insensitivity
- Has protective sensation
- NO plantar ulcer
- Well Fitting Shoe
Risk category 1
- Extra-depth shoes
- Heat-molded soft insert
Risk category 2
- Extra-depth shoe
- Rigid rocker soles
- Custom molded orthoses
Risk category 3-5
- Extra depth or custom molded shoes
- Custom molded inserts
- Custom Molded AFO orthoses with a rigid rocker
Rocker bar or sole indications
- Metatarsal phalangeal joint arthritis (hallux limitus, rigidus)
- Status – post Keller bunionectomy, first MTPJ fusion
- Forefoot ulceration
- Neuropathy
- Rocker bar vs. rocker sole
Forefoot disorders treated with forefoot rocker
- Hallux rigidus
- Sesamoiditis
- Gout
- Met head fractures
- Diabetic ulcers
Contraindications of forefoot rocker
- Balance issues
Disorders treated with double rocker
- Charcot midfoot
- Midfoot ulcer
Contraindications of double rocker
- Balance issues
Forefoot disorders treated with negative heel rocker
- Hallux rigidus
- Sesamoiditis
- Dorsiflexion contractures
- Met head fractures
- Diabetic ulcers
Contraindications of negative heel rocker
- Tight gastrocs
- Equinus
Direct mold off-loading insert
- Soft and molded inserts are effective in reducing foot pressure in patients with high risk feet
- Molding multi-density Plastazote material directly to the patients foot is an effective design for reducing pressure over long periods of use
Foot and ankle bracing selection should be determined by
- Patient factors
- Purpose
Patient factors in determining foot and ankle bracing
- Patient’s pathology or dysfunction
- Patient’s activity level
- Patient goals
- Age
- Footwear
Purposes for determining foot and ankle braces
- Control motion
- Support motion
- Restore motion
Supra-malleolar orthosis (SMO) indications
- Severe pronatory forces
- Ankle joint frontal plane instability
Case: posterior heel ulceration with forefoot amputation
- Cast for accommodative appliance
Charcot restraint orthopedic walker (CROW boot) inlay
- Plastizote #1 inlay
Supportive motion bracing functions
- Support natural motion of foot and ankle
- Reinforce the structure of the foot and ankle from the outside in
- Help relieve painful joint movement
- Limit ROM
Restorative motion bracing indicators
- High activity Level
- Nerve impairment
- Joint immobility
- Good muscle strength
- Good muscle and tendon flexibility
- Physical therapy
Restorative motion bracing functions
- Restore dynamic gait function
Ankle-foot orthosis (AFO)
- Controls foot and ankle movement
- Composed of thermoplast (polypropylene)
- “Old” style AFO constructed of leather and steel
- Intrinsic (modern) and extrinsic (old) types
- Fixed, hinged and dynamic types
- Richie brace (fixed) may serve as an AFO
Ankle-foot orthosis (AFO) indications
- Drop foot deformity
- Other paralytic/neuromuscular conditions
- Ankle joint arthritis
- Unstable gait
- Severe foot deformity
Types of ankle-foot orthosis
- Fixed (90 degrees)
- Hinged
- Dynamic: dorsiflexion – assist (spring loaded)
- Tension-band (everts / inverts foot)
Dynamic-assist (spring) hinged AFO: Requirements
- Dropfoot deformity
- Stable knee
- Ankle joint dorsiflexion (knee extended) 90 degrees minimum
Hinged AFO prescription
- Dropfoot deformity with stable knee
Fixed AFO prescription
- Dropfoot deformity with unstable knee
Leaf – spring AFO prescription
- Weak anterior and posterior leg
Hinged AFO with plantarflexion stop prescription
- Toe walking (uncompensated ankle equinus)
AFO in equinus with heel lift prescription
- Fixed ankle equinus
Tension band AFO prescription
- Foot/ankle in flexible varus/valgus
Arizona brace
- An AFO with frontal plane support of the foot
- More ankle support than an AFO
Arizona brace used for
- Great for rigid, pronated foot in the presence of dropfoot or anterior weakness.
- Charcot foot: Arizona brace with depth-inlay shoe
Supportive motion bracing indicators
- Moderate to high activity
- Painful dysfunction caused by overuse
- Conservative option before surgery or not a surgical candidate
- Physical Therapy
Arizona brace/Richie brace indications
- Severe rigid pes planus (ie. Charcot foot): Arizona brace
- Severe flexible pes planus: Richie brace (AKA custom stirrup orthotic)
Multi-purpose bracing(KAFO) knee ankle foot orthosis indications
- Duchene muscular dystrophy
- Friedrich’s ataxia
- Neuromuscular/spino-cerebellar degeneration with muscular weakness/flaccid paralysis
- Proximal femoral fractures
- Total hip replacement
Tone-reducing ankle-foot-orthosis (TRAFO/DAFO) indications
- Muscle spasticity (Cerebral palsy, CVA)
- Pressure and prolonged stretch over muscles and tendons
Tone-reducing ankle-foot-orthosis (TRAFO/DAFO)
- Pediatric brace
- Effectively improve control and function through biomechanical and neurophysiological effects
Prosthetic K levels
- Defined by Medicare based on an individual’s ability or potential to ambulate and navigate their environment
- Once determined, prosthetic components covered by Medicare can be determines
- K0-K4
SACH foot
- Most basic prosthetic foot available in United States
- Heel is composed of a foam wedge that provides cushioning in the heel section during heel strike
- Commonly used on pediatric or geriatric amputees
Single axis foot
- Includes bumpers, which control ankle’s ROM
Dynamic response foot
- Dynamic elastic response imitates the energy return characteristics of a normal ankle
- Reduces energy expenditure and improves gait
Multi-axial foot
- Multiple components at the ankle
- Provide maximum amount of motion on all planes
