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Biomechanics > 12) Custom Molded Footwear > Flashcards

12) Custom Molded Footwear Flashcards

1
Q

Custom molded/extra depth shoes indications

A
  • Neuropathy
  • Severe deformities
  • Unstable gait
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2
Q

Footwear plays a key role in prevention of

A
  • Plantar ulceration contributing to a reduction in lower extremity amputation in the diabetic and neuropathic population
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3
Q

A successful footwear plan includes

A
  • Patient Compliance
  • Regular footwear Checks
  • Proper footwear selection based on foot risk category
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4
Q

Custom molded shoes steps

A
  • Negative cast taken of patients foot and ankle (Orthotist or Podiatrist)
  • Plaster or fiberglass “system”
  • Customized shoe constructed
  • Plastizote insole
  • Rocker sole or bar
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5
Q

Extra depth shoes (depth inlay shoe)

A
  • Not a customized shoe
  • No negative cast necessary
  • Lace-up oxford shoe which has extra depth
  • Plastizote insole (+/- custom molded)
  • +/- rocker bar
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6
Q

Risk factors for wounds (5)

A
  • 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
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7
Q

Risk category 0

A
  • Has disease that can lead to insensitivity
  • Has protective sensation
  • NO plantar ulcer
  • Well Fitting Shoe
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8
Q

Risk category 1

A
  • Extra-depth shoes

- Heat-molded soft insert

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9
Q

Risk category 2

A
  • Extra-depth shoe
  • Rigid rocker soles
  • Custom molded orthoses
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10
Q

Risk category 3-5

A
  • Extra depth or custom molded shoes
  • Custom molded inserts
  • Custom Molded AFO orthoses with a rigid rocker
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11
Q

Rocker bar or sole indications

A
  • Metatarsal phalangeal joint arthritis (hallux limitus, rigidus)
  • Status – post Keller bunionectomy, first MTPJ fusion
  • Forefoot ulceration
  • Neuropathy
  • Rocker bar vs. rocker sole
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12
Q

Forefoot disorders treated with forefoot rocker

A
  • Hallux rigidus
  • Sesamoiditis
  • Gout
  • Met head fractures
  • Diabetic ulcers
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13
Q

Contraindications of forefoot rocker

A
  • Balance issues
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14
Q

Disorders treated with double rocker

A
  • Charcot midfoot

- Midfoot ulcer

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15
Q

Contraindications of double rocker

A
  • Balance issues
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16
Q

Forefoot disorders treated with negative heel rocker

A
  • Hallux rigidus
  • Sesamoiditis
  • Dorsiflexion contractures
  • Met head fractures
  • Diabetic ulcers
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17
Q

Contraindications of negative heel rocker

A
  • Tight gastrocs

- Equinus

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18
Q

Direct mold off-loading insert

A
  • 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
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19
Q

Foot and ankle bracing selection should be determined by

A
  • Patient factors

- Purpose

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20
Q

Patient factors in determining foot and ankle bracing

A
  • Patient’s pathology or dysfunction
  • Patient’s activity level
  • Patient goals
  • Age
  • Footwear
21
Q

Purposes for determining foot and ankle braces

A
  • Control motion
  • Support motion
  • Restore motion
22
Q

Supra-malleolar orthosis (SMO) indications

A
  • Severe pronatory forces

- Ankle joint frontal plane instability

23
Q

Case: posterior heel ulceration with forefoot amputation

A
  • Cast for accommodative appliance
24
Q

Charcot restraint orthopedic walker (CROW boot) inlay

A
  • Plastizote #1 inlay
25
Q

Supportive motion bracing functions

A
  • 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
26
Q

Restorative motion bracing indicators

A
  • High activity Level
  • Nerve impairment
  • Joint immobility
  • Good muscle strength
  • Good muscle and tendon flexibility
  • Physical therapy
27
Q

Restorative motion bracing functions

A
  • Restore dynamic gait function
28
Q

Ankle-foot orthosis (AFO)

A
  • 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
29
Q

Ankle-foot orthosis (AFO) indications

A
  • Drop foot deformity
  • Other paralytic/neuromuscular conditions
  • Ankle joint arthritis
  • Unstable gait
  • Severe foot deformity
30
Q

Types of ankle-foot orthosis

A
  • Fixed (90 degrees)
  • Hinged
  • Dynamic: dorsiflexion – assist (spring loaded)
  • Tension-band (everts / inverts foot)
31
Q

Dynamic-assist (spring) hinged AFO: Requirements

A
  • Dropfoot deformity
  • Stable knee
  • Ankle joint dorsiflexion (knee extended) 90 degrees minimum
32
Q

Hinged AFO prescription

A
  • Dropfoot deformity with stable knee
33
Q

Fixed AFO prescription

A
  • Dropfoot deformity with unstable knee
34
Q

Leaf – spring AFO prescription

A
  • Weak anterior and posterior leg
35
Q

Hinged AFO with plantarflexion stop prescription

A
  • Toe walking (uncompensated ankle equinus)
36
Q

AFO in equinus with heel lift prescription

A
  • Fixed ankle equinus
37
Q

Tension band AFO prescription

A
  • Foot/ankle in flexible varus/valgus
38
Q

Arizona brace

A
  • An AFO with frontal plane support of the foot

- More ankle support than an AFO

39
Q

Arizona brace used for

A
  • Great for rigid, pronated foot in the presence of dropfoot or anterior weakness.
  • Charcot foot: Arizona brace with depth-inlay shoe
40
Q

Supportive motion bracing indicators

A
  • Moderate to high activity
  • Painful dysfunction caused by overuse
  • Conservative option before surgery or not a surgical candidate
  • Physical Therapy
41
Q

Arizona brace/Richie brace indications

A
  • Severe rigid pes planus (ie. Charcot foot): Arizona brace

- Severe flexible pes planus: Richie brace (AKA custom stirrup orthotic)

42
Q

Multi-purpose bracing(KAFO) knee ankle foot orthosis indications

A
  • Duchene muscular dystrophy
  • Friedrich’s ataxia
  • Neuromuscular/spino-cerebellar degeneration with muscular weakness/flaccid paralysis
  • Proximal femoral fractures
  • Total hip replacement
43
Q

Tone-reducing ankle-foot-orthosis (TRAFO/DAFO) indications

A
  • Muscle spasticity (Cerebral palsy, CVA)

- Pressure and prolonged stretch over muscles and tendons

44
Q

Tone-reducing ankle-foot-orthosis (TRAFO/DAFO)

A
  • Pediatric brace

- Effectively improve control and function through biomechanical and neurophysiological effects

45
Q

Prosthetic K levels

A
  • 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
46
Q

SACH foot

A
  • 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
47
Q

Single axis foot

A
  • Includes bumpers, which control ankle’s ROM
48
Q

Dynamic response foot

A
  • Dynamic elastic response imitates the energy return characteristics of a normal ankle
  • Reduces energy expenditure and improves gait
49
Q

Multi-axial foot

A
  • Multiple components at the ankle

- Provide maximum amount of motion on all planes

Biomechanics (7 decks)

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