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PassPMR - 08 Prosthetics & Orthotics > 8. Shoes & Foot Orthosis > Flashcards

8. Shoes & Foot Orthosis Flashcards

1
Q

Columns of the Foot

A

Medial column is more mobile while lateral column is stiffer

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2
Q

Components of Eversion vs Inversion. 3 marks 🔑🔑

A

Inversion

  1. Ankle plantarflexion
  2. Subtalar supination
  3. Forefoot adduction

Eversion

  1. Ankle dorsiflexion
  2. Subtalar pronation
  3. Forefoot abduction
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3
Q

Clubfoot. Components & Tx 🔑🔑

A

CAVE

  1. Cavus
  2. Adductus
  3. Varus
  4. Equinus

CONSERVATIVE TREATMENT

  1. Denis Brown Orthosis
  2. Ponseti casting method

SURGICAL TREATMENT

  • Surgical correction should not be performed until the child is ready to begin bearing weight through the lower extremities because crawling with internally rotated feet has a deforming force that can lead to recurrence.
  • May require soft tissue releases or tendon transfers to balance the forces across the ankle.
  • Postoperative bracing is necessary to hold the foot and ankle in proper alignment.
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4
Q

Pes cavus 2 Complications & 2 Tx. 🔑🔑

A

Complications

  1. Plantar metatarsal head prominence
  2. Increased forefoot plantar loading during ambulation
  3. Metatarsalgia

Treatment

  1. Foot orthoses (metatarsal pad - metatarsal bar)
  2. Custom-molded shoes
  3. Metatarsal osteotomies
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5
Q

Answer 🔑🔑 EXAM 2016-2017

A

UPPER

  1. Quarters (two pieces sewn together): The pieces that make up the posterior part; lower cut to avoid irritation on the lateral malleolus
  2. High quarter: Referred to as high top, offers ML stability
  3. Lace stay: Portion containing the eyelets for laces
  4. Vamp (one piece): Anterior part covering the instep and toes
  5. Tongue: Strip of leather lying under the laces
  6. Throat: Opening at the base of the tongue, entrance to shoe, room for internal modification (extra depth shoes also allow more room for shoe orthotics).
  7. Ball: Widest part of sole, at the metatarsal heads
  8. Toe box: Anterior part of the vamp, protects toes from trauma

SOLE

  1. Outsole: Part that touches the ground; may be made of leather, rubber, crepe, plastic, wood, or other materials
  2. Insole: Made of thin leather or man-made material; part closest to foot
  3. Filler is usually made of cork dust and latex
  4. Shank: Narrowest part of sole; between heel and ball, provide additional 6support for arch of the foot

HEEL

  1. Heel counter: Reinforces the shoe, stabilizing the foot by supporting and controlling the calcaneus
  2. Breast: Anterior part of heel
  • Shock absorber and prevents shoe from wearing out
  • Shifts weight to the forefoot
  • Made from: Leather, wood, plastic, rubber, or metal
  • Athletic shoes eliminate the heel because one can run faster
  • High heels make ankle and foot more unstable

Cuccurollo 4th Edition Chapter 6 P&O pg509-510

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6
Q

Internal shoe modification for heel stability 🔑🔑 EXAM

A

University of California Biomechanics Lab (UCBL) orthosis

  1. FLEXIBLE calcaneal deformities (rearfoot valgus or varus)
  2. Transverse plane deformities of the midtarsal joints (forefoot abduction or adduction)

Heel Cup

  • Provides calcaneal support
  • Prevent calcaneal valgus in the flexible flat foot

Cuccurollo 4th Edition Chapter 6 P&O pg510

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7
Q

List 1 shoe modification for hammer toe

A
  1. Toe crest

Cuccurollo 4th Edition Chapter 6 P&O pg510

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8
Q

List 5 Heel Modifications

A
  1. Cushioned heel (“SACH” heel): Absorb shock at heel (foot) strike.
  2. Heel wedge
  3. Heel flare
  4. Heel extension: medially (Thomas heel) or laterally (reverse Thomas heel).
  5. Heel lift: fixed pes equinus deformity or for a leg length discrepancy of more than 2 cm or if symptomatic

Cuccurollo 4th Edition Chapter 6 P&O pg511

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9
Q

List 4 benefits for Rocker Soles

A
  1. Decreases heel-strike forces on the calcaneus and talus
  2. Reduces the ankle motion
  3. Reduce pressure under the first to fourth metatarsals (Metatarsalgia)
  4. Offload an area of plantar pressure (Athletic shoes)
  5. Aid in propulsion at toe-off (Hallux rigidus)
  6. Charcot-foot
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10
Q

List 2 shoe modifications to promote eversion or inversion 🔑

List 2 shoe modifications to modify frontal plane of movements of the foot 🔑

A

INTERNAL

  1. Heel Wedge
    • Medially: promote hindfoot inversion (flexible pes planus)
    • Laterally: promote hindfoot eversion (flexible pes varus)

EXTERNAL

  1. Sole/Heel Wedge
    • Lateral sole wedge promotes forefoot eversion
    • Medial wedge promotes fore foot inversion.
  2. Flare
    • Provides greater stability by widening the base of support of the shoe
    • Medial flare resists eversion
    • Lateral flare resists inversion of the foot

Cuccurollo 4th Edition Chapter 6 P&O pg510-511

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11
Q

List 2 shoe modifications for heel pain.

A
  1. Heel cushion-relief
  2. Cushioned heel (“SACH” heel)

Cuccurollo 4th Edition Chapter 6 P&O pg510

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12
Q

List 6 Causes of Insensate and Dysvascular Foot

A
  1. Stroke
  2. Spinal cord injury
  3. Myelodysplasias
  4. Peripheral neuropathies
  5. Diabetic foot
  6. PVD
  7. Chronic venous insufficiency

Cuccurollo 4th Edition Chapter 6 P&O pg511

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13
Q

Preventive foot program

A

💡 Daily foot care and inspection program.

  1. Not be aware that footwear is too tight or breakdown is occurring.
  2. May need mirror
  3. Daily foot examination
  4. Handicapped patient may need assistance
  5. Particular attention to metatarsal heads
  6. Skin may lack normal perspiration moisture
  7. Skin may have scaling and fissuring
  8. Daily foot soaks followed by application of emollient

Cuccurollo 4th Edition Chapter 6 P&O pg512

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14
Q

List 4 shoe modification for pes planus 🔑

A

INTERNAL

  1. Scaphoid pads/arch cookies/navicular pad
  2. Longitudinal arch insert

EXTERNAL

  1. Shank filler: Applied medially to support medial longitudinal arch or laterally to support lateral longitudinal arch
  2. Medial heel extension (Thomas heel)

Cuccurollo 4th Edition Chapter 6 P&O pg510

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15
Q

List 4 shoe modifications to relief metatarsal pain 🔑🔑 EXAM 2021

A

INTERNAL

  • *1. Metatarsal pad**
  • *2. Inner sole excavation/relief**

EXTERNAL

1. Metatarsal bar

  • Posterior to the metatarsal heads
  • Relieves pressure by transferring load to the metatarsal shafts during stance

2. Rocker bar (longer than the metatarsal bar)

  • Relieve metatarsal pain (by relieving pressure)
  • Quicken the gait cycle (by assisting rollover during stance)
  • Assist dorsiflexion or decrease demand on weak plantar flexors (push off)
  • Plantar fasciitis
  • Neuropathic ulceration, and trauma to the midfoot or metatarsal region.

3. Steel shank

Inserted between the inner and outer soles to prevent motion of the anterior sole (bending of the sole) and thus reduce stress on metatarsals/phalanges.

It is commonly used with the rocker bar to assist rollover.

Cuccurollo 4th Edition Chapter 6 P&O pg10-511

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16
Q

List 4 Shoe modification for Arthritic Foot (Charcot Foot)

A
  1. Toe Box
    • High toe box for hammer toes
    • Wide toe box for bunion/hallux valgus
    • Soft toe box to adjust for deformities
  2. Insole
    • Metatarsal pad
    • Full length-molded insole
  3. Rocker
    • Metatarsal bar
  4. Heel
    • Soft heel counter

Cuccurollo 4th Edition Chapter 6 P&O pg512

17
Q

List 4 factors associated with foot pain in patient who recently started running 🔑🔑 Dr. Jamal Q

A

💡 Think: Program - Place - Shoes - Athlete

  1. Training errors: Most common cause
  2. Poor or worn footwear
  3. Poor training surface
  4. Biomechanical abnormalities
  5. Poor flexibility
  6. Inadequate warming-up

Cuccurollo 4th Edition Chapter 6 P&O pg513

18
Q

List 4 associations with pronated foot & list 4 shoe modifications

A

ASSOCIATIONS

  1. Plantar fasciitis
  2. Posterior tibial tendinitis
  3. Achilles tendinitis
  4. Tibial stress syndrome
  5. Patellofemoral syndrome

SHOE MODIFICATIONS

  1. Heel cup
  2. Medial heel wedge
  3. Medial heel flare (or wide flare)
  4. Medial arch support

Cuccurollo 4th Edition Chapter 6 P&O pg513

19
Q

Mention 4 cases that need foot orthosis.

A
  1. Diabetics with polyneuropathy +/- PVD (protection to feet, limiting ulceration)
  2. Rheumatoid arthritis (Pressure relief over bony prominences, hallux valgus)
  3. Athletic foot deformities
  4. Specific foot lesions (Metatarsalgia)
20
Q

Mention 4 foot lesions and how to fix them with FO

A
  1. Metatarsalgia: metatarsal pad/bar
  2. Morton’s neuroma: Avoid narrow tight fitting shoes. Provide metatarsal relief.
  3. Plantar fasciitis: Medial arch support + silicone gel heel pad
  4. Achilles tendonitis: good stretching program + heel lift in the shoe
21
Q

Most common reasons foot orthoses do not work

A
  1. Prescribed inappropriately
  2. Inappropriate shoes.
  3. Orthoses are not worn consistently.
22
Q

Components of pes planus (Describe each joint/bone alignment)

A
  1. Pronation at the subtalar joint
  2. Eversion of calcaneus
  3. Flattening of the medial arch
  4. Forefoot abduction at the tarsometatarsal junction
23
Q

List 6 Risk factors of acquired flat foot

List 4 MSK causes of flat foot

A

RISK FACTORS

  1. Diabetes
  2. Obesity
  3. History of trauma
  4. Degeneration of bones and joints
  5. Increased age
  6. Seronegative inflammatory disorders
  7. Corticosteroid use

Ref: aaprm.com

MSK CAUSES

  1. fractures of the navicular, first metatarsal, or calcaneal bones
  2. trauma to plantar fascia
  3. deltoid/spring ligament
  4. Dysfunction of the posterior tibial tendon

Ref: aaprm.com

24
Q

How to check for flexible pes planus 🔑🔑 Dr. Haitham

A
  1. Tip Toing
  2. Big toe dorsiflexion
25
Q

Heel Pain 8 differential diagnosis and 3 orthosis

A

1. Achilles Tendonitis

Overuse injury - Mild swelling around the tendon and morning stiffness

2. Haglund’s Syndrome

Bony prominence at the back of the heel rubs against rigid shoes

Wearing tight or poorly fitted shoes

Limping and signs of inflammation like swelling, warmth, and redness.

3. Stress Fracture

Athletes or long distance runners - swelling and tender heel - improves with rest.

4. Heel pad bursa

Occur after trauma (e.g., landing from a high fall or stepping on a stone) or excessive weight-bearing exercises (e.g., running long distances in poorly cushioned shoes).

5. Tarsal Tunnel

Aching or burning - numbness and tingling - pain is often worse at night.

6. Planter Fasciitis

7. Fat Pad Atrophy

In older adults, the cushioning fat of your heel pad may atrophy or breakdown.

Pain absent in the morning but worsens with activity during the day.

8. Heel pad syndrome

Thinning of this fat pad that results from trauma, such as marathon runners or pressure put on the foot due to obesity. Worsens with weight-bearing activity.

Orthosis

  1. Calcaneal bar
  2. Calcaneal pad
  3. Rocker bottom shoes
26
Q

Toe Pain, 4 differential diagnosis and one orthosis

A
  1. Gout
  2. Arthritis
  3. Hallux rigidus
  4. Turf toe
  5. Sesamoiditis
  6. Fracture

Orthosis: Hallux valgus splint

27
Q

Name is and mention 4 uses

A

Heel Lifts

Uses

  1. Plantar flexor spasticity
  2. Plantar flexor contracture
  3. Achilles Tendonitis
  4. Achilles Enthesitis
  5. Limb-length discrepancy

PassPMR - 08 Prosthetics & Orthotics (9 decks)

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