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PEDS 6032 > Foot Orthoses: Assessment + Casting > Flashcards

Foot Orthoses: Assessment + Casting Flashcards

1
Q

Define foot orthosis

A
  • Device inserted into shoe
  • support/accommodate/prevent foot abnormalities
  • improve how the foot functions
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2
Q

Custom vs over the counter foot orthoses: 5 custom features

A
  • produced via negative cast
  • unique to patient’s needs
  • covered by insurance
  • available through skilled clinician
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3
Q

Custom vs over the counter foot orthoses: 5 OTC features

A
  • mass produced
  • not unique/customized to ptnt
  • not typically covered by insurance
  • available at pharmacies, sport stores, etc
  • low cost option
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4
Q

Define Modified OTC foot orthoses

A

OTC device with additions/modifications to customize device

2D force plate tech may be used to guide MT pads; not a custom device
Mild symptoms, children, financial barriers

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5
Q

Define component OTC foot orthoses

A

OTC with prefabricated parts assembled to customize device

Not a custom device; different levels of support

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6
Q

Custom vs over the counter foot orthoses: 4 key differences

A
  • OTC more cushioning than correction
  • custom more control, precise adjustments
  • heat mouldable products more effective done by clinician vs DIY
  • custom typically longer lifespan (OTC 6 months - 1 yr)
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7
Q

Custom vs over the counter foot orthoses: 6 factors to consider when choosing

A
  • urgency of ptnt situation
  • short vs long term requirements
  • significant biomechanical abnormalities
  • ptnt activity level, occupation, environment
  • cost barrier
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8
Q

Custom vs over the counter foot orthoses: 4 other pedorthic tools to consider

A
  • footwear/modifications
  • complimentary devices
  • external referrals
  • patient education
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9
Q

7 Common complimentary assistive devices

A
  • compression therapy
  • subtalar control AFO
  • night splints
  • below knee walkers
  • ankle braces
  • toe splints / spacers
  • custom shoe fillers
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10
Q

complimentary device: compression therapy goal

A

Improve venous return and reduce swelling by supporting peripheral blood vessels

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11
Q

complimentary device: compression therapy supplements treatment for 3 condition categories

A

venous disease, varicose veins, chronic venous insufficiency, venous leg ulcers
edema, lymphedema
Clots, DVT prevention, postoperative treatment

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12
Q

complimentary device: subtalar control AFO goal

A

Manage function of anatomy distal to ankle by controlling subtalar ROM

Proximal length of scafo does not extend beyond junction of gastrocnemius and Achilles’ tendon; Richie braces, Arizona AFOs

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13
Q

complimentary device: subtalar control AFO used in treatment in what type of conditions

A

Conditions where foot requires more surface area to control forces
- severe posterior tibial tendon dysfunction

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14
Q

complimentary device: night splints 2 condition types

A

1st MTP joint conditions (hallux abductovalgus, bunions)

Ankle joint conditions (dorsiflexion - Achilles tendinitis, plantar fasciitis; dorsal / boot / strassberg sock)

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15
Q

complimentary device: night splints goals

A
  • reduce joint angle of 1st MTP, alleviate pressure/pain
  • keep ankle at ~90 degrees , maintain slight tension on Achilles’ tendon (reduce contracture), supplement treatment, improve recovery, prevent re-injury
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16
Q

complimentary device: below knee walker conditions

A

Fractures, wound healing

severe Achilles’ tendon injury, shin splints, ankle sprains, trauma to foot or lower leg

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17
Q

complimentary device: below knee walker goal

A

Divert plantar pressure to lower leg

Air bladders provide contact around leg (offload sole of foot)

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18
Q

complimentary device: ankle brace conditions

A

Multiple ankle conditions present

Ankle instability, posterior tibial tendon dysfunction, other ankle injuries

19
Q

complimentary device: ankle brace goal

A

Support ankle

Variety of designs, support levels, complimentary to pedorthic treatment (add more)

20
Q

complimentary device: toe splints and spacers goals

A

low barrier tools, improve alignment, reduce inter-toe friction

21
Q

complimentary device: toe splints and spacers conditions

A

Treatment/prevention of mild toe deformities and/or skin conditions

22
Q

complimentary device: custom shoe fillers (or custom to spacers) conditions

A

Spacers - Advanced toe deformities

Fillers - digital or trans MT amputation

23
Q

complimentary device: custom shoe fillers (or custom to spacers) goals - 2 each

A

Spacers - improve alignment, reduce inter-toe friction (epoxy)
Fillers - reduce shift of foot within footwear, reduce shear, prevent further complications, low durometer material lined with low friction interface, improve comfort

24
Q

3 main casting techniques

A
  • non-weight bearing NWB
  • semi-weight bearing SWB
  • full weight bearing WB
25
Q

Casting techniques: SWB

A

Performed seated or standing; ptnt and/or clinician will bear some weight through foot

26
Q

Casting techniques: NWB

A

Performed seated, lying prone, or lying supine; no weight placed on structures

27
Q

Casting techniques: WB

A

Performed standing with full weight bearing down

28
Q

Main goals of casting (negative casts) x3

A

Goals vary with each ptnt.

  • capture most desired position of ptnt foot
  • accurately reflect ptnt foot anatomy
  • establish solid, accurate foundation for fabrication of custom foot orthoses
29
Q

6 common casting techniques

A
  • plaster slipper or STS slipper cast
  • foam box cast
  • digital scanning
  • contact digitizing
  • wax
  • direct mold
30
Q

Casting techniques: Plaster slipper / STS slipper cast

  • position
  • 2 benefits
  • orthotic type
  • cast features
A
  • NWB position (prone/supine) most common; occasionally SWB or WB
  • captures rearfoot/forefoot relationship well
  • easy for clinician to visualize, make fine tuning adjustments
  • corrective: more aggressive functional orthotic
  • negative cast has no accommodation for soft tissue expansion during casting, narrower positive cast requires dressing for soft tissue expansion and keeping foot in place when WB
31
Q

Casting techniques: foam box cast

  • position
  • 2 benefits
  • orthotic type
  • cast feature
A
  • typically SWB (seated or standing); occasionally WB
  • particularly useful for ptnt with rigid deformity requiring accommodation
    - ptnt unable to maintain a prone or supine position due to injury, medical condition, or pregnancy
  • accommodative
  • cast permits quick intrinsic modifications
32
Q

Most common style of casting

A

Foam box cast

Ease of use, rapid application versatility, readily available for purchase from orthopaedic suppliers

33
Q

Casting techniques: digital scanning

  • position
  • benefits
  • orthotic type
  • cast features
A
  • able to switch between NWB, SWB, and WB (no change in set up required)
  • ptnt with mobility issues, complex plantar pressure considerations
  • shows forefoot/rearfoot relationship or desired position, foot type
  • reduction in shipping time/cost, carbon footprint, storage space/cost
  • type
  • cast is measurable
34
Q

Casting techniques: contact digitizing

  • benefits
  • 3 limitations
A
  • benefits similar to digital scanning (mobility, reduced shipping/costs)
  • lower sensitivity / digital detail depending on number of pins per square inch
  • greater chance of mechanical equipment failure
  • not so good for severe deformities, wide feet, other anomalies
35
Q

Distinguish the two digital casting methods

A

Digital scanning: 3D scanning tech renders virtual model of foot including skin texture
Contact digitizing: pins that raise/lower to measure contours of plantar surface

36
Q

Casting techniques: wax sheets

  • position
  • benefit
  • limitations
A
  • NWB, SWB, or WB
  • application similar to slipper method, but more positions
  • must be applied correctly (skill involved)
37
Q

Casting techniques: direct mold

  • summary
  • 3 limitations
A
  • materials of an orthotic directly molded against ptnt foot
  • high margin for error
  • limited material options (low workable temperature)
  • rejected by insurance companies
38
Q

Casting techniques: 7 considerations when making choice

A
  • positioning
  • ptnt foot ROM, lower body ROM
  • foot morphology/deformity
  • how casting affects final device, type of device
  • cost (time and $)
  • urgency
  • insurance requirements
39
Q

A good foot orthoses can only be made from a good ________ and a good __________.

A

Cast & Lab process

40
Q

Define essential work order

A

Official documentation of the design of the orthosis you intend to manufacture

AKA lab sheet, order form

41
Q

Essential work order: core info x 4

A 
Bare minimum
- all materials for each step
- specifications of thickness/size
More information is better 
- positive cast modifications 
- special instructions
42
Q

Essential work order: bad habits to avoid

A
  • ambiguous terms (e.g. little bit, small amount, half of regular amount; use mm or fractions of an inch instead)
  • terms or instructions such as ‘at the discretion of the technician’
43
Q

Define cast (model)

A

3D physical or digital model capturing the anatomy and contours of the plantar aspect of the foot

44
Q

Pedorthic treatment options for ptnt should always account for 4 factors

A
  • age + wt of individual
  • ADLs at home, work, sports, leisure
  • condition presenting with
  • structure and function of their foot

PEDS 6032 (5 decks)

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