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orthotics > foot orthotics > Flashcards

foot orthotics Flashcards

1
Q

what is a foot orthotic

A
  • device that is placed in a shoe to reduce or eliminate pathological stresses to the foot or other portions of the lower kinetic chain
  • device used to support the foot, improve function, and improve alignment of the foot and/or lower extremity
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2
Q

functions of foot during gait

A
  • provide base of support
  • mobile adapter
  • shock attenuation
  • accommodation of transverse plane motion
  • provide rigid support
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3
Q

talocrural joint axis

A

through malleoli
- lateral malleolus is inferior and posterior to medial malleolus

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4
Q

talocrural PF

A

adduction (inv)

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5
Q

talocrural DF

A

abduction (Ev)

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6
Q

subtalar joint open chain calcaneus pronation

A

everts, abducts, DFs

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7
Q

subtalar joint open chain calcaneus supination

A

inverts, adducts, PFs

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8
Q

closed chain pronation

A
  • calcaneus everts
  • talus adducts and PFs
  • leg internally rotates
  • knee flexes
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9
Q

closed chain supination

A
  • calcaneus inverts
  • talus abducts and DFs
  • leg externally rotates
  • knee extends
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10
Q

mid-tarsal joint longitudinal axis

A

pronation/supination
(eversion/inversion)

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11
Q

mid-tarsal joint oblique axis

A

PF/DF

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12
Q

tarsometatarsal joint purpose

A

keep MT heads on the ground

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13
Q

TMT joint supination twist

A
  • 1-2nd MT DF secondary to GRF
  • 4-5th MT PF secondary to flexor muscles
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14
Q

stance phase components

A
  • initial contact
  • loading response
  • mid-stance
  • terminal stance
  • toe-off
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15
Q

swing phase components

A
  • initial swing
  • mid-swing
  • terminal swing
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16
Q

goal #1 of foot

A

get both calcaneal condyles on the ground

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17
Q

at HS, STJ is in ______

A

supination

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18
Q

initial contact with lateral or medial condyle of calcaneus

A

lateral condyle

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19
Q

what has to occur to get medial condyle to ground

A

STJ pronation

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20
Q

goal #2 of foot

A

get metatarsal heads on ground

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21
Q

what has to occur to give forefoot mobility to adapt to surface

A

STJ pronates

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22
Q

goal #3 of foot

A

provide rigid lever for toe off

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23
Q

what happens to STJ during midstance

A

moves toward neutral, increasing the stability of the forefoot

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24
Q

what happens to STJ during terminal stance/toe off

A

STJ is supinated to provide rigid foot

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25
Q

max pronation or supination prior to toe off?

A

max supination

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26
Q

foot is in _____ prior to loading response

A

supination

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27
Q

STJ _____ occurs until 50% of the gait cycle

A

pronation

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28
Q

_____ initiated during mid-stance, by 60% of gait

A

re-supination

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29
Q

pronating or supinating foot during heel contact and foot flat?

A

pronating foot

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30
Q

pronating or supinating foot during neutral, heel lift, and toe off?

A

supinating foot

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31
Q

functional neutral standing position

A
  • knees extended
  • arms at sides
  • feet 6 inches apart
  • comfortable amount of toe-off
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32
Q

compensation definition

A

change in the structure, position, or function of one part to neutralize an abnormal force or a deviation in structure, position, or function of another part

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33
Q

foot orthotic functions

A
  • distribute WB forces evenly on the plantar surfaces of the foot
  • reduce excessive stresses to the proximal structures from pronation/supination
  • reduce magnitude and rate of excessive pronation
  • balance intrinsic foot deformities
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34
Q

orthotic indications

A
  • LE/spine symptoms
  • PT goals achieved or patient plateau
  • course of therapy completed
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35
Q

what kind of orthotic for an intrinsic abnormality

A

controlling orthotic

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36
Q

what kind of orthotic for an extrinsic abnormality

A

accommodative orthotic

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37
Q

foot orthotic requirements

A
  • conforms to contours of the foot
  • rigid enough to control pronation, but flexible enough to allow normal motion
  • capable of being adjusted with precision
  • durable
  • comfortble
  • does no harm
  • cost-effective
  • lightweight
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38
Q

examples of extrinsic abnormalities

A
  • coxa valga/vara
  • tibial varum/valgum
  • femoral anteversion/retroversion
  • tibial torsion
  • leg length discrepancies
  • equinus deformity
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39
Q

what is the angle of inclination

A

angle between neck and shaft of femur

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40
Q

what is coxa valga

A
  • increased angle of inclination
  • increased compression at hip
41
Q

coxa valga compensations

A
  • genu varum (increased medial compression at knee; increased stress on popliteus, LCL, lateral hamstrings/gastroc/ITB)
  • tibial varus > rapid pronation > posterior tib tendinitis > complain of medial leg symptoms
42
Q

what is coxa vara

A
  • decreased angle of inclination
  • increased joint stability
  • increased stress on femoral neck
43
Q

coxa vara compensations

A
  • genu valgum (lateral knee joint compression, medial knee gapping, VMO weakness, pes anserine, medial capsule)
  • forced pronation (pain in arch of foot, medial malleolus, PT tendinitis at insertion)
44
Q

what is tibial varum

A
  • distal tibia deviated inward towards midline of body
  • excessive inversion at heel strike
  • calcaneus everts farther than normal
45
Q

what is tibial valgus

A
  • distal tibia deviated outward away from midline
  • tend to contact ground with medial aspect of calcaneus
46
Q

what is the angle of anteversion

A

angle between neck and shaft of femur in horizontal plane

47
Q

what is femoral anteversion

A
  • increased angle of anteversion
  • shaft of femur faces medially
  • rest of limb in alignment
  • heel strike with pronated foot
  • forefoot varus compensation
48
Q

what is known as pigeon toed

A

femoral anteversion

49
Q

what is femoral retroversion

A
  • decreased angle of inclination
  • feet point laterally
  • contact more laterally > excessive pronation during loading response
50
Q

what is tibial torsion

A
  • external rotation
  • contact with external rotation > quick pronation
51
Q

what do you usually complain of with tibial torsion

A

PF symptoms

52
Q

compensations for long leg

A
  • rearfoot pronation
  • knee flexion or hyperextension
  • genu varum/valgum
  • hip abduction
  • pelvic tilt
53
Q

compensations for short leg

A
  • supination
  • excessive PF
54
Q

equinus deformity

A
  • need 10 DF at end of mid-stance
  • if DF inadequate, will pronate through STJ and mid-tarsal joint
  • early heel rise if rigid
55
Q

examples of intrinsic foot deformities

A
  • subtalar varus
  • forefoot varus/valgus
  • forefoot valgus deformity
  • PF 1st ray
56
Q

normal subtalar joint neutral

A
  • rearfoot: 0-3 deg varus
  • forefoot: calcaneus perpendicular to MT line
57
Q

what is subtalar varus

A
  • inversion deformity of calaneus secondary to incomplete de-rotation during development
58
Q

what is an osseous deformity

A

rotation within the calcaneus
- associated with subtalar varus???

59
Q

what is forefoot varus

A

forefoot is in an inverted position relative to the calcaneal bisection, secondary to lack of de-rotation fo talus

60
Q

what is forefoot valgus

A

forefoot in in an everted position relative to the calceaneal bisection

61
Q

forefoot valgus deformity compensation

A

will occur through the rearfoot; rearfoot will be more supinated during mid-stance

62
Q

orthotic components

A

shell and posts

63
Q

soft shell goals and material

A
  • pressure relief and shock attenuation
  • soft foams
64
Q

soft shell posts

A

extrinsic posts

65
Q

soft shell indications

A

DM, hyposensitivity, pes cavus, supinatory foot

66
Q

semi-rigid shell goal and material

A
  • motion control and shock absorption
  • cork, leather, low-temp plastics
67
Q

semi-rigid shell posts

A

intrinsic or extrinsic

68
Q

semi-rigid shell indications

A

motion control

69
Q

rigid shell goal and materials

A
  • CONTROL
  • heat-moldable plastics; casting required
70
Q

rigid shell posting

A

intrinsic

71
Q

rigid shell indications

A

control of excessive pronation

72
Q

posting functions

A
  • control motion, bring ground to foot
  • maintain abnormal joint relationships
  • prevent compensation/reduce abnormal motion
  • enhance muscle activity
73
Q

intrinsic posting

A
  • within shell of orthotic
  • forefoot posting is almost always intrinsic
  • decreased bulk to better fit in shoe
  • difficult to adjust
  • expensive
74
Q

extrinsic posting

A
  • most orthotics have extrinsic rearfoot posting
  • stronger
  • easier to adjust
  • less arch pressure
  • more bulk in shoe
75
Q

varus post location

A

medial side of foot

76
Q

valgus post location

A

lateral side of foot

77
Q

0 deg post

A
  • extrinsic post without angulation (LIFT)
  • large FF varus, no RF abnormality
78
Q

bar post

A
  • runs straight, flat across
  • usually extrinsic
  • rigid PF 1st ray (bar post under rays 2-4)
79
Q

rearfoot posting determination

A
  • approximately 50% of varus
  • max 6 deg
80
Q

forefoot posting determination

A
  • approximately 40%
  • max 8 deg
81
Q

age and weight posting determination

A
  • more conservative with increasing age
  • more aggressive with increasing weight
82
Q

accommodative orthotic (soft shell)

A
  • allows significant amount of flexibility
  • supinatory foot type (improve shock absorption, distribute forces to foot, controls motion and lets foot come to ground more easily)
  • congenital malformations
  • ROM problems
  • insensate feet
  • diabetic/ rheumatoid feet
  • illness, old age, unhealthy feet
  • rigid PF 1st ray
83
Q

biomechanical orthotic (rigid/semi-rigid)

A
  • increased rigidity of shell
  • durometer- indication of flexibility/rigidity (higher number = more rigid)
  • pronatory foot problems
84
Q

biomechanical orthotic requirements

A
  • conform exactly to contours of foot
  • sufficiently rigid to maintain contours with use
  • control abnormal motion
  • allow normal motion to occur in proper sequence
  • stand up to stress and wear
  • capable of being adjusted with precision
85
Q

dual density

A
  • usually semi-rigid shell
  • provides control of excessive pronation
  • softer, accommodating material on top
  • allows shock attenuation
  • easier for patients to break in
86
Q

patient considerations for selection of orthotics

A
  • patient condition
  • pronatory vs supinatory
  • intrinsic/extrinsic deformities
  • patients footwear
  • types of stress you are trying to reduce
  • type of material
  • customized vs over the counter
  • cost
  • fabrication time
87
Q

orthotic break in period

A
  • day 1: 1-2 hrs
  • increases total wear time by 1-2 hours/day
  • more rigidity = longer break in period
  • tolerate 6-8 hrs/day prior to wearing for sports
  • sports: begin 1/3 of time and increase by 1/3’s
88
Q

orthotic longevity

A
  • long term use: evaluate 1-4 yrs
  • semi rigid: 1-2 yrs
  • soft orthotics: 6 months to 1 year max
89
Q

dress shoes and orthotic

A
  • as heel height increases, function of orthotic decreases
  • max heel height = 2 in
90
Q

diabetes typical foot changes

A
  • intrinsic foot weakness
  • toe deformities (hammer/claw)
  • prominent MT heads
  • fat pad atrophy
91
Q

diabetes shoe considerations

A
  • wide toe box
  • good plantar contact
  • straight last
92
Q

diabetes orthotic considerations

A
  • decrease plantar pressures (total contact: 1st and 5th MT heads, talus, navicular)
93
Q

best orthotic for diabetes

A

accommodative or dual-density

94
Q

rheumatoid arthritis shoewear

A
  • straight last
  • good heel counter
  • wide toe box
95
Q

what kind of orthotic for RA with hallux rigidus

A
  • rocker-bottom shoe or MT bar
96
Q

primary cause of orthotic issues

A

shoe gear, worn post, orthotic fatigue, gouging of shoe insole by post, physiological changes in the patient

97
Q

medial foot callus causes

A
  • not fully controlling foot- pronating against orthotic
  • excessively high post
98
Q

lateral foot callus good or bad

A

good because it means you’re actually keeping foot in pronated position

99
Q

orthotic postural complaints reasons

A
  • not following break in schedule
  • as a result you need to decrease wearing time

orthotics (4 decks)

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