O - Foot Orthoses Flashcards
what is an orthosis
device used to assist, resist, facilitate, stabilize, or improve ROM and functional capacity
what is a foot orthosis
custom or stock orthosis used to treat foot
what is a custom foot orthosis
device derived from 3D representation of pt’s foot
via plastic cast, foam box, scanning
what are custom foot orthosis categories
rigid
semi-rigid
soft/flexible
functional/biomechanical
accommodative
what dictates the type/category of orthosis
type of material used
what type of materials are used for custom foot orthoses and what are each of its functions
soft/flexible = shock absorbing
hard/rigid = motion controlling
what are the guiding principles behind custom orthotic devices
exams identify deficits contributing to development of path
varying features of orthosis can modify foot mechanics to dec pain and improve function
custom vs prefabricated orthotics in pts w plantar fasciitis
similar benefits
a lit review demonstrated effectivness of custom foot orthoses in what patholgies (4)
stress fx/reactions
foot pain
PFPS
soft tissue running related injuries
what does literature say about custom vs prefabricated orthotics overall
evidence showing both work and there are a lot of similarities in material
may be hard to justify time, effort and cost needed for custom as a result
balanced foot orthotic:
what is it
what type of orthotic
what models/theories is it based on
uses posts at RF and/or FF to control abnormal motion
biomechanical
- podiatric model
- root theory
- STJ neutral theory
total contact foot orthotic
what is it
what type of orthotic
provides total plantar surface contact including medial longitudinal arch
accommodative
what 2 orthotics fall under the foot orthosis theory
balanced foot
total contact foot
balanced foot vs total contact foot orthotic
how are they cast
functions
balanced foot orthotic:
* foot cast in off-weight STJN position
* STJ functions around neutral
* control abnormal motion w posts/wedges at RF/FF
total contact:
* foot cast in resting position
* normal function doesn’t overload tissues
* med and lat long arches stabilized thru total plantar surface contact
what are 2 reasons as to why foot orthotics work
- impact lower limb kinematics
- shock attenuation
how much motion control is considered clinically significant when orthotics impact lower limb kinematics
individualized - a subtle number may be enough to dec load on tissues and dec the pt’s sx
how do foot orthoses help w shock absorption
dec loading rate and vertical impact force
do foot orthotics help w NM control
limited/no evidence
can help w controlling RF which improves postural ocntrol
how does PFPS present
ant knee pain w:
* squatting
* stair climbing
* running
PFPS
what potential risk factors have been identified
weakness prox (hip) and distal (foot)
PFPS
what are specific potential risk factors in the kinetic chain (6)
excessive foot pronation
dec knee flex angle
inc hip IR during jump land
dec quad/HS strength
inc hip ER strength
increased navicular drop
inc hip ER strength may be compensatory
inc navicular drop is a component of excessive pronation
PFPS
how could excessive pronation lead to PFPS
tibial IR leads to femoral IR
inc contact pressure on lateral facets of patella
PFPS
how would foot orthoses help to treat PFPS
foot orthoses may dec pain by limiting foot pronation and lower limb rotation
PFPS
what did a study reveal when looking at PFPS in runners and their:
* hip ABD and ER strength pre/post run
* arch heigh pre run
* LE kinematic data pre/post run
arch height didn’t change
runners w PFPS displayed weaker hip ABDs which was more pronounded at end of runners
top down study
PFPS
what did a study find when examining ROM of TC, ST, knee during walking&running after an foot orthotic intervention
was helpful for walking not w running
* control GRF w walking, but once you start running w higher impact - not so helpful
during walking it was able to dec knee motion in frontal plane during contact & midstance –> but motion was inc w running
PFPS
what did a study find when comparing outcomes in the following groups:
1. foot orthoses + PT
2. PT
3. foot orthoses
4. flat inserts
foot orthoses > flat inserts
no diff b/w 2 and 3
no diff b/w 1 and 2
practicioners may seek to hasten recovery by prescribing prefabricated orthoses
PFPS
what did a study find with prefabricated orthoses and runners w PFPS
did produce significant overall improvement
* pts w inc midfoot mobility (aka pronation) were more likely to have more success w the orthotic
plantar foot pain
what does the CPG say about foot orthotic and plantar foot pain
clinicians should use orthotics (custom or prefab) to support med arch and cushion heel
esp in individuals who respond positively to antipronation taping techniques
improve function for short and long term periods
aka start w antipron tape –> see how they respond and then talk about orthoses if it helps
plantar foot pain
what did a study find when comparing customized to prefabricated orthotics
no significant difference, will benefit from either one
plantar foot pain
what improvements were seen in plantar foot pain after 2 weeks of an orthotic intervention (2)
healing
foot alignment improving
used to prescribe orthoses for forever, this is now something that may be more temporary
plantar foot pain
what did a study find about custom vs prefab in duration of improvement of sx
short term improvement in pain and function
* temporary use while they heal, work to improve other components
plantar foot pain
what did a systematic review find about the clinical effectiveness of foot orthoses in treatment and prevention of lower limb injuries
customized semi-rigid foot orthosses demonstrate mod to large benefits in treating and preventing plantar fasciitis
semi-rigid prevent excessive amts of motion
plantar foot pain
4 what are non-custom foot orthotic options
vasyli
freedom BFO
superfeet
powerstep
plantar foot pain
vasyli orthotic:
* characteristics
* lifespan
* function
lower density = less durable
short lifespan (3-16mo)
* temporary utilization
able to modify RF and FF posts
plantar foot pain
freedom BFO orthotic:
* characteristics
* lifespan
* function
flexible
lifespan 2-3mo
wedge modifications
inexpensive, temporarily try it out see if it works w/o huge cost if it doesn’t
plantar foot pain
superfeet orthotics
* characteristics
* function
come in different materials and durability
insoles designed for various footwear and activity
plantar foot pain
powerstep
* characteristics
* function
extrinsic 2deg post
give some support and control motion
exercise related lower leg pain
what are 5 possible reasons for pain b/w knee and ankle during exercise
- medial tibial stress syndrome (MTSS)
- chronic exertional compartment syndrome
- stress fx
- foot/ankle tendinopathy
- nerve/vascular entrapment
exercise related lower leg pain
what did studies find w foot/ankle position/mobility and exercise related lower leg pain
no association found
no relationship found b/w foot type and orthotic use
findings all over the place, hard to find good clinical direction
exercise related lower leg pain
what did one study find with efficacy of orthotics and prevention of ERLP
orthotics more helpful for preventative/protection purposes
dec amt of injuries occurring
stress fx
what did studies show of the efficacy of orthotics
dec incidence of stress fx/reactions
* orthoses help w shock attentuation
* helpful w absorbing GRF, if hx of stress fx
stress fx
what did a study show with the efficacy of orthoses in post tib stress fx
custom semi-rigid foot orthoses mod to larg benefits in treatign and preventing
what are mr jims take homes on prescribing foot orthotics and PT
- not a lot of high level evidence to support
- careful w interpretting low level studies
- decision making guided by “expert” opinion and individual results
- PTs are mvmt dysfunction experts, don’t obsess over orthotics and think of things we can do for kinetic chain and impairments first
he goes for footwear change first -> taping -> prefab before custom
