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Assistive Tech > O - Foot Orthoses Principles > Flashcards

O - Foot Orthoses Principles Flashcards

1
Q

what is a biomechanical orthosis

A

any device capable of controlling motion path in the foot/leg by maintaining the foot in or close to its neutral subtalar position

not trying to lock the foot at any point
want to help it move more efficiently

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2
Q

what are 5 characteristics of biomechanical orthoses

A
  1. conform to all contours of foot
  2. sufficiently rigid to maintain its contours and angular relationships
  3. control abnormal/excess motion and allow normal motion
  4. reasonably comfortable w gradually inc wearing time (breaking in period)
  5. capable of being worked on or adjusted
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3
Q

what are 4 goals of biomechanical orthoses

A
  1. minimize abnormal/excess motion
  2. encourage healing -> dec load on soft tissues and joints
  3. dec inflammation
  4. improve motion (normal mvmt patterns)
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4
Q

what are the 3 main components of biomechanical orthoses

A

shell/module
posts
top covers

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5
Q

what is the shell/module

A

off-weight neutral cast which conforms to plantar contours

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6
Q

what is the part of the biomechanical orthosis that will be fabricated

A

shell/module

via plaster cast, foam box, scanning

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7
Q

where is the shell/module on biomechanical orthoses

A

begins at heel and extends just prox to MT heads

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8
Q

what are 2 types of material that the shell/module can be made of and why

A

rigid - carbon graphite, polyethylene
* controls motion

soft - foam
* absorbs shock

depends on what the patient needs

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9
Q

what are posts and where are they placed

A

fills space created by a deformity and brings ground up to the foot so the foot can function better w/o going thru excessive amts of motion

placed at WB-ing sites (calcaneus, MTs)
* varus = medial wedge
* valgus = lateral wedge

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10
Q

what are the 2 main functions of the posts

A

stabilize the shell
provide motion control in frontal plane

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11
Q

what are the 2 main types of posts

A

extrinsic and intrinsic

doesn’t have to be one or the other, can be a mix in the orthosis

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12
Q

what type of post is the most common

A

extrinsic

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13
Q

what are extrinsic posts?
pros and cons

A

material added to plantar surface of shell

pros:
* easy to adjust
* excellent strength (can use different materials from shell)

cons:
* adds additional bulk in shoe

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14
Q

extrinsic posts

what is a bias

A

extrinsic post but made of softer material
* see in pts w hypopronated feet, looking for material to be a little softer

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15
Q

what are intrinsic posts?
pros and cons

A

positive plaster model of foot is modified to embody deformity and shell assumes the shape

pros:
* less bulk in shoe - shell assuming shape of deformity

cons:
* difficult to adjust (once it’s made, it’s made)
* material of shell determine strength (same material as the post)

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16
Q

extrinsic bar post vs single tip

A

bar post = goes all the way across
single tip = one side

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17
Q

what is the top cover

A

covers the dorsal surface of shell and is in contact w the pt

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18
Q

what are the 2 main functions of top covers

A

comfort
durability

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19
Q

what are the varying lengths the top cover could be

A

extends to MT heads, to the sulcus, or to toes

depending on pt comfort

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20
Q

why does mr jim prefer full length top covers

A

can trim it to what you want
* shifts less than the shorter ones
* could also be more comfortable depending on how sensitive the pt is

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21
Q

what are 4 examples of additions to orthoses

A

deep heel seat
1st ray cut out
flanges/clips
padding

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22
Q

additions: deep heel seat

what is it
function
con

A

normal is 6-8mm, deep is 12+mm
* deeper = wider

controls calcaneal position
* control excessive amts of calcaneal eversion

con - bulk in shoe

pedi pop could likely tolerate this the best, more aggressive of an intervention

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23
Q

additions: 1st ray cut out

what is it/who is it for

A
  • rigid PF 1st ray - cut out to compensate for that
  • flexible PF 1st ray - accomodate for this for MTP joint integ, hallux DF ROM
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24
Q

additions: 1st ray cut out

what is a 2-5 bar post and what is a con to this

A

allows 1st ray to stay in down position
* does same thing as the cut out

bar post is more bulky bc added material

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25
Q

additions: flanges/clips

what are they
3 indications

A

extensions of shell and rearfoot posting

  1. peds
  2. ruptured tib post
  3. soft tissue spill over
26
Q

why is pediatrics an indication for flanges/clips additions

A

can tolerate more aggressive options

27
Q

why is a ruptured tib post an indication for flanges/clips additions

A

foot won’t be able to control pronation/maintain arch
* flanges/clips gives pt ability to not have to compensate as much

28
Q

why is tissue spill-over an indication for flanges/clips additions

A

can happen in other orthotics
* this dec it

29
Q

additions: padding

what is it / where is it

A

placed on shell and held in place by top cover
* embedded between

30
Q

additions: padding

3 functions

A

shock absorption
pain control
pressure relief

31
Q

additions: padding

3 indications

A

interdigital neuroma
heel spur
sesmoiditis

32
Q

where are the 4 locations of posting that you should know

A

RF valgus
RF varus
FF varus
FF valgus

33
Q

what is Hoke’s Law

A

body responds to small increments of change

body reacts to large increments of change

34
Q

how does Hoke’s law apply to orthotics

A

if we are too aggressive w the orthosis and post too much –> large change and the pt will react to that

35
Q

biomechanical vs accomodative orthotics

A

biomechanical: (rigid)
* change or control position/mvmt
* goal: promote function near neutral position

accommodative: (soft)
* allow compensation
* conforms to foot
* dissipates forces
* designed for comfort

36
Q

what are 3 contraindications for biomechanical devices

A

acute path
dec ROM
incomplete eval

37
Q

why is dec ROM a contraindication for biomechanical orthotics

A

biomechanical orthotics designed to control motion
* anything additional to someone w less ROM will further dec motion

38
Q

why is an incomplete eval a contraindication for biomechanical orthotics

A

need to assess entire kinetic chain

39
Q

what are the 5 main lower kinetic chain concerns in the geriatric population

A
  1. subtalar joint ROM
  2. equinus influences limiting DF
  3. pron/sup at midtarsal joints (general midfoot mobility)
  4. abnormal (varus/valgus) influences at knees
  5. hip ROM (lose hip ext, some rotation)
40
Q

geriatric population

what does it mean if someone is chronologically old

A

large age in years but active and healthy

41
Q

geriatric population

what orthotics are most appropriate for a chronically old pt pop

A

biomechanical device that is semi-flexible
* would tolerate this well bc not a huge change

accommodative device that uses more agggressive materials

42
Q

geriatric population

what does it mean if someone is physiologically old

A

significant PMH and comorbidities
sedentary, not doing a lot
limited tolerance to change

43
Q

geriatric population

what orthotics are appropriate for a physiologically old pt pop

A

accommodative device that is flexible w minimal posting
* don’t want to do too much change bc won’t tolerate well
* wouldn’t do biomech bc wouldn’t tolerate well

additional shock absorption
* add extra to dec GRF

44
Q

pediatric population

what is the goal with orthotics in the pedi pt pop

A

objective is to establish normal osseous relationships w the foot

allow normal development and foot function

*need to be familiar w developmental stages

45
Q

pediatric population

what should you have caution w when using orthotics in this pt pop

A

caution w early intervention that may prohibit natural derotation from a deformity

born w lot of varus –> derotate w age and walking
have a lot of pronation when little
–> but will not be the same by 8-11yo

46
Q

pediatric population: neonate

what developmental trends do you see at: hip, knee, ankle, and foot

A

hip = inc anteversion

**knee **= inc varus bowing of tib

ankle:
* inc DF
* minimal to no external mall position

**foot: ** lot of compensated pronation
* RF = 10deg varus in STJN
* FF = 12-15deg varus

47
Q

pediatric population: 12mo

what developmental trends do you see at: hip, ankle, foot

A

hip: fem anteversion 10-15deg
ankle:
* external mall position 10-15deg when lat mall is moving post and inf

**foot: **inc pronation in standing & walking
* RF and FF varus <10deg
* relaxed calcaneal stance position 5deg eve

48
Q

pediatric population: 5yo

what developmental trends do you see at: hip, ankle, and foot

A

hip: fem ant 10-15deg
ankle: ext mall position 15-25deg
foot:
* RF varus 2-4deg
* FF varus 0-2deg
* relaxed calcaneal stance position 4deg eve

49
Q

pediatric population

at what age do you see normal derotation of skeletal maturity

A

b/w 5-7yo

50
Q

pediatric population

what is the take home point to know when intervening w orthotics in a pedi pop

A

under 7yo caution not to over correct and inhibit normal skeletal development and normal derotation

51
Q

what type of orthotic is appropriate in the running population and what should you avoid

A

full length top cover that is cushioned
semi-rigid orthosis

avoid very rigid shell or posting materials
* don’t want to fx the shell bc all the impact and pounding of running

think ab impact and loading response, the heel strike

52
Q

what type of orthotic is appropriate in the aerobic population (ex: crossfit lol) and what should you avoid

A

cushion FF d/t inc WBing

avoid excessive RF postin d/t abrupt direction changes

53
Q

what type of orthotic is appropriate in the court sport population and what should you avoid

A

full length top covers
possible lateral flange (if hx of lat ankle sprains)

avoid aggressive RF posting

basketball and volleyball sneakers have a lot of room to accommodate orthoses well

54
Q

what type of orthotic is appropriate in the field sport population and what should you avoid

A

durable cover to withstand elements (ie playing in rain)

avoid anything that will add bulk (ie intrinsic post)
* need to dec bulk and width in cleats

55
Q

what are red flags to watch for during the break in period of an orthotic

A

skin integ
joint line pain

56
Q

what does the break in period look like for an orthotic and what is normal

A

period of 2 weeks
* inc wear 1-2hrs each day

some achiness is normal bc changing their alignment

57
Q

what law provides the basis for the break in period for orthotics

A

hoke’s law

if you walk around w new orthoses for 8-10hrs on first day, body will react
* use gradual schedule –> body will respond

58
Q

what is the typical cost for orthotics

A

self pay (insurance won’t cover)
* can cost upwards of 100s

paying for materials, time/skill, lab cost

59
Q

what is the life expectancy for biomechanical vs accomodative orthotics?

A

biomechanical - rigid materials
* avg of 2-7yrs (he’s seen up to 15yrs)

accomodative - softer materials
* 6-12 months

depends on the density of the material it is made of

60
Q

what is a factor that can shorten the life expectancy of biomechanical and accomodative orthotics

A

shorter in active/athletic population

Assistive Tech (17 decks)

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