O&P Flashcards
Difference between accommodative vs corrective orthosis?
Accommodative: for fixed deformities to redistribute forces
Corrective: modify CKC and loading.
What type of shoe opening do you want for use with orthoses
Blucher - has vamps that open wide for ease of application
NOT bal that has stitched down vamps.
Post vs wedge with orthotics?
Post – placed inside shoe for modification
Wedge – placed outside of shoe for modification (external modification)
Medial wedge (varus post)
limits or controls excessive eversion (pronation) and IR of tibia at heelstrike.
Lateral wedge (valgus post)
controls calcaneal and subtalar joints that are excessively inverted (supinated) and supinated at heelstrike
Heel lift
accommodates for leg length discrepancy
Inside shoe - up to 3/8 inch
Outside shoe - anything greater than 3/8 of inch.
Rocker bar
located proximal to metatarsal heads and improves weight shifting onto the met heads
Rocker bottom
located proximal to metatarsal heads and improves weight shifting onto the met heads
Subtalar neutral norm
~1-4 deg of inversion
Noted tibiofibular varum in subtalar neutral requires what compensation
medial foot elevation requiring excessive compensatory foot pronation during gait
Reasons for genu recurvatum
equinus deformity at the ankle
poor control of quad/hamstring
LLD (slight) – larger LLE will cause excessive knee flexion contralateral
Navicular Drop
Greater than 10 mm drop is considered abnormal. Places pt in excessive pronation
What rotational components superiorly can cause abnormal foot pronation
internal tibial torsion leads to increased medial rotation forces
Femoral anteversion leads to increased medial rotational forces
What rotation components superiorly can cause abnormal foot supination
Excessive external tibial rotation leading to increased lateral rotation forces
Excessive femoral retroversion leading to increased lat. rotation forces
Metatarsalgia
Pain at met heads from compression of plantar digital nerve
Solution: Shoe with….
Wide width (reduce pressure on transverse met. arch)
Long shoe with high toe box so that MTP’s are not cramped
Cushioned sole for shock absorption
Low heel to minimize pressure on met heads
If severe: transverse metatarsal bar (moves pressure from met heads to met shafts) Rocker sole (reduces motion of painful joints)
Sesamoiditis
Inflammation of sesamoid bones under 1st met heads
Solution: Shoe with…
Transverse metatarsal bar → (pressure from met heads to met shafts)
Rocker sole → (reduces motion at hallux joint)
Morton’s Syndrome
Pain between 1st & 2nd met heads; 2nd toe as long or longer than 1st toe
Solutions: Shoe with…
Long medial counter for rearfoot support/stability
Morton’s extension: flexible platform under 1st met & toe (1/8 to ¼”)
High & wide toe box to reduce compression on transverse arch
Long shoe to accommodate long 2nd toe
Thomas heel or medial sole wedge to support medial longitudinal arch
Mortons interdigital Neuroma
Pain at proximal phalanx or intersitital space b/w met heads (especially b/w 3rd & 4th)
Solutions: Shoe with…
Wide shoe to relieve transverse arch compression
Long enough to ↓ PF of MTP joints
Long medial counter to ↓pronation
Cushioned sole for ↑ shock absorption
Low heel to take pressure off of met heads
Metatarsal bar or rocker bar
Hallux Valgus (Bunions)
Pain at medial aspect of 1st MTP
Solution: Shoe with…
High/wide toe box
Thermold/soft upper
Long enough so toes are not cramped
Soft cushioned outsole
Low heel
Metatarsal Bar or Rocker sole
Hammertoes
Presentation: Weight bearing on met heads & distal phalanx
MTP: hyperextension
PIP: flexion
DIP: extension
Solutions: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP’s & extension of PIP’s
Soft cushion outsole
Low heel
Metatarsal bar or Rocker sole
Claw toes
Presentation: Pressure on the tip of the distal phalanx
MTP: hyperextension or flexion
PIP: hyperflexion
DIP: hyperflexion
Solution: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP joint & ext. PIP’s
Soft cushion outsole
Low heel
Metatarsal bar, rocker sole
Mallet toes
Presentation: Weight bearing on tip of distal phalanx
MTP: hyperextension
PIP: neutral
DIP: flexion (buckles)
Solution: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP’s & extension of PIP’s
Soft cushion outsole
Low heel
Metatarsal bar, rocker sole
Pes planus
Observable pronation of midfoot results of foot to supinate during midstance
Solutions: Shoe with
o Fixed:
Broad shank (extra wide mid-foot)
Straight Last
Long Medial Counter
Medial Wedge sole to ↓ pressure on met heads & stabilize foot
o Flexible:
Long medial counter
Thomas heel with medial flare
Straight Last
Pes Equinus
Plantarflexion deformity
Solution: Shoe with…
o Fixed:
Posterior platform to support rearfoot from heel strike to midstance & mimics DF at toe-off
Equalize LLD (when equinus is unilateral)
o Flexible:
Low heel
Rocker bottom to provide DF assist and reduce loads on met heads