Orthotic Dilema Flashcards
Stereotype most common why orthotics prescribed
Over-pronation
Pathology that involve pronation (4)
Post tib tendon dysfunction
Plantar fasciapaathy
Sinus tarsi syndrome
Patella femoral pain syndrome
Pronation and low limb pathology
Some evidence that foot pronation increases the risk of some lower limb injuries
Very weak link
Is pronation a cause
Correlation: relationship between the 2 variables, can predict but not always
Cause: observed event or action appears to have caused a secondary event or action
Arch profile and injury
High and low arch feet are associated with injury
Strength of relationship is low
Journal of foot and ankle research 2014
Investigated foot posture (measured statistically as a potential risk factor for lower limb injury)
Pronation and lower limb pathology summary
Some evidence that foot pronation may increase the risk of some lower limb injury - link is very weak
Do orthotics change foot kinematics?
Been made for decades to stop over pronation of the RF AND MF
Majority of the pts get better
Study: quality of foot orthoses on RF complex kinematics during walking conclusion?
Anti-pronation: decreased range of pronation during contact phase, decreased the total range of RF complex
Anti-supinatory: increased range of pronation during contact, increased total RF range
Study: Influence of custom foot orthotics intervention on lower extremity dynamics in healthy runners - conclusion?
Decrease in maximum RF eversion angle
Orthotic intervention led to significant decreases in RF dynamics
Does everyone respond the same way to orthoses?
People will all respond differently
Evidence may contraindicate bow we view function and orthoses
What do we do? Ignore the evidence and adjust our view
What causes tissue damage
Increased force/load. Not the motion
How have podiatrists been trying to measure motion and control motion
Through a foot orthotic - but actually controlling force and load
What is the purpose of a biomechanical assessment
To control force and load not really motion
Assumption when doing biomechanical testing (this unit)
- the problem is mechanical/dysfunction
- foot orthotics are indicated
- other interventions can also be indicated (manual therapy, stretching/strengthening)
Clinical examinations should be:
Valid
Repeatable
Correlation to dynamic function
Potential to alter the intervention
Manual supination resistance test (Msrt)
Described by Kirby and green 1992
- measure of the force needed to resupinate the foot
Greater the force require, the greater the force that will need to come from the intervention orthotic
How to perform msrt
1 Pt stand in relaxed calcaneal position and natural base of gait
2 place tips of index and middle fingers directly plantar to the medial aspect of the navicular
3 pt remain relaxed and inform testing to see how strong they are
4 pull upward in vertical plane and parallel to tib
5 look for any muscle activity
RATE: very low, low, medium, high. Very high
Interpod device
Used for msrt for a number of how much force is being applied
Mrst correlation to dynamic function
When controlling body weight, msrt was not found to be a predictor of differences in grf during gait
Jacks test
Clinically uses to determine the force required to elevate/DF the hallux
Measures stiffness if 1st MPJ
How to perform jacks test
- Pt stand in relaxed calc position and natural base of gait
- Place tips of index and middle fingers directly plantar to the hallux
- Ask pt to remain relaxed and that testing how strong they are
4 pull upward and df the hallux - Look at any muscle activity (EHL, tib ant )
2 measurement aspects to jacks test
Force: high - medium - low
Timing: immediate - delayed onset - none
Results of jacks test
High force - great effort required by body to progress the cop over the foot
Increase load through tissue
Timing - if delayed= foot may not be supported when heel is unloading
No assistance for resupination = tissue have to work harder - increase load in tissues
Can you use jacks test to diagnose FnHl
No
Does jacks test have potentional to influence treatment
Delayed - tension earlier
Heel raise. Cluffy wedge
High force - lower force
RF wedging, FF valgus posting, reverse Morton’s extension, met dome, 1st ray cut out
All allow 1st ray to PF
Lunge test
Measure of WB ankle DF
Torque applied is greater than that applied during the non wb methods
Can measure distance from wall and angle
How to perform lunge test
- Pt stand with one foot up against the wall(longest toe is just touching)
- 2nd foot is positioned one foot length behind the front foot
- Pt is asked to lunge the front knee forward until the knee touches the wall - While the heel remains in contact with the floor
4 pt is then asked to slide the foot back from the wall and reattempt the lung
5 test is completed at a distance where the knee can just touch whilst the heel remains on the ground
Lunge test acceptable distance
> 9cm angle is 25-30 degrees
Lunge test influence on treatment
Heels raises Higer pitched shies stretching manual therapies st therapies
Fascial tension test
Looks at tension in the plantar fascia while hallux is DF
If it is prominent than has the ability to press into orthotic she’ll during propulsion when hallux is DF
Hamstring tension test and treatment
Measure the force required to get the hamstring to end range
Heel raises manual therapies
