Orthotic Dilema

Question 1

Stereotype most common why orthotics prescribed

Answer 1

Over-pronation

Question 2

Pathology that involve pronation (4)

Answer 2

Post tib tendon dysfunction
Plantar fasciapaathy
Sinus tarsi syndrome
Patella femoral pain syndrome

Question 3

Pronation and low limb pathology

Answer 3

Some evidence that foot pronation increases the risk of some lower limb injuries
Very weak link

Question 4

Is pronation a cause

Answer 4

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

Question 5

Arch profile and injury

Answer 5

High and low arch feet are associated with injury
Strength of relationship is low

Question 6

Journal of foot and ankle research 2014

Answer 6

Investigated foot posture (measured statistically as a potential risk factor for lower limb injury)

Question 7

Pronation and lower limb pathology summary

Answer 7

Some evidence that foot pronation may increase the risk of some lower limb injury - link is very weak

Question 8

Do orthotics change foot kinematics?

Answer 8

Been made for decades to stop over pronation of the RF AND MF
Majority of the pts get better

Question 9

Study: quality of foot orthoses on RF complex kinematics during walking conclusion?

Answer 9

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

Question 10

Study: Influence of custom foot orthotics intervention on lower extremity dynamics in healthy runners - conclusion?

Answer 10

Decrease in maximum RF eversion angle
Orthotic intervention led to significant decreases in RF dynamics

Question 11

Does everyone respond the same way to orthoses?

Answer 11

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

Question 12

What causes tissue damage

Answer 12

Increased force/load. Not the motion

Question 13

How have podiatrists been trying to measure motion and control motion

Answer 13

Through a foot orthotic - but actually controlling force and load

Question 14

What is the purpose of a biomechanical assessment

Answer 14

To control force and load not really motion

Question 15

Assumption when doing biomechanical testing (this unit)

Answer 15

• the problem is mechanical/dysfunction
• foot orthotics are indicated
• other interventions can also be indicated (manual therapy, stretching/strengthening)

Question 16

Clinical examinations should be:

Answer 16

Valid
Repeatable
Correlation to dynamic function
Potential to alter the intervention

Question 17

Manual supination resistance test (Msrt)

Answer 17

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

Question 18

How to perform msrt

Answer 18

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

Question 19

Interpod device

Answer 19

Used for msrt for a number of how much force is being applied

Question 20

Mrst correlation to dynamic function

Answer 20

When controlling body weight, msrt was not found to be a predictor of differences in grf during gait

Question 21

Jacks test

Answer 21

Clinically uses to determine the force required to elevate/DF the hallux
Measures stiffness if 1st MPJ

Question 22

How to perform jacks test

Answer 22

1. Pt stand in relaxed calc position and natural base of gait
2. Place tips of index and middle fingers directly plantar to the hallux
3. Ask pt to remain relaxed and that testing how strong they are
   4 pull upward and df the hallux
4. Look at any muscle activity (EHL, tib ant )

Question 23

2 measurement aspects to jacks test

Answer 23

Force: high - medium - low
Timing: immediate - delayed onset - none

Question 24

Results of jacks test

Answer 24

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

Question 25

Can you use jacks test to diagnose FnHl

Answer 25

No

Question 26

Does jacks test have potentional to influence treatment

Answer 26

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

Question 27

Lunge test

Answer 27

Measure of WB ankle DF
Torque applied is greater than that applied during the non wb methods
Can measure distance from wall and angle

Question 28

How to perform lunge test

Answer 28

1. Pt stand with one foot up against the wall(longest toe is just touching)
2. 2nd foot is positioned one foot length behind the front foot
3. 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

Question 29

Lunge test acceptable distance

Answer 29

> 9cm angle is 25-30 degrees

Question 30

Lunge test influence on treatment

Answer 30

Heels raises Higer pitched shies stretching manual therapies st therapies

Question 31

Fascial tension test

Answer 31

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

Question 32

Hamstring tension test and treatment

Answer 32

Measure the force required to get the hamstring to end range
Heel raises manual therapies