Orthotic precription Flashcards
Goals of orthotic therapy for achilles tendinopathy
-Limit eversion and internal rotation of tibia preventing the twist of achilles tendon
-Reduce load of tendon
-Stabilze midtarsal joint to provide a efficient lever for heel lift
Recommendations for achilles tendinopathy
–medial heel skive, to control heel eversion
-Heel lift 3mm, decreases tensile load of heel lift
Goals of orthotic therapy for limitus and HAV
-Promote first ray plantarflexion
-Reduce compression in the 1st MTPJ
-Improve Hallux range of motion
Recommendations for Hallux limitus or HAV
-Heel cup 14mm
-Minimum cast fill
-Heel skive 2 deg
-inversion 2 deg
-Reverse Morton’s, allows first ray plantarflexion, decreases compression at 1st MPJ, reduces tensile force of plantar fascia
What are some mechanical causes within the foot for FHL
-Rearfoot eversion
-Forefoot valgus
-1st Ray plantarflexion
When would you use a Morton’s extension
-to take pressure away from the 2nd met head
-Limit 1st MTPJ ROM
When would you use a Reverse Morton extension
-Decrease pressure at 1st MPJ
-limit inversion at forefoot
-promote 1st ray function
What is the purpose of rearfoot valgus posting?
-stabilizes inverting rearfoot
-eversion of heel at heel strike
When to use Valgus posting
-Over supination of subtalar joint
What would you prescribe in peroneal tendonitis
-Forefoot valgus extension, to decrease inversion of the foot, reducing tensile load of PL
Goals for orthotics in metatarsalgia
-transfer forces away from the met heads
-provide extra cushioning to forefoot
What are some recommendation for metatarsalgia
-Poron forefoot extension
-metatarsal bar
Goals for Morton neuroma
-reduce intermetatarsal pressure
-separate affected metatarsal heads
Recommendation for neuroma
-forefoot extension with poron
-Neuroma pad
What are some conditions associated with pes cavus foot type
-Metatarsalgia
-Heel pain
-Lateral ankle stability
Goals for pes cavus
-Increase plantar surface contact area, distribute pressure evenly
-resist excessive supination, prevent lateral ankle sprains
-resist both excessive pronation and supination forces, flexible pes cavus foot
Recommendation for pes cavus
-Poly, effectively redistrubte pressure evenly
-deep heel cup, provide more stability to rearfoot
-valgus extension, promote pronatory moment and conteractive excessive supination
-Heel lift, 3mm promote ankle dorsiflexion
Goal for tarsal tunnel syndrome
-decrease tibial nerve traction by control heel eversion by plantarflexing foot and providing medial arch support
Recommendation for Tarsal tunnel syndrome
-Deep cup limit heel eversion
-Medial heel skive, greater force medial to the axis of STJ reducing heel eversion
-heel lift 4mm, encouraged ankle joint plantarflexion
What does the heel post do?
-Provides more stability inside the shoe
-EVA Compression more tolerable and shock absorption
What does a medial heel skive do?
-Increases supinatory moment to reduce excessive pronation
-Shift the force further medial at the heel
-Increases lever arm medial to STJ axis and spinatory torque around the axis
-A deeper heel cup is needed
Goals for plantar fasciitis
-Prevent first ray dorsiflexion
-incorporate valgus correction
-Maintain close contour with arch
-Reduce rearfoot eversion that leads to first ray dorsiflexion
Reccommendations for Plantar fasciitis
-Valgus wedge (forefoot valgus deformity)
-Morton extension (if 1st ray is plantarflexed)
-Minimum arch fill (raise the TNJ to prevent 1st ray dorsifelxion)
-Invert rearfoot
Goals of post tib dysfunction
-Reduce pronation in foot at rearfoot and forefoot
-Shifting the force medial to the subtalar joint axis
Post tib dysfunction recommendation
-Varus wedge or medial heel skive, increase lever arm medial to the STJA, increasing supination moment
-Medial flange, warps up around the arch to apply supinator torque and limit excessive pronation
-Sweet spot navicular, accommodate navicular
Tarsal tunnel goals
-Support the MLA
-decrease eversion of the heel
-Plantarflex the ankle joint
Tarsal tunnel prescription recommendations
-Minimum arch fill, support the MLA
-medial heel skive, increase supination moment
-Heel lift, plantarflex the ankle joint
If supination resistance if high what tissues will be affected
-Increased load on the supinators
-More force needed to institute the windlass
-External rotators have more difficult time
-Increased bending strain in medial tibial
Recommendation for high supination resistance
-Deep heel cup medially
-Increased rigidity
-Varus wedging to increase supinator force
If supination resistance is low what tissues will be affected
-Peroneal tendons
-Lateral ankle ligament
Recommendation for low supination resistance
-Deep heel cup
-Valgus wedge
-max arch fill
-Cuboid pad
What does an easy jacks test indicate?
-Windlass if efficient
-Easy for heel to come off the ground
What does an difficult Jacks test indicate?
-Windlass less efficient
-increase plantar fascia
-Harder to left heel off the ground
-Overall increase work of the supinators
What are recommendations for a high/difficult jacks test?
-Inversion of rearfoot
-elevate the lateral forefoot
–reverse Morton’s
–forefoot valgus extension
–plantarflex 1st during modelling
–first ray cut out
–increase flex under distal first ray
Benefits of high heel cup
-More contour of heel
-More control
-Stiffer and wider
-Depend on footwear
Benefits of medial and lateral heel cup height
-Increase in medial will control early midstance pronation
-increase in lateral will control heel inversion in cavus foot type
What does a medial heel skive do and why better option than a Flare
-Supinatory moment at heel contact through to early stance
-Resisting pronation
-Lateral heel skive has opposite effect
-They are better than Flare or Rearfoot posts as they fit into footwear easier
