Orthotics 2 Flashcards
What aspects of force are important to consider with orthotics?
- magnitude
- direction
- applied
What can the forces from an orthosis cause for the pt?
can be a source of problem and cause skin issues
Things we worry about in the bed: need to take these into account when using an orthotic
- shear
- pressure
- friction
decreased sensation: implications on orthotics and PT
- too hard of plastic on malleoli can cause pressure ulcer
- should CONSTANTLY be performing skin checks
What can cause shear in an orthotic?
sweaty foot slides while plastic stays in place
friction and orthotics
- any play or wiggle can lead to pistoning
- ex. wearing a shoe that’s too big
What must the pt do if they have an orthosis?
must wear shoes!
Why are shoes so important with an orthosis?
- it’s the interface that holds it onto the foot
- can add things just to the shoe
purpose of shoes
- protection
- support (depending on type)
- shock absorption
How can shock absorption be modified for gait?
- can change density
- changes timing of initial contact to loading response
parts of a shoe
- sole
- heel/bottom
- upper/top
sole function
- shock absorber
- stability
- flexibility
- allows movement
shank function
- increases stability
- decreases flexibility
What are the parts of the upper?
- vamp (toe box)
- tongue
- rear quarters
vamp considerations
- width
- how much space do they need (diabetes, peripheral neuropathy, etc.)
vamp: shoe inserts
- inserts make the whole foot rise in the shoe
- toes can come in contact with the toe box
tongue function
provides closure system
long tongue benefits
- easier to get foot in (especially with spasticity
- provides input to great toe » hip flexion
tongue: dress shoes
may not have them, but instead have tongue area
What should you think about with laces?
- What are their deficits?
- Do they need velcro closures?
- Curly cue springy laces?
Ideal socks for orthotic use
- cotton
- white
- proper fit
- no toe seam
- no wrinkles
- prevent pistoning
socks: why cotton?
absorb moisture away from the body
socks: why white?
- neuro issues to LE
- will be able to see an open wound if it bleeds
socks: fit
- not too long or too short
- not too tight around ankle to decrease blood flow
socks: Why are wrinkles problematic?
If doubled over, more pressure created over that point
socks: How do you prevent pistoning?
- ideal to have sock as high as the AFO
- decreases skin contact with plastic
If leg length discrepancy is less than ____, can use a heel lift inside the shoe
3/8 inch
If the leg length discrepancy is _____, can’t use a heel lift in the shoe
1/2 inch
What is done for a leg length discrepancy of 1/2 inch or more?
- stacked shoes
- either fix the shoe or walk with gait deviation
How does gait change with leg length discrepancy?
toe contact instead of heel contact at initial contact
wedge categories
- heel wedge
- rearfoot
- forefoot
What does a heel wedge do?
- raises calcaneus
- causes increased knee flexion
What can a heel wedge correct and how?
- hyperextension
- changes GRF
Two types of deformities are fixed or flexible:
- varus
- valgus
What does a rearfoot medial wedge do?
- corrects a flexible valgus deformity
- accommodates a fixed varus deformity
Where is a rearfoot medial wedge placed? How does it work?
- at back of shoe
- creates varus moment to get rearfoot to neutral
- fills space to keep in anatomical alignment
What does a rearfoot lateral wedge do?
- corrects a flexible varus deformity
- accommodates a fixed valgus deformity
What does a forefoot medial wedge do?
- corrects a flexible valgus deformity
- accommodates a fixed varus deformity
What does a forefoot lateral wedge do?
- corrects a flexible varus deformity
- accommodates a fixed valgus deformity
