Orthotics

Question 1

What is the role of a pedorthist?

Answer 1

The design, manufacture, fit, and modification of foot orthotics and footwear for the management of painful or disabling conditions of the lower limb.

Question 2

What is the role of a chiropodist?

Answer 2

The assessment of the foot, and the treatment and prevention of diseases, disorders, or dysfunctions of the foot by therapeutic, orthotic or palliative means

Question 3

What is the joint axis of the subtalar joint?

Answer 3

i) 42’ from transverse

ii) 15’ from sagittal plane

Question 4

How is neutral subtalar position determined?

Answer 4

i) 2/3 inversion, 1/3 eversion
ii) Equal congruency of medial and lateral talar heads on palpation.
iii) Observe equal concavity superior and inferior to lateral malleolus.

Question 5

Describe the components of subtalar pronation in OKC.

Answer 5

i) calcaneal dorsiflexion
ii) calcaneal ABD
iii) calcaneal eversion

Question 6

Describe the components of subtalar pronation in CKC.

Answer 6

i) calcaneal eversion
ii) talar plantarflexion
iii) talar adduction

Question 7

What is the position of the tibia, knee and hip on pronation?

Answer 7

i) tibia: IR
ii) knee: flexed
iii) hip: flex, ADD, IR
- Note the opposite occurs in supination.

Question 8

For some reason in THIS ORTHOTIC LECTURE ONLY, what is the difference in components of pronation/supination in OKC and CKC.

Answer 8

The calcaneus moves on the talus for inversion/eversion only. The remainder of the movement involves talus moving (DF/PF/ADD/ABD)

Question 9

List two criteria for overpronation..

Answer 9

i) eversion > 20’

ii) calcaneus rests in >2 degrees eversion

Question 10

What is the normal range of inversion/eversion of the calcaneus in resting stance?

Answer 10

2-4’ inversion.

Question 11

Describe the criteria for hallux limitus. Name on resultant impairement.

Answer 11

i) 1st MTP ROM: 20-40’ extension.

ii) absent or impaired Windlass mechanism

Question 12

Describe the criteria for ankle equinus.

Answer 12

Dorsiflexion <10’. Can be assisted with orthotics but requires PT to address gastrocs/soleus complex.

Question 13

Describe what is meant by a functional leg length discrepancy and structural leg length discrepancy. What is the range of difference required to be considered pathological?

Answer 13

i) structural: resulting from inequalities in bony structure.
ii) functional: unilateral asymmetry of the lower limb resulting from soft tissue contractures.
- 3mm will become pathological.

Question 14

What are the functions of an orthotic?

Answer 14

i) correct biomechanic misalignment
ii) limit or immobilize an injured body part
iii) offload abnormal pressure

Question 15

Explain how functional orthotics work. Which two categories can they be broken into?

Answer 15

i) They control joint movement using a series of levers and wedges. This way they can deviate GRFs through neutral positions.
ii) They come in sport (ex. runners) and dress (ex. heels, dress shoes)

Question 16

Explain how accomodative orthotics work. When might they be indicated?

Answer 16

i) To provide cushioning and/or relief to high pressure areas of the foot. They do not change aligments.
ii) senior, palliative, sedentary, low tolerance for functional orthotics.

Question 17

Name three casting strategies and whether or not they are in weightbearing.

Answer 17

i) plaster or paris: non-WBing
ii) 3D Laser Scan: non-WBing
iii) Foam box: semi WBing