wk 6- orthotic prescription principles Flashcards
what is valuator model based around (6)
- Broad approach to value
- Person-centred goal setting and measuring value
- Zone of optimal bio-psycho-social stress
(ZOOBPSS) - BPS assessment
- Monitoring Value
- Clinical strategies and foot orthotic design
what is broad approach to value
Value of the intervention for the patient
* Towards reducing MSK pain
* Prevention
* performance
* Consider psychosocial (i.e. beliefs, mental health and alongside biological
factors)
what is person centred goal setting and measuring value
- Involve the patient in goal setting
- Respect the values and preferences of the person
- Don’t just measure biological measures i.e. plantar pressures, think more
holistic
what is ZOOBPSS
- The zone where person experiences body, mind and tissue homeostasis
(optimal function)
What is BPS assessment
- Use of questionnaires
- Foot function index, VAS, Lower extremity functional score
what does monitoring value do and how can u measure
- May help with selecting an endpoint of care
1. Clinical measures - How a person feels, functions
- PROMS, patients feedback
2. Non-clinical measures - Objectively measured indicators of physiologic or pathogenic process
- Response at the level of skin, muscle, tendon
3. Surrogate measures - Clinically meaningful outcomes that serve as substitute
what is clinical strategies and foot orthosis design
- Geometric features
- Material properties
- Visual properties
Base all these off patients expectations, sociological measures, clinic
measures benchmarks i.e. plantar pressures and biophysical
characteristics.
what is the goal of orthotic therapy (5)
- reduce pain
-facilitate motion
-increase GRF
-reduce moments (force)
-restrict motion
what would u want to achieve with a heavily pronated foot type (roots) and how would u do it in the rearfoot/midfoot
increase medial orthotic reaction force
rearfoot:
1. rearfoot varus post (ext or int) 2-4deg
2. medial heel skive 15deg 3-5mm
3. inverted pour- increases arch height
4. combo of 2 of these
midfoot
1. arch pad
2. medial flare
3. medial flange
what two things will you alter depending on how much someone is pronated and how much weight is behind it
- density
- thickness of material
what would u do for someone with a heavily supinated foot type (ROOTS) and how would u do it in rearfoot/midfoot/forefoot
increase the lateral orthotic reaction force
rearfoot:
1. rearfoot valgus post (ext or int)
2. lateral heel skive
3. everted pour
midfoot:
1. lower arch fill
2. lateral arch fill
3. cuboid notch
4. lateral flare
5. lateral flange
forefoot:
1. forefoot valgus extension
2. reverse mortnos extension
orthotic condiserations for SPT REARFOOT/MIDFOOT/FOREFOOT
rearfoot:
1. rearfoot varus post (ext, int)
2. medial heel skive
3. heel raise
midfoot:
1.arch fill
2. arch pad
3. plantar fascial groove
4. lateral arch fill
5. cuboid notch
forefoot:
1. 1st met cut out
2. 1st ray cut out
3. cluffy wedge
4. forefoot valgus extension
5. reverse mortons exension
orthotic considerations for TSM in rearfoot/midfoot/forefoot
rearfoot:
1. heel pad/aperture
2. heel raise
midfoot:
1. plantar fascial groove
2. lower arch height
3. arch pad
4. cuboid notch
forefoot:
1. met dome
2. soft extension
3. 1st met cut out, cut away
4. forefoot valgus extension
5. reverse mortons extension
custom cut outs for corns, ulcers, etc
orthotic considerations for high risk foot rearfoot/midfoot/forefoot
rearfoot: shock absorbing
1. heel pad/full length layer
midfoot: comfort
1. arch pad
2. custom cut outs
forefoot:
1. forefoot extension
2. speciality covers (PLASTAZOTE, DIABETIC ANTI SHEAR)
3. shell material (soft EVA)
orthotic considerations for hard to fit footwear
rearfoot:
- heel cup height
- lower rearfoot post angles
- elevate orthotic to match pitch in shoe
midfoot:
-narrow shape
-shell material (proproylene)
forefoot:
-low bulk top covers
-cover length
what is the most commonly used material for rigidiity
polyporylene
orthotic decision pathway (ODP) for foot position
- choice
- justification
- choice
-STJ neutral
-semi WB
-WB - Justification
- rigid foot (SWB OR WB bc cant manipulate foot neutral)
-mobile foot (STJ neutral)
-aim is for function (STJN) or accommodative (WB)
-materials available
-patient characteristics (child, neurological conditions, ulcer)
ODP material/technology choice and justification
choice
-plaster
-foam
- 3d scanner
justification
- position
-availability
-pt characteristics
-environment
ODP cast pour, choice and justification
choice
- vertical
-inverted (increase arch height)
-everted (lower arch height)
- as it lies
justification
- aim of orthotic
-footwear
ODP forefoot platform balance
choice
-balance
-inverted
-everted
justification
- how the FF-RF was captured IN nwb
-mobile v rigid FF
- functional/accommodation of FF
ODP lateral plaster modification
choice
- expansion amount
-lateral flare
justification
-fat pad expansion
-cover thickness
-shoe type
-foot shape
-orthotic aim
ODP medial plaster modification
choice
- fill amount % of arch
-medial flare
justification
- arch capture (NWB, allow to drop within 15%, SWB, support arch, WB, increase arch height)
-orthotic aim
-foot shape
-shoe type
ODP special plaster modications
choice
-PF groove
-depression/aperture
-medial/ lateral heel skive
justification:
-tight fascia, extosis, increase orthotic reaction force
ODP materials
choice
-polyproylene
-suborthalene
-carbon fibre
-EVA
-poron
-plastazote
justification
- shank dependent/non
-orthotic aim
-body weight
-activity
-footwear
-characteristics requird
-test results
ODP shape
choice
-narrow
-standard
-wide
-medial/lateral flare
-medial/lateral flange
justification
-aim
-footwear
-footshape
ODP heel cup height
choice
-low
-standard
-high
justification
-footwear
-aim
-foot shape
ODP rearfoot post
choice
-intrinsic/extrinsic
-Varus
-valgus
justification
-footwear
-aim
ODP covering material
choice
-vinyl
-multiform
-poron
-leather
-lunasoft
-spenco
(and length)
justification
-footwear
-activity
-aim
-allergies
-pt choice
ODP additions
choice
-heel raise
-cuboid notch
-reverse mortons ext
-mortons ext
-FF valg/var
-met dome
-forefoot extension
-arch cookie
justification
-aim
-test results
