Foot Orthotics

Front 1

3 types of foot deformity

Back 1

Mobile, fixed and combination

Front 2

Cause of mobile deformity

Back 2

Biomechanical imbalance on WB/gait (result of ligamentous laxity, developmental process, lower limb pathology and/or trauma/surgery)

Front 3

Most common presentation of mobile deformity

Back 3

Abnormal pronation/pes planus

Front 4

Cause of fixed deformity

Back 4

Biomechanical/muscle imbalance during gait or as a consequence of surgery, trauma and/or pathology

Front 5

Most common presentation of fixed deformity

Back 5

Pes cavus/CTEV

Front 6

Cause of combination deformity

Back 6

Usually acquired as a result of a long term untreated mobile deformity, other joints may compensate for fixed structures

Front 7

Prescription for fixed/rigid deformity

Back 7

Total contact insole (accommodate)

Front 8

Definition of foot orthosis

Back 8

An in-shoe medical device which is designed to alter the magnitudes and temporal patterns of the reaction forces acting on the plantar aspect of the foot in order to allow more normal foot and lower extremity function and to decrease pathological loading forces on the structural components of the foot and lower extremities during weightbearing activities

Front 9

Aims of foot orthoses

Back 9

To alter foot motion

To alter stress experienced by bony and soft tissues

To alter the distribution and magnitude of load applied to the plantar surface

Front 10

Types of foot orthoses

Back 10

Simple/flat bed insoles

Total contact insoles

Functional foot orthosis

Front 11

Subtalar and foot action at IC/loading (coronal plane)

Back 11

Mobile adaptor

Flexibility allows adaptation to terrain

Shock absorption

Front 12

Subtalar and foot action at midstance (coronal plane)

Back 12

Foot moves from being flexible to being more rigid via a neutral position

Front 13

Subtalar and foot action at terminal stance/preswing (coronal plane)

Back 13

Foot functions as a rigid lever to allow propulsion to take place

Front 14

Simulated STJ position at IC-loading

Back 14

STJ pronated (observed as calcaneal eversion)

Front 15

Simulated STJ position at midstance

Back 15

STJ stops pronating and starts supinating (due to tibialis posterior and soleus contraction)

Front 16

Simulated STJ position at terminal stance-preswing

Back 16

STJ supinated (displayed clinically as inversion of calcaneus)

Front 17

Centre of rotation at 1st rocker

Back 17

Heel

Front 18

3 things that happen at 1st rocker

Back 18

Foot plantarflexes under body weight

Pretibial muscles control rate of plantarflexion

Limb rolls forward on calcaneus

Front 19

Centre of rotation of 2nd rocker

Back 19

Ankle

Front 20

2 things that happen during 2nd rocker

Back 20

Ankle dorsiflexion allows limb to roll forward on stationary foot

Stability depends on restraint by plantarflexor muscles

Front 21

Centre of rotation of 3rd rocker

Back 21

Metatarsal heads

Front 22

3 things that happen during 3rd rocker

Back 22

Heel rises

Foot and limb roll forward over met heads

Isometric activity of plantarflexors

Front 23

Ankle joint equinus consequences (5)

Back 23

Loss of heel strike at IC (forefoot contact)

Compensations may occur during the forward progression stage when approx. 10 degrees of dorsiflexion is required(heel plantarflexed with knee flexed on affected side/hyperextended knee to facilitate heel contact)

STJ may pronate excessively (closed chain) to give sufficient movement (dorsiflexion), leg may externally rotate

Premature heel rise or anterior trunk lean

Excessive hip and knee flexion for ground clearance

Front 24

Pathway of centre of pressure

Back 24

Lateral heel at initial contact (pronating STJ), moves along foot passing midpoint at midstance then moves medially along foot to hallux

Front 25

Possible problems of prolonged high heel wearing (7)

Back 25

Metatarsalgia

Hallux valgus

Achilles tendon contracture

Gastroc/soleus contracture

OA changes at the 1st MTPJ

Ankle instability leading to ankle sprains

Ingrown toenails

Front 26

Rearfoot varus description

Back 26

Neutral alignment of calcaneus is inversion

May have tibial varum (bowed legs)

If flexible, excessive pronation is required at STJ to bring heel flat on ground from IC-L

Delayed ability of foot to become a rigid lever for propulsion as STJ is excessively pronated

Front 27

Forefoot varus description

Back 27

A congenital fixed osseus deformity where forefoot is inverted relative to rearfoot when STJ is neutral and MTJ is pronated/locked

Front 28

3 patterns of compensation for forefoot varus

Back 28

Fully compensated

Uncompensated

Partially compensated (combination)

Front 29

Forefoot varus compensation

Back 29

Will occur via STJ pronation to bring forefoot parallel to supporting surface

Forefoot inverted - needs eversion to contact ground - STJ compensates via pronation

Excessive pronation unlocks distal structures, MTJ ROM increase, leads to forefoot hypermobility

STJ pronated for longer period of stance - delayed resupination

Front 30

Uncompensated forefoot varus

Back 30

No pronation available at STJ to compensate

Forefoot held in inverted position

Excessive lateral contact throughout stance with late stance phase WB on IPJ of hallux

Can lead to hyperkeratosis over 5th MTPJ and IPJ of hallux and excessive lateral shoe wear

Front 31

Forefoot valgus definition

Back 31

A congential fixed osseus deformity where the forefoot is everted relative to the rearfoot when the STJ is neutral and MTJ is pronated/locked

Front 32

Forefoot valgus compensation

Back 32

Dependent on ROM of MTJ and STJ and degree of deformity ('spectrum' of compensation)

Front 33

Appearance of flexible forefoot valgus

Back 33

High arch non WB, flattens on WB

Forefoot splays on WB

Normal or hypermobile MTJ

Front 34

Rigid forefoot valgus

Back 34

No MTJ ROM (requires inversion to make foot plantargrade, inadequate ROM at MTJ)

STJ compensatory supination (supinatory 'rock' to lateral aspect, inadequate shock absorption and lateral instability, in some cases the STJ may be excessively supinated prior to intial contact)

Front 35

Appearance of forefoot valgus

Back 35

Pes cavus

High arch WB and non WB(does not reduce)

Heel inverted

Restricted MTJ ROM

Clawed lesser digits