foot orthosis physical medicine and rehabilitation

1. FOOTWEARS AND FOOT ORTHOSES
SKNAYAK
DNB PMR- 2ND YR

2. FOOT WEAR
• INCLUDES SHOE AND BOOT

3. FOOT WEAR IS THE CENTRAL COMPONENT OF
THE GENERAL FUNCTION OF FOOT ORTHOSIS.

4. PARTS OF FOOT WEAR
• UPPER- COVERS THE DORSAL ASPECT OF FEET
• SOLE – LIES UNDER THE PLANTAR SURFACE OF FEET
• HEEL – LIES UNDER THE ANATOMIC HEEL
• LINING /REINFORCEMENT

7. UPPER
• ANT. SECTION –
VAMP
TOE BOX
THROAT
LACE STAY WITH EYELETS
TONGUE
• POST. SECTION (QUARTER) – HEEL COUNTER
• TONGUE – STRIP OF LEATHER UNDER LACES
• THROAT – AT THE BASE OF TONGUE
• LACE STAYS – CONTAIN EYELETS FOR LACES

9. TYPES OF THROAT
BLUCHER (PRUSSIAN GENERAL) : OPEN LACING –
WIDE -OPENING.
BALMORAL (ENGLISH CASTLE): CLOSED LACING-
NARROW OPENING

12. – OUTER SOLE :TOUCHES THE FLOOR.
– MID SOLE :IN BETWEEN COMPRESSIBLE MATERIAL
– INNER SOLE :TOUCHES THE FOOT MADE OF LEATHER

13. PARTS OF SOLE
• BALL – WIDEST PART OF SOLE
• WAIST – CONTRICTED PART BETWEEN BALL AND ANTERIOR BORDER OF HEEL
• SHANK – RIGID PIECE OF CORRUGATED MATERIAL
• TOE BREAK – CORRESPONDS TO METATARSAL HEAD
• TOE SPRING – SPACE BETWEEN ANTERIOR PORTION OF SOLE AND FLOOR

17. SOLE MATERIALS
• LEATHER
• HARD RUBBER- CREPE(MOST COMMON)
• VIBRAM- MICRO CELLULAR RUBBER
• ETHYLENE VINYL ACETATE (EVA)- MOLDABLE
AND LIGHT WEIGHT.

18. PARTS OF HEEL
• PROXIMAL AND DISTAL
• HEEL BREAST

19. • HEEL HEIGHT- FROM OUTER SOLE TO THE TIP
OF HEEL.

20. FITTING CRITERIA
• NO PAIN, SKIN PROBLEMS AND DEFORMITY
• SHOULD BE PURCHASED AT THE END OF THE DAY.
• SHOULDN’T FALL OFF.
• LENGTH SHOULD BE ATLEAST HALF AN INCH (1.2CM)
BEYOND THE LONGEST TOE.
• FREE SPACE FOR FIRST AND FIFTH MT WITH WIDTH
GREATEST AT THE BROADEST PART OF FOOT.

21. FITTING CRITERIA...
• NO GAP BETWEEN THE MEDIAL AND LATERAL
QUARTERS.
• HEEL COUNTER SHOULD CLOSE AROUND CALCANEUS
WITHOUT BULGE- GIVES PISTONING EFFECT.
• HEIGHT OF THE VAMP SHOULD BE ADEQUATE TO
PREVENT IRRITATION ON TOE.
• NEW SHOE SHOULD BE WORN FOR 2HRS/DAY IN
INITIAL DAYS.

22. FOOTWEAR MODIFICATION
• INNER SOLE MODIFICATION
• HEEL MODIFICATION
• TOE BOX

23. INNER SOLE MODIFICATION
• SPONGE INSOLE
• METATARSAL PAD/BAR
• INNER ARCH SUPPORT
• CALCANEAL SPRING
• CORK-INSOLE

24. • SPONGE INSOLE-
– EXCAVATED HEEL(U SHAPED CUSHION)
– FOAM RUBBER INSOLE
– HEEL RAISE
• CONDITIONS-
– CALCANEAL SPUR, PLANTAR FASCITIS, POST CALCANEAL
BURSITIS, FOOT ULCERS

25. OTHER MODIFICATIONS
• METATARSAL BAR- PES CAVUS
• METATARSAL PAD- FOREFOOT PAAIN
• CALCANEAL SPRING- CALCANEAL GAIT
• CORK INSOLE- FOR LLD
• MEDIAL ARCH SUPPORT- PES PLANUS

26. HEEL MODIFICATION
• THOMAS HEEL/CROOKED HEEL
• REVERSE THOMAS HEEL
• FLARE HEEL
• HEEL WEDGE
• ROCKER BOTTOM HEEL
• HEEL LIFT/ HEEL RAISE

27. • THOMAS HEEL- EXTENSION OF MEDIAL HEEL
BREAST.
• MAINTAINS MEDIAL LONGITUDINAL ARCH
• REVERSE THOMAS HEEL- SUPPORTS LATERAL
LONGITUDINAL ARCH.

28. HEEL WEDGE-
GENU VARUM DEFORMITY: LATERAL WEDGE
GENU VALGUM DEFORMOITY: MEDIAL WEDGE

29. ROCKER BOTTOM HEEL- FACILITATING PLANTAR
FLEXION AND FACILITATES GAIT IN SWING
PHASE.
BENEFITS- ANKLE FUSION, ANKLE SPRAIN,
METATARSALGIA.

30. • HEEL RAISE- FOR LLD
• HEEL FLARE- FOR MEDIOLATERAL STABILITY

31. COMMON CONDITIONS
• PES PLANUS- PRONATION OF FOOT-
IINVOLVES EVERTION AT MID FOOT.
• MODIFICATIONS-
– MEDIAL ARCH SUPPORT
– THOMAS HEEL- FOR HEAVIER INDIVIDUALS
• ALL PATIENTS OF PES PLANUS SHOULD NOT BE
TREATED BY ORTHOSES.

32. • PES CAVUS- EXCESS PRESSURE OVER THE
HEEL AND THE MT HEADS.
• MODIFICATIONS- HEEL RAISE/LIFT

33. • METATARSALGIA (FOREFOOT PAIN)-
• MODIFICATIONS-
• A QUARTER INCH THICK METATARSAL PAD IS
APPLIED PROXIMAL TO THE LATERAL ASPECT
OF FIRST MT HEAD MEDIAL TO THE FIFTH MT
HEAD.
• ROCKER BOTTOM SHOE

34. • HEEL PAIN-
• MODIFICATION-
– RUBBER HEEL PAD
– CALCANEAL BAR
– HEEL RAISE
– ROCKER BOTTOM SHOE
– PLANTAR FASCIA NIGHT SPLINT

35. • TOE PAIN- HALLUX RIGIDUS, GOUT, OA
• MODIFICATIONS-
– FULL LENGTH CARBON INSERT
– METAL SHANK
• LEG LENGTH DISCREPANCY-
• LLD OF LESS THAN HALF INCH IS ACCEPTABLE.
• HEEL PAD- 75% OF LLD TO BE CORRECTED.

36. • OSTEOARTHRITIS KNEE- LATERAL HEEL
WEDGE FOR MEDIAL COMPARTMENT
INVOLVEMENT.
• A QUARTER OF INCH THICKNESS IS USED WITH
MEDIAL TAPPERING