Footwear and foot orthotics are important for foot function and treatment of various conditions. Footwear consists of an upper, sole, and heel. The upper covers the dorsal foot and includes the vamp, toe box, and quarter. The sole lies under the plantar foot and includes the ball, waist, and heel. Foot orthotics are modifications made to shoes to treat conditions like pes planus, pes cavus, heel pain, and leg length discrepancy. Common modifications include heel wedges, pads, arch supports, and rocker bottoms. Proper shoe fitting and use of orthotics can help treat many foot and lower limb issues.

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