FOOT ORTHOSIS

KAMRAN YOUSUF SIDDIQUI

FOOT ORTHOSIS
▪ The insert worn inside the shoe that corrects foot alignment and improves function
may also be used to relieve pain . Foot orthotics are custom mold or ready made
and are often designed for a specific level of functioning
TERMINOLOGY
▪ ARCH SUPPORT

▪ INSOLE MEDIAL LATERAL WEDGES

▪ METATARSAL PAD HEEL WEDGES

TYPES OF ORTHOTICS
▪ Pre fabricated otc( Over the counter)
▪ ADVANTAGE
▪ CHEAP
▪ CONVENIENT
▪ EFFECTIVE

▪ DISADVANTAGE
▪ Mass produced
▪ Non specific arch contour
▪ Fails to address positional/structural deformities and compensation
▪
ANATOMY OF FOOT
ARCHES OF THE FOOT
▪ TRANSVERSE ARCH
▪ MEDIAL LONGITUDINAL ARCH
▪ LATERAL LONGITUDINAL ARCH
ARCHES OF FOOT
FOOT ORTHOSIS
▪ Foot orthosis range from arch supports found at a local pharmacy or at athletic
store , to customized orthoses fabricated by orthotist.
▪ The effectiveness of orthosis depends on proper diagnosis of the foot condition ,
appropriate selection of orthotic material and proper molding .
▪ Foot orthosis affect the round reaction forces , acting on joints of the lower limb.
▪ Mild conditions can be treated with the over the counter orthoses.
▪ More severe problems and chronic medical conditions require customized orthoses
.
FOOT ORTHOSIS
▪ For custom foot orthosis to be made , the subtalar joint should be placed in a
neutral position before casting. This position minimizes abnormalities related to foot
and ankle rotation, such as hyper-pronation
▪ The custom orthosis is obtained by heating and form fitting (often by using vaccum)
▪ The orthosis should be examined at each follow-up visit to determine when a new
one is necessary.
NORMAL MOVEMENT
TYPES OF FOOT ORTHOSIS
▪ These are available in in three types
▪ Soft type
▪ Semi rigid type
▪ Rigid type
SOFT TYPE FOOT ORTHOSES
▪ A soft type is most commonly used in over the counter orthoses.

▪ SEMI RIGID TYPE

▪ Orthotist usually provide semi-rigid orthoses, which provide more support than the
soft type but are still shock absorbing.

▪ RIGID TYPE
▪ A rigid orthosis is indicated only for a problem that requires aggressive bracing to
control a deformity.
INDICATIONS
▪ Custom made FO’s are preferred when maintenance of a specific foot alignment
over along periods of time.
▪ Relieve pressure
▪ To support weak or flat longitudinal or transverse arches
▪ To control foot position
▪ Help in alignment of lower limb joints
INTERNAL MODIFICATIONS
▪ Orthotic interventions
▪ Inserts and Internal Modifications
▪ Most common foot orthosis can be placed in many shoes
▪ An alternative FO’ is an internal shoe modification, which is biomechanically
identical to the insert but cant be removed or transferred
▪ Not visible
▪ Advantage :- guarantees the patient wears the appropriate shoes using modification
EXTERNAL MODIFICATIONS
▪ External modifications
▪ Modification to the exterior of the shoe assuring that the suitable shoes will be
worn and does not reduce space inside the shoe
▪ Hampers with the appearance of the shoe
MATERIALS

• Most rigid FO’s were made up of metal usually steel or dura-luminium, covered with
leather and molded on a positive casts of the patients foot.
▪ Plastazote available in different thicknesses and densities. They are commonly
used for Ischemic, Insensitive, Ulcerated, and arthritic feet
• Semi rigid and rigid FO’s are made of materials like leather, cork, and metals
• They are molded to support under the longitudinal arch and metatarsal area and to
provide relief of pain or irritated areas.
SHOES
▪ The purpose of wearing shoes is to protect the feet.
▪ The presence of calluses indicates areas of friction from poorly fitting (loose)
shoes .
▪ The presence of corns indicates areas of friction over bony prominences , most
often caused by tight fitting shoes.
▪ Leather shoes are good choices for all type of activity. They are durable , allow
ventilation ,and mold to the feet with time.
PARTS OF FOOTWEAR
▪
PARTS OF SHOES
ROCKER BAR

▪ It has a plantar transverse convexity which changes stance phase loading

▪ Apex of the curve lies slightly posterior to the metatarsal heads reducing
meta-tarsalgia
▪ It helps in achieving stance phase earlier than in flat feet
▪ Helpful in patients with weakness of plantar-flexors
▪ Diminishes need of full ankle excursion.
ROCKER BAR SOLE
 METATARSAL BAR
▪ A flat plantar surface present posteriorly from the fore foot. The bar lies transversely
across the sole beneath the metatarsal shafts Transfers weight from the metatarsal
heads to its shafts
COMMON FOOT CONDITIONS
▪ PES PLANUS

▪ Symptomatic relief of pain is obtained by controlling excess pronation of the foot

▪ Pronation can be defined as rotation of foot in longitudinal axis, resulting lowering
of the medial aspect
▪ Foot pronation is a component of eversion
▪ Eversion involves pronation at the sub-talar joint, dorsiflexion at ankle joint and
abduction of the forefoot AT TARSO-METATARSAL JOINT
▪ The key to controlling excess pronation is controlling the calcaneus to keep
sub-talar joint in a neutral position
PES PLANUS(FLAT FOOT)
▪ Pes planus can be due to abnormalities , such as
▪ Excessive internal torsion of tibia or mal-alignment of the calcaneus & ligamentous
injury.
▪ The orthosis should extend beyond the metatarsals heads to provide better leverage
for controlling of deformity
▪ A custom molded foot Orthosis designed to prevent hyper-pronation is also reffered
as UCBL .
▪ Some cases , a longitudinal arch support can be helpful for elevating pain
▪ The height of arch can be increased as necessary as the foot develops a tolerance
for insole,
COMMON CONDITION
RIGID ORTHOSIS UCBL
▪ The UCBL was developed in 1967 at the University of California Biomechanics
Laboratory or University of California at Berkeley Laboratory. [1] It is a rigid foot
orthosis used to correct and/or stabilize a flexible foot deformity
HALLUX VALGUS
HALLUX VALGUS
▪ Lateral deviation of big toe

Hallux valgus deformity is a very common pathological

condition which commonly produces painful disability. It is
characterized as a combined deformity with a mal-positioning
of the first metatarsophalangeal joint caused by a lateral
deviation of the great toe and a medial deviation of the first
metatarsal bone
CALLUS /CORNS
PES CAVUS
▪ A typical complication of pes cavus is excessive pressure along the heel and
metatarsal head areas , which can lead to pain.
▪ This can be prevented by making height of longitudinal arch just high enough to fill
in the space
FOREFOOT PAIN( METATARSALGIA)
▪ Relief of pain in the forefoot is accomplished by distributing weight bearing forces to
an area proximal to meta tarsals heads
▪ This can be done by internal and external modification
▪ A metatarsal pad can be placed inside the arch /shoe proximal to second , third ,
fourth metatarsal heads.
▪ A rocker bottom sole /shoe can be used for metatarsalgia.
▪ Patients should avoid shoes with high heels or pointed toes.
HEEL PAIN
▪ The painful area can be elevated with an orthosis to help distribute weight
▪ Rubber heel pads can be applied inside the shoe to offer relief in pain.
▪ Rocker shoes can also be used to help initiate heel strike anterior and ground
reaction force anterior to painful calcaneus.
▪ A common cause of heel along anterio-medial calcaneus is plantar fasciitis.
▪ This can be treated by means of silicone gel heel pads or shift the weight on
forefoot area.
▪ In addition to orthotic intervention for plantar fasciitis night splint in few degrees of
dorsiflexion provide relief in pain .
▪ Plantar fasciitis is common in patients with high arches
HEEL SPUR
▪ Heel spurs are frequently mistaken as the source of heel pain
▪ Heel spurs related to plantar fasciitis are the result of mechanical stress acting
through plantar fascia onto its origin at calcaneus.
▪ Silicone gel heel pads are used for spur patients
TOE PAIN
▪ The goal of orthotic intervention in toe pain is to decrease pain by immobilization
▪ This is done by incorporating full length carbon insert along the sole of the shoe
▪ Common conditions associated with toe pain include hallux rigidus , gout , and
arthritis
LEG LENGTH DISCREPANCY
▪ Asymptomatic leg length discrepancy should first evaluated with proper
measurement.
▪ True leg length is measured from distal tip of anterio- superior iliac spine to the
distal tip of medial malleolus.
▪ Apparent leg length is measured from umbilicus to distal tip of each malleolus.
▪ Leg length discrepancies less than half of an inch don't need correction.
OSTEO-ARTHRITIS OF KNEE
▪ Osteo-arthritis of the knee is not a foot condition it is mentioned here because pain
related to it can be alleviated with foot orthoses .
▪ Lateral wedges can be used for conservative treatment of osteo-arthritis when
medial compartment narrowing is present
▪ The heel wedges used are a quarter of an inch thick along the lateral border and
taper medially . External modification in the is recommended for good results
FOOT ORTHOSIS FOR CLUB FOOT

Clubfoot refers to a condition in which a newborn's foot or feet

appear to be rotated internally at the ankle. The foot points
down and inwards, and the soles of the feet face each other. It
is known as talipes equinovarus (TEV) or congenital talipes
equinovarus (CTEV).
DIABETIC FOOT
▪ A diabetic foot is any pathology that results directly from peripheral arterial disease
(PAD) and/or sensory neuropathy affecting the feet in diabetes mellitus; it is a
long-term (or "chronic") complication of diabetes mellitus.
TYPES OF DIABETIC FOOTWEAR
INSOLES FOR DIABETIC FOOT