Biomechanics -- Final Material shoes-orthotic and prosthetics

pod2ndyear's version from 2015-07-22 18:51

Orthotics and Prostetics

Question Answer
goals of lower limb orthosesmaintain/correct body alignment
assist/resist jt motion
relief distal weight bearing
protect against physical insult
how do "Purpose specific" orthosis affect motionresist, enhance, resist undesired, limit, stops
two classes of AFOsstatic and Dynamic
3 pruposes for AFOscontrol arc motion of tibia over foot
control STJ motion
control the calf
4 types of AFOsingle and double bar, total contact, floor rxn, off-WB
single vs double AFO indicationkids vs adults
hybrid single and double bar AFOusing a molded plastic foot orthosis
springs vs pins in the AFOassist/resit motion vs limit motion
Dorsiflexory assist AFO fxnweak dorsiflexors
allows controlled loading of the foot from heel strike to FF loading (avoids slapfoot)
assist swing phase toe clearance
indications for plantarflexory stop AFOspacticity of the deep and/or superficial posterior m group (strong PFors)
spastic equinus
knee hyperextension pathology
(this AFO creates knee flexion moment)
indications for dorsiflexory stop AFOweak Platarflexors- inability to decelerate momentum of tibia over foot.
weak quads-inability to resist knee flexion during loading phase
(This AFO creates knee extension moment)
how is function determined in posterior splint AFOtrimlines and ankle position

orthotics and Prostetics cont.

Question Answer
pros for total contact AFO (aka solid ankle)thermoplastic molded
fits into shoe better
control in all 3 planes
(anterior trim line is at center of malleoli)
cons for total contact AFOdoenst accomodate for edema, warmer
explain floor rxn AFOsimilar to solid ankle (total contact) AFO but footplate extends further
ankle is held in slight PF
provides sagittal plane knee stability (prevents knee flexion collapse past the middle of midstance)
posterior leaf spring AFOsimilar to solid ankle AFO but the post ankle area is trimmed back for more flexibility
off-loading AFOreduce axial load (off loads ulcers)
supramalleolar orthoses (SMO)evolved from UCBL
addresses sagittal plane problems
facilitates clearance during swing
(proximal trimlines are just above the malleoli to just below the soleus m belly, mimics the effect of high top shoes but with better control, may be used as a transitional orthoses, may be used for chronic inversion instability
what is the indication for spring leaf AFOsdropfoot or slapfoot
Arizona brace
Richie brace
custom gauntlet accomodative
functional orthoses footplate with stirrups
What AFO is commonly used by cerebral palsy and other spastic problemstension reducing AFO
Knee-Ankle foot orthoses typessingle and double bar
total contact
unweighting KAFO
(all of these need a hinge to allow for every day use)
reasons for amputationdisease, trauma, tumor, congenetial deformity pain
when would shoe fillers be useddistal to listfrancs amputation ONLY
describe the SACHIts a prosthtic foot where a heel is used to compress at heel strike to mimic plantarflexion (solid ankle cushioned heel)
describe the energy storing footreduces energy consumption by storing it

Internal Shoe modifications

Question Answer
purpose of shoe modsimprove shoe fit
name the 6 internal shoe modsheel grip, tongue pad, heel pad, val/var wedge, met raise, FF extension,
why should a heel grip be avoided forces foot into the toebox
function of tongue padbest way to prevent heel slipping and relieves irritation on the dorsum
3 ways to use the met raisedirectly to foot, orthotic modification, shoe modification
how does the met raise workextend from the 1st-4th interspace just proximal to met head 2-4. spreads the met heads.
the neuroma pad is what type of internal shoe modificationmetatarsal raise
3 indications of met raisesneuroma, HPK or pain on sub 2-4 met heads, shallow foot
what is the purpose of a FF extension take up space in the toebox
How do pedorthists inappropriate use wedgesslow down the wearing of the heel. helps shoe fit better (not good for ft)
purp of heel padprevent malleolar irritation from the topline, may be used when heel counter is too rigid and/or concave and/or hitting the wrong spot of foot.
Heel pad vs heel liftheel lift treats pathology. heel pad improves shoe fit

External Shoe mods

Question Answer
7 external shoe modsflares, stabilizers, rockers, bars, excavations, sole expansions, closures
fxn for external shoe modssingle modality, in conjunction with other modalites like foot orthoses, severe pathology or deformity
general fxn for flaresincrease base of support
purp of lat heel flaresforces early pron at heel strike, prevents lateral roll-over in midstance, lateral ankle instability, residual clubfoot deformity. BUT it may cause pronatory symptoms
purp of med heel flaredecelerates pron in midstance and prevents roll over in the direction of pronatin, common for pts who pronate through their shoes, PTTD
purp for stabilizersincrease the base of support, reinforce the upper so that the foot doesn't roll out of sole. extends from sole about 1/2 the upper. aka flanges
med stabilizer 2 indicationspronatory problems (PTTD and severe flexible flatfoot)
lat heel stabilizer 2 purposeslateral instability: severe RF varus from a residual clubfoot pt who have excessive lateral shoe wear
5 rocker typesheel, FF, toe, double, heel to toe
pt who needs heel rockermore controlled loading at heel contact, for pts with decreased ankle joint motion, required for very rigid shoes ( prevent Frankenstein gait), helps with shin splints
FF rocker indicationsdecreases or eliminates need for MTP motion, hallux limitus....
which mod decreases ankle joint DF in terminal stanceforefoot rocker
purp for toe rockerprovides toe off, important for rigid soled shoes
2 purp of double rockerhelps offloads midfoot: midfoot arthritis, plantar prominence in midfoot
heel to toe rocker for gaithelps control loading,
indications for heel to toe rockerafter pantalar arthrodies, ankle fusion, anklyosis of the ankle
purp of met barsoff load met heads, similar to FF rocker
excavation purposesoffload a bony prominence, recurrent ulcers, or areas of severe hyperkeratoses
3 purp for sole expansionwidens the sole, bunions, or midfoot colapse in charcot neuropathy
closure typesVelcro-good support and for pt that cant reach feet, elastic-allows for changing edema and pt that cant reach feet, side/back-pt cant reach feet
custom molded shoes indicated forsig deformity: charco foot, stage 3 PTTD, congenital deformity, RA with deformity, post partial amputation
custom molded shoebi-valve-dificult but easy to remove, univale-easier but need a saw for removal or STS sock easy to use and no saw,
must go above ankle
usually a very rigid shoe



Question Answer
four components of shoe fitwidth, girth, heel to ball, heel to toe
What does the width of the shoefit measure1st-5th met heads
What does the girth of the shoefit measuredorsal to plantar thickness
what does the proper heel to ball length shoe allow for1.allows the arch of the shoe to be in the correct position on the foot
2.proper bending of the foot at the 1st MTP
what is the most important size in shoesheel to ball length
what is the arch lengththe heel to ball length
what happens if the heel to ball length is too shortDF 1st ray
what are the 7 different shoe typesmoccasin, mule, clog, oxfords, pumps, sandals, boots MM COPS B
what shoe types is used for posterior heel irritationmule and clog
what type of shoe develops rim callusmule, sandal, clog
what shoes are bad for hammer digit? why?clogs, because toe grips to keep shoe on
what is a good shoe for nail problemssandals
what are the indications for the oxford bulcher opening1. orthoses 2 higher insteps 3. thicker feet
what are the 4 indications for boots?increased ankle stability
hide AFO
accommodate orthoses
what are the indications for moccasinprovides protection but doesn't need support like a child learning to walk or a wheelchair bound person.
what are the contraindications for moccasinsomeone who needs support
what are the indications for muleany kind of posterior heel irritation like handlund's deformity, Achilles enthesopathy.
what is a common problem with the mule shoe typeheel callus/rim callus
what are the indications for a pump shoedorsal exostosis or norieties
which type of pt should not wear a sandal everneuropathic pt
name the two types of oxford openingblucher and balmoral
which oxford opening is V shapedbalmoral
which shoe type is any slip-on open-toed shoe? pump
which shoe type is the standard shoeoxford
what are the inidcations for a general oxford shoe typegood support
adequate toe space
best for orthoses
what is a contraindication for the oxford shoe typemay cause difficult with haglund's deformity and dorsal exostoses in the midfoot

shoe anatomy

Question Answer
upper (6 parts)part of shoe not plantar to the foot (toebox/toecap, vamp, lininings, quarters, counter, tounge)
sole (4 parts)part of the shoe plantar to the foot (outer, mid and insoles, shank)
Heel vs heel baseheel: aka toplift- part of the shoe that wears down and can be replaced.
heelbase: actual heel of the shoe
quarterback half of the shoes upper (medially and laterally)
Counter"between quarter and sole) reinforcement at the back of the heel. provides RF control and maintains the shape of the shoe. Can be important in a running shoe
Vampfront part of the shoe
Throatlineseam that connects the vamp and quarter
shankportion of the sole that connects the heel to ball of the shoe. may be reinforced, prevents the shoe from collapsing
toplinetop rim of shoe's quarters. Can irritate the malleoli mostly laterally and in children dress shoes
toeboxportion of shoe that covers the toes. an extra depth toe box needed for accommodative orthoses or significant sagittal plane deformities
outsoleportion of shoe that contacts the ground
midsolebetween in and out sole. important in athletic shoes because the midsole is where most shock absorption happens
insoleportion of shoe that comes in contact with the foot. its leather, fabric or synthetic. can contribute to hyperhydrosis(seating) and/or bromhydorises(odor)
last-3 definitionsmodel on which the shoe is constructed.
method of attaching the upper to the sole.
shape of the sole of the shoe