Footwear modification & foot Orthosis Made by: Armghan Anjum Orthotist & Prosthetist King Edward Medical University Lahore

Why we wear shoes??? Protection of foot Prevention from corns and calluses

Parts of shoes Upper part: Lower part: Quarter Sole Heel counter Shank Ball Toe Spring Heel Upper part: Quarter Heel counter Vamp Toe box Tongue Throat

Foot orthosis The effectiveness of orthosis depend upon: Proper diagnosis of condition Selection of appropriate orthotic material Proper molding

Pes planus (flat foot) Reduction of medial arch May be planovalgus Consist of pronation and abduction at subtalar joint Pronation can be controlled by keeping subtalar joint in neutral position

Types of flat foot Flexible Rigid Foot wear modification Medial arch collapse only in weight bearing Results in pronated foot and longitudinal arch strain Foot wear modification Thomas heel shoe Medial arch support Custom made orthosis: UCBL Thomas heel with medial heel wedge* Rigid Medial arch collapse both in weight bearing & non weight bearing Should be filled with arch support or Thomas heel Shoe modification is done only for pain relief, not for correction Foot wear modification Polyurethane foam backed by microcellular rubber provide comfort to sole * Only for children 1/16 inch wedge up to 2 years, 1/8 inch up to 5 years & 3/10 inch after 5 years

Pes cavus High arched foot which leads to excess pressure on heel and metatarsal head areas

Foot wear modification Cavus without supination: Longitudinal arch support to fill space between shoe and arch Extended to metatarsal heads Cavus with supination: Custom made foot orthosis with subtalar joint in neutral position is used

metatarsaligia Painful metatarsal heads due to uneven weight distribution Pain can be relieved by distributing proximal to metatarsal heads Can be done by internal or external modification Internal modification: metatarsal pad External modification: metatarsal bar

Heel pain- plantar fascilitis Due to stretching of plantar fascia at anteromedial calcaneum Minor discomfort without hyperpronation or high arch can be managed by Heel pad in sole Calcaneal bar distal to painful area Scooped cushion heel Hyperpronation with decreased medial arch Custom made orthosis with subtalar at neutral joint position High arched foot Elevated arch support

Pain behind heel Retrocalcaneal Bursitis* Enthesopathy** is commonest cause Treated by raised heel thus reducing weight bearing and relieving pain *Two bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles tendon and the calcaneus **an enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the entheses. If the condition is known to be inflammatory, it can more precisely be called an enthesitis.

Toe pain Pain can be reduced by: Extending the shank distally to reduce mobility of the joint Metatarsal bar partly immobilize and reduce pain

Limb length discrepancy True length: From ASIS to tip of medial malleolus Apparent length: From umbilicus to tip malleolus True length may be normal but shortening may occur as a result of pelvic obliquity secondary to scoliosis or contractures ½ inch discrepancy doesn’t need correction- left for ground clearance 1 inch is corrected by raising insole More than 1 inch is corrected by raising both heel and sole

Knee osteoarthritis Foot orthosis can alter ground reaction force thus is useful in management for problems in proximal joints Lateral heel wedge ¼ inch thick can reduce pain in OA with Genuvarum

Insensitive foot Loss of sensation in foot can occur due to lesions like: Peripheral nerve lesion Spinal cord injuries *Myelodysplasia On weight bearing it lead to: Concentrated pressure on bony areas Scarred plantar surface due to trauma Bony deformity *The myelodysplastic syndromes (also known as MDS or myelodysplasia) are hematological (i.e., blood-related) medical conditions that cause ineffective production (or "dysplasia") of all blood cells. Patients with MDS can develop severe anemia and require blood transfusions

Footwear modifications For Concentrated pressure: Microcellular insole to distribute weight over wide area Extra deep shoe For Scarred plantar surface: any one combination of insole Molded polyethylene foam backed by microcellular rubber (MCR) Molded polyethylene foam with latex cork Plastazote with or without added microcellular rubber (MCR) For Bony deformity: Molded insole of Polyurethane foam with area of relief over bony area

Club foot boot Congenital talipes equino varus deformity can be corrected by manipulation with strapping or surgery Correction is maintained by club foot boot May or may not associated with cavus Sequence of CTEV correction: Cavus if any Forefoot adduction Invesion/varus equinus

correction CTEV is corrected as follow: Fore foot adduction: Medial border of boot is made straight Varus/Inversion Lateral border of foot is raised that keeps the foot in eversion Equinus No heel Front ankle straps that keep the heel down

Boots for amputation Toe filler spacer in toe amputation Chopart’s boots in chopart’s amputation

Any question??

Thanks You 