Foot Orthotic prescription variables. Craig Payne

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Vivien Johns
6 years ago
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1 Foot Orthotic prescription variables Craig Payne

2 Put aside all preconceptions about different devices It s not: Its: Prefab vs custom (they all orthotics!) Rigid vs flexible (get over it!) Cheap vs expensive (how best to deliver the variables needed) Plaster cast vs foam box cast vs whatever Brand a vs brand b (how can they all be the best?) Shank dependent vs shank independent How can I best achieve the prescription variables that are needed for each patient

3 Shank Dependent vs independent Fundamental decision Shank Dependent Rests on the shank of the shoe Shank Independent Does not rest on the shank of the shoe Can the shank of the shoe take it, if a shank dependent device is used? See: showthread.php?t=6588

5 Next Decision List of prescription variables from clinical assessment How best to deliver those prescription variables? Library device or which method of negative model production?

6 Variables or Parameters Four categories of variables: Negative model production variables Positive model modifications or variables Shell modifications or variables Top cover modifications or variables (Fifth: Footwear)

7 Negative Model Production Eyeballing ( prefabricated device) Cast Foam Scan etc

8 Positive model modifications Cast expansion Cast fill Balancing Intrinsic forefoot posting Heel expansion Heel pitch Arch contour Wedging

9 Lateral column support Plantar fascial groove Forefoot wedging Sweet spots / button

10 Cast Expansion Prescription variable: -use of a top cover

12 Lateral column support Prescription Variable:? Facilitate transfer to high gear

13 Feehery Modification

15 Heel pitch Prescription variables: Shank dependent rocking on shank Heel pitch of shank independent Bending of orthotic by cad/cam systems

16 Heel Post Pitch

17 Cast fill

19 How much cast fill? How does lab decide?

20 Wedging Kirby medial skive Medial wedging Blake inverted DC Wedge MOSI Prescription Variable: How much force is needed? Where is that force needed?

21 Kirby Medial Skive

23 Blake Inverted

25 DC Wedge

26 Medial Oblique Shell Inclination (MOSI)

27 CAD/CAM Wedging

28 Wedging Prescription Variables Medial or lateral wedging Kirby Medial skive (or lateral) Medial wedging with no lateral heel cup and cuboid notch(dc Wedge) Skive medial to STJ axis, low arch profile and no lateral heel cup (MOSI)

29 Shell modifications Thickness/flexibility Arch flexibility First ray flexibility Arch reinforcement Anterior edge length Forefoot width Heel raise First ray cut out

30 Heel post flare Low bulk grind Cobra design Hour glass grind Heel seat depth Heel spur aperture Type of post Non-beveled anterior edge

31 Heel cup height Effect on arch flexibility?

32 CAM options

34 Sweet spot / Button

35 First Ray Cut Outs Clinical test to determine

36 Varus Posting Is MTSS due to increased tibial bending moments?

37 Top cover modifications Fabric Material Thickness Length Met dome Preload the hallux Mortons extension

38 Reverse mortons extension Varus/valgus estensions High medial overlay Gluing of top cover accomodations

39 Kinetic Wedge

40 Preload the hallux

41 Cluffy Wedge

42 Vasyli - Dananberg

44 Comparisons of devices Clinical outcomes are showing no differences Comparisons of biomechanical outcomes are showing significant differences

45 Which orthotic when What are the prescription variables that are needed for this patient? What is the best device for providing those prescription variables Shank dependent vs non-shank dependent Library device or which negative model method?

46 Thank you Questions?

Functional Hallux Limitus Orthotic Therapy for Hallux Valgus and Hallux Rigidus

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