Footwear, Orthotics, Bracing, and Taping Course Objectives Footwear, Orthotics, Taping and Bracing Laura Fralich, MD Primary Care Update Friday, May 4, 2017 Better understand types of footwear and the role of orthotics in treatment of various lower extremity injuries and conditions Recognize indications for lower extremity taping and bracing and demonstrate basic taping techniques of the foot, ankle, and knee. Types of Feet Silvesterfootclinic.com Types of Feet Types of Footwear Cavus High arch Rigid, stable Arch distributes significant stress up kinetic chain Goal of footwear: increase shock absorption Planus Flat arch Flexible Arch allows for dissipation of vertical force loads inside foot Goal of footwear: stability control Cushion Motion control Stability Trail Racing flat Triathlete.com There is no quality evidence to support prescription of shoe type but recommendations can be made based on individual needs of runners.
Types of Footwear Running Shoe Buying Tips for Patients Cushion: soft midsole, cushioned heel & forefoot, good for supinators or cavus foot Motion control: dense midsole, rear & forefoot postings, good for heavy runners & over-pronators Stability: dense midsole, cushioned forefoot, rear foot posting, good for light runners, mild pronators or planus foot Trail: stability for increased support on uneven surfaces, carbon rubber for durability Racing flat: thin, light midsole Try on more than one pair At end of day or after exercise Bring orthotics if wearing Consider ½-1 size bigger than street shoes Allow at least 1 thumb width (1/2 inch) of space between longest toe and front end of shoe Wide toe box allows forefoot to spread out during contact Lifespan of running shoe: 300-500 miles or 6 months Orthotics Orthotics Alter foot function by controlling excessive motion, stimulating the somatosensory system, & supporting biomechanical efficiency while reducing abnormal stress Allow subtalar joint to function in neutral position Subtalar joint (aka talocalcaneal joint) allows maximal motion at the midtarsal joints which allows foot to absorb energy during heel strike aofas.org Orthotics Clinical Indications for Orthotics Replaces the removable stock insert in shoes Custom & off the shelf brands Shown to be useful in management of lower extremity injuries in knee, shin, ankle, & foot Improve proprioception & neuromuscular response Re-distribute plantar weight-bearing forces Improve biomechanics Support May prevent injuries (ie stress fractures) GOALS: control excessive movement of the foot through the stance phase of gait, reduce abnormal stress, improve biomechanical efficiency, & stimulate the somatosensory system Plantar fasciitis Posterior tibal tendon dysfunction (can been seen in pes planus, over-pronation, pain medially) Stress fracture prevention in femur, tibia, & metatarsals Shin splints (MTTS) Painful pes cavus (custom is best) Painful hallux valgus
Types of Orthotics Types of Orthotics Soft: OTC, affordable, limited lifespan Hard: minimal cushion, good motion control, best for those not in agility sports ie running Semi-rigid: combo of support & cushion, appropriate for agility sports Carbon: provides support/treatment for turf toe, metatarsal fxs, midfoot sprains Heel cups: improve shock absorption ability of calcaneal fat pad Pintrest.com Improving Orthotic Compliance Bracing & Taping Comfortable (precisely conform to all contours of foot, particularly heel) End proximal to metatarsal heads Durable (rigid to maintain shape, withstand stress & wear) Fit in all shoes and allow 1 st & 5 th ray function Improve muscle function Allow for normal motion while controlling abnormal motion qualityorthopedicservice.com Used in conjunction with manual therapy & exercise in comprehensive foot & ankle rehabilitation programs NOT A SUBSTITUTE FOR REHABILITATION Provide support, improve proprioception, improve biomechanics, & enhance neuromuscular activation Used for PREVENTION and REHABILITATION Selection and utilization plan involves physician, athlete/patient, PT, ATC, orthotist, parent/guardian redder.collegiatesportsmedicine.ca Bracing vs. Taping Bracing: Knee Advantages Convenient Less skin irritation than tape No skill required to apply Can be more affordable Supports longer than tape (Tape: loosens in 10 mins & provide minimal mechanical support after 30 mins) Disadvantages Less compliance than w/tape Sizing issues Can limit ROM Susceptible to breaking/difficult to replace Weight of brace Expensive Migration of brace Hinged, functional knee brace Post-operative, instability (including patella) Knee sleeve Inflammation Provide warmth, compression Patella stabilizing knee brace Post-operative, PF joint dysfunction donjoyperformance.com
Bracing: Knee OA Unloader knee brace Routine bracing for knee OA not recommended Unloader knee brace may improve pain and function in some patients Active patients who want to delay surgery (osteotomy or arthroplasty) Contraindications: instability Unloader brace AAOS Appropriate Use Criteria (2013) Symptomatic unicompartmental medial or lateral OA Less than 10 degrees varus or valgus deformity Medial more responsive than lateral www.ossur.com Bracing: Ankle Taping May help prevent recurrent ankle sprains but no hard data exists to support using taping (or taping) for prevention in those who have never sustained an ankle sprain Requires skill and practice! Types of tape: Classic athletic taping Kinesio taping (KT taping) McConnell taping LE techniques for today: Knee Plantar fascia, arch Ankle Achilles reddeer.collegiatesportsmedicine.ca Kinesiotaping (aka KT taping ) Developed by Japanese chiropractor in 1970s Became popular during 2008 Olympics Proposed mechanism: Improving circulation of blood and lymph Decreasing pressure on nocioceptors Increasing proprioception through skin mechanoceptors McConnell Taping Developed by Australian PT to assist with patellar tracking Rigid, highly adhesive Leukotape Cover-roll stretch tape Use up to 18 hours MC use: PF pain Mcconell-institute.com Can be used for treating shin splints, patellofemoral pain including PF knee OA, patellar & Achilles tendinopathy, whiplash, acute and chronic LBP, ankle sprains, hip issues
Patellar Taping Risk Factors for Plantar Fasciopathy Tailoring patellar taping application (ie, to control lateral tilt, glide, or spin) to optimize pain reduction is important for efficacy. Possible mechanisms behind patellar taping efficacy include earlier VMO onset and improved knee function capacity (ie, ability to tolerate greater internal knee extension moments). Actionsportphysio.com Trainoutpain.blogspot.com 2014 Br J Sports Medicine: Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms Clinical Journal of Sport Medicine. 14(5):305-309, September 2004. Treatment of Plantar Fasciopathy Plantar Fascia Taping Clinical Journal of Sport Medicine. 14(5):305-309, September 2004. Anti-pronation Taping Anti-pronation Taping clined.tumblr.com Corrects LE muscle activation and kinematics in patients w/overpronation Anti-pronation taping: -reduces internal rotation of tibia -can increase medial longitudinal arch height -decreases calcaneal eversion -reduces posterior tibialis muscle activity Foot orthoses, motion control footwear and therapeutic adhesive taping were able to control rear foot eversion with therapeutic adhesive taping being the most effective. In the clinical practice, selection of an anti-pronation intervention should be based on patient characteristics, type of activity and personal preference. Cheung RTH, Chung RCK, Ng GYF Efficacies of different external controls for excessive foot pronation: a meta-analysis British Journal of Sports Medicine 2011;45:743-751
Ankle Taping Ankle Taping MC taped joint in sports May help prevent recurrent ankle sprains but no hard data exists to support using taping (or bracing) for prevention in those who have never sustained an ankle sprain bouldercentre.com Philadelphiapodiatrist.com Lateral ankle sprain treatment: Strong evidence for structured rehab program, including weight bearing w/support during resistance exercises and progressive AROM External support & progressive weight bearing is strongly encouraged for acute lateral ankle sprain treatment Martin RL, et al. Orthopaedic Section American Physical Therapy Association: Ankle stability and movement coordination impairments: Ankle ligament sprains. J Orthop Sports Phys Ther 2013;43[9]:A1-A40. Achilles Taping Indications: strain of gastrocs/soleus/achilles tendinitis KT tape has been used to limit dorsiflexion of the foot for the patient with an Achilles tendon strain, and rigid athletic tape has been used to limit all movements to give the Achilles tendon support. Firsth BL, et al. The Effect of Kinesiotape on Function, Pain, and Motoneuronal Excitability in Healthy People and People With Achilles Tendinopathy. Clin J Sport Med 2010;20:416 421. Summary 1. There is no quality evidence to support prescription of shoe type 2. Lifespan of running shoes is 300-500 miles or 6 months 3. Orthotics allow the subtalar joint to function in neutral position 4. Orthotics can reduce abnormal stress on foot/ankle, improve biomechanical efficiency, stimulate the somatosensory system, and may prevent injury. 5. Bracing & taping are used for injury prevention & in conjunction with manual therapy & exercise to restore function, and are not substitutes for rehabilitation. blog.rundocrun.com Summary Taping Stations! 6. Bracing supports joints longer than tape, which loosens in 10 mins & provides minimal mechanical support after 30 mins) 7. Routine bracing for knee OA not recommended but unloader knee brace may improve pain and function in some patients 8. Bracing & taping may help prevent recurrent ankle sprains but no hard data exists to support using them for prevention in those who have never sustained an ankle sprain 9. Kinesiotaping has been shown to improve swelling, bruising, and overall function by promoting circulation of blood and lymph 10. Taping requires skill and practice! Knee Plantar fascia Arch Ankle Achilles Photo: Soobum Im, USA TODAY Sports
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