Orthotics 2

Question 1

What aspects of force are important to consider with orthotics?

Answer 1

• magnitude
• direction
• applied

Question 2

What can the forces from an orthosis cause for the pt?

Answer 2

can be a source of problem and cause skin issues

Question 3

Things we worry about in the bed: need to take these into account when using an orthotic

Answer 3

• shear
• pressure
• friction

Question 4

decreased sensation: implications on orthotics and PT

Answer 4

• too hard of plastic on malleoli can cause pressure ulcer

- should CONSTANTLY be performing skin checks

Question 5

What can cause shear in an orthotic?

Answer 5

sweaty foot slides while plastic stays in place

Question 6

friction and orthotics

Answer 6

• any play or wiggle can lead to pistoning

- ex. wearing a shoe that’s too big

Question 7

What must the pt do if they have an orthosis?

Answer 7

must wear shoes!

Question 8

Why are shoes so important with an orthosis?

Answer 8

• it’s the interface that holds it onto the foot

- can add things just to the shoe

Question 9

purpose of shoes

Answer 9

• protection
• support (depending on type)
• shock absorption

Question 10

How can shock absorption be modified for gait?

Answer 10

• can change density

- changes timing of initial contact to loading response

Question 11

parts of a shoe

Answer 11

• sole
• heel/bottom
• upper/top

Question 12

sole function

Answer 12

• shock absorber
• stability
• flexibility
• allows movement

Question 13

shank function

Answer 13

• increases stability

- decreases flexibility

Question 14

What are the parts of the upper?

Answer 14

• vamp (toe box)
• tongue
• rear quarters

Question 15

vamp considerations

Answer 15

• width

- how much space do they need (diabetes, peripheral neuropathy, etc.)

Question 16

vamp: shoe inserts

Answer 16

• inserts make the whole foot rise in the shoe

- toes can come in contact with the toe box

Question 17

tongue function

Answer 17

provides closure system

Question 18

long tongue benefits

Answer 18

• easier to get foot in (especially with spasticity

- provides input to great toe » hip flexion

Question 19

tongue: dress shoes

Answer 19

may not have them, but instead have tongue area

Question 20

What should you think about with laces?

Answer 20

• What are their deficits?
• Do they need velcro closures?
• Curly cue springy laces?

Question 21

Ideal socks for orthotic use

Answer 21

• cotton
• white
• proper fit
• no toe seam
• no wrinkles
• prevent pistoning

Question 22

socks: why cotton?

Answer 22

absorb moisture away from the body

Question 23

socks: why white?

Answer 23

• neuro issues to LE

- will be able to see an open wound if it bleeds

Question 24

socks: fit

Answer 24

• not too long or too short

- not too tight around ankle to decrease blood flow

Question 25

socks: Why are wrinkles problematic?

Answer 25

If doubled over, more pressure created over that point

Question 26

socks: How do you prevent pistoning?

Answer 26

- ideal to have sock as high as the AFO | - decreases skin contact with plastic

Question 27

If leg length discrepancy is less than ____, can use a heel lift inside the shoe

Answer 27

3/8 inch

Question 28

If the leg length discrepancy is _____, can't use a heel lift in the shoe

Answer 28

1/2 inch

Question 29

What is done for a leg length discrepancy of 1/2 inch or more?

Answer 29

- stacked shoes | - either fix the shoe or walk with gait deviation

Question 30

How does gait change with leg length discrepancy?

Answer 30

toe contact instead of heel contact at initial contact

Question 31

wedge categories

Answer 31

- heel wedge - rearfoot - forefoot

Question 32

What does a heel wedge do?

Answer 32

- raises calcaneus | - causes increased knee flexion

Question 33

What can a heel wedge correct and how?

Answer 33

- hyperextension | - changes GRF

Question 34

Two types of deformities are fixed or flexible:

Answer 34

- varus | - valgus

Question 35

What does a rearfoot medial wedge do?

Answer 35

- corrects a flexible valgus deformity | - accommodates a fixed varus deformity

Question 36

Where is a rearfoot medial wedge placed? How does it work?

Answer 36

- at back of shoe - creates varus moment to get rearfoot to neutral - fills space to keep in anatomical alignment

Question 37

What does a rearfoot lateral wedge do?

Answer 37

- corrects a flexible varus deformity | - accommodates a fixed valgus deformity

Question 38

What does a forefoot medial wedge do?

Answer 38

- corrects a flexible valgus deformity | - accommodates a fixed varus deformity

Question 39

What does a forefoot lateral wedge do?

Answer 39

- corrects a flexible varus deformity | - accommodates a fixed valgus deformity