Foot Orthoses
HUDBA ASGHER
CONTENTS
Shoes style
Parts of Shoes
Examination of Foot
Orthotic interventions
Pediatric Foot Orthoses
Guidelines for prescription
2
Orthoses
• A mechanical device fitted to the body to maintain it
in an anatomical or fuctional position
Foot Orthoses
• A semi rigid or rigid insert worn inside a shoe that corrects foot
alignment and improves function may also be used to relieve
pain. Foot orthotics are custom molded and are often designed
for a specific level of functioning
Shoe style
• Shoes are design in vast array of design and materials, they are design to
protect the planter surface of foot from abrasion and laceration.
• Orthopedic shoes connotes a sturdy, laced shoes which suits many
patients with paralysis and foot deformity.
• Shoes are design according to patient requirements
• Mass-produced shoes are less expensive and available without waiting
period.
• Custom-made shoes require several weeks for their construction. Unless
foot is markedly deform custom shoes are unnecessary.
Part of Shoe
Upper part components
• Quarter
• Heel counter
• Vamp
• Toe box
• Tongue
• throat
Part of Shoe
Components of lower part of shoe
• Sole
• Ball
• Shank
• Toe spring
• Heel
Part of Shoe
Outer-sole: the hard layer that protect the planter surface of the foot and
contacts the floor.
Inner-sole: the softer inner layer that interface with planter surface of the foot.
Ball: the widest part of the sole located below the metatarsal heads.
Upper: divided into three parts that covers the dorsum of the foot.
Vamp: covers the anterior foot.
Tongue: an extension of the vamp that protects the foot from the eyelet
rows and laces.
Quarters: medial and lateral quarters extend posteriorly, under
malleolus in low shoes or covers the malleolus in high shoes and join at the heel.
Part of Shoe
Eyelet rows: the laces are contained within the eyelet stays.
Closures or throat styles: the part that ease of donning and internal
adjustability of the shoe.
Heel: located posteriorly under the outer sole, under the anatomical heel.
Heel counter: help to maintain the anatomical heel in neutral position.
Toe box: reinforcement material, protect the anatomic toes.
Shank: between the ball and heel
Lasts: shoes are constructed over a model of the foot stylized from wood,
plaster, plastic, or computer generated design called a last
Foot Examination
• Skin : color, texture, moisture, temperature, mobility,
lesions, sensation
• Hair : quality, distribution
• Nails : color, thickness, deformities (pits, grooves),
redness
• Osseous or soft tissue deformities, such as bunions,
subluxed fat pads, charcot’s joints
• passive mobility: Talocrural, subtalar,
metatarsophalangeal, interphalangeal
• Foot and ankle muscle strength
• Pulses : dorsalis pedis, posterior tibial
• Achilles’ tendon reflex
• Special tests : homan’s sign (DVT), plantar fascia test (heel
spur)
Orthotic interventions
• Internal Modifications
• Inserts,
• External Modifications
• Most common foot orthosis can be placed in many shoes
Internal Shoe Modification
An alternative FO’ is an internal shoe modification, which is
biomechanically identical to the insert but cannot be removed or
transferred
Not visible
Internal heel orthoses
Hind and mid foot orthoses
Insoles
Metatarsal Pads
Internal heel orthoses
• Reduce discomfort with heel spurs
• A resilient, tapered cushion absorbs shock at heel contact and
transfers load to the forefoot
• The cushion has a concave relief to minimize pressure in heel
spur condition
Hind and mid foot orthoses
• Used in malalignment of the hind and mid foot
• Pes planus (pes valgus, pes planovalgus)
• Pes varus
• FO for pes planus should apply an upward and laterally
directed force to the Talus and medially direct forces to the
calcaneus and forefoot to counteract the abnormal foot
alignment
Insoles
• It influences pressure distribution and shock absorption
• made of resilient plastics like closed cell polyetylene foam, open
cell foam, viscoelastic polymer,etc
• Diabetic neuropathy patients
• Poor balance
Metatarsal Pads
• Helps to reduce stress over the metatarsophalangeal joints.
• Convexity is present over the metatarsal shafts
• Sesamoiditis and Toe deformities
Inserts
• Inserts are of different material ranging from rigid
plastic to semirigid cork, molded leather and plastics
to relatively resilient plastics
• Optimal firmness is measured by patient’s weight
activity and the extent of deformity
• Medial wedge (posterior) within the shoe
helps the shoe counter to fit properly
• A shoe with long medial counter is
sometimes prescribed for childeren with
flexible flat foot
UCBL insert orthosis : for flexible
hyperpronation
screw-adjustable midsection
• One can raise or lower the height of
midsection to confirm the the contour
of the wearer’s foot by adjusting the
screw
Conditions That Can Be Managed By Inserts
• Heel spurs
• Achilles’ tendon contracture
• Hind foot malalignment
External Modifications
• Modification to the exterior of the shoe assuring that the suitable
shoes will be worn and does not reduce space inside the shoe
• Heel modifications
• Outsole
• Rocker Bar
• Metatarsal Bar
• Heel And Sole Elevations
Heel modifications
• Heel flare to stabilize the hind foot
• A resilient heel or heel with posterior bevel
aids knee stability.
• Lateral resilient:- it accommodates hind
foot varus without causing the midfoot to
increase its pronation
• Thomas heel :- it has anterior border
curved with a medial extension and a
slight medial wedge
Outsole
• Resilient outsole reduces the
differences in the pressure
concentration and absorbs shock
• A sponge rubber sheilds the wearer
from the abrupt forces caused by
the irregular walking surface than
leather outsole
• Rubber sole improves traction
between it and pavement
Rocker Bar
• It has a plantar transverse convexity
which changes stance phase loading
• reduce metatarsalgia
• It helps in achieving stance phase earlier
than in flat feet
• Helpful in patients with
weakness of plantarflexors
• Diminishes need of full ankle
excursion
Metatarsal Bar
A flat plantar surface present posteriorly from the fore foot.
The bar lies transversely across the sole beneath the metatarsal shafts
Transfers weight from the metatarsal heads to its shafts
Heel And Sole Elevations
• Pes equinus :- helps to bear the
weight on the heel when the
patient stands
• Leg length discrepency
• For the patient in hemiparesis a 1
cm heel and toe lift in the shoe on
non paretic side faciliates paretic
foot to clear during swing phase
and weight bearing symmetry in
stance on the paretic side
Pediatric Foot Orthoses
Dennis Browne Splint Hinged shoe
Guidelines For Prescription
To reduce pressure on the heel
1. heel cushion
2. resilient insole
To stabilize the hindfoot
3. Shoe with high firm uppers
4. Medial heel flare
5. Lateral heel flare
6. Bilateral heel flare
7. Heel with resilient medial wedge
To increase comfort in the presence of plantar fascitis or patellofemoral
discomfort
1. heel cushion or resilient heel
2. hindfoot and mid foot longitudinal arch support
To reduce flexible hyperpronation
3. medial heel wedge
4. UCBL insert
5. hind foot and mid foot longitudinal support
6. thomas heel
To accommodate fixed hyperpronation
7. Shoe with long medial counter
To accommodate fixed hypersupinated foot
1. resilient hind and mid foot longitudinal support
To reduce pressure on the metatarsal head
2. metatarsal pad
3. metatarsal bar
To reduce pressure on hammer toes
4. Shoe with a high toe box and extra depth
To reduce pressure on bunions
5. Shoe with extra medial width; maybe made on bunion last
To stabilize knee during early stance
1. resilient heel
2. beeveled heel
To facialiate mid and late stance
3. Rocker bar
References
Rehabilitation medicine principles and practice 3rd edition by Joel a
Delisa
Orthotics by Joan E. Edelstein and Jan Bruckner
Physical medicine and rehabilitation by Randall L. Braddom
Physical therapy by Susan O’ Sullivan
Orthosis by Sunder
