Filling the prescription… the Pedorthic Assessment

1. Filling the prescription…the Pedorthic Assessment • History • Non-Weight Bearing Seated Assessment • Weight Bearing Observation • Supine Physical Assessment • Prone Physical Assessment • Weight Bearing Assessment • Gait Analysis

2. Filling the Orthotic Prescription • Detailed lower limb history • Current SSx • Previous SSx • Surgical interventions • Previous Injury • Previous Treatments • Systemic Disease Hx • Diabetes • Arthritis • Venous insufficiency

3. Physical Assessment • Seated NWB • Navicular height • Med. Long. Arch • Digital alignment • Tibial/knee alignment • Weight Bearing • Δ navicular height • Δ MLA • Δ digital alignment • Δ tibial/knee alignment

4. Physical Assessment…cont. • NWB Supine • Passive ROM at • Subtalar joint • Midtarsus • 1st Ray position • Hallux dorsiflexion • Lesser toes • Resisted Muscle Tests • Palpation of areas of pain

5. Physical Assessment…cont. • NWB Prone • Subtalar ROM • Symetry in medial maleoli • Landmarking • Biomechanical measures • Rearfoot alignment • Forefoot to Rearfoot • Ankle dorsiflexion • WB Posterior View • Relaxed Calcaneal Stance • Tibial Alignment

6. Gait Analysis • Barefoot • Heel Strike • Midstance • Heel off • Propulsion • With Current Footwear • Same as barefoot

7. Fabrication • Three Dimensional Volumetric Casting • Cast Correction/Modification • Orthosis Manufacture or milling • Grinding and Finishing

8. Three Dimensional Volumetric Casting • Plaster of Paris • Casting Foam • Direct Laser Scanning • Contact Digitizing • Wax Casting Currently “Subtalar Joint Neutral” is the industry standard for casting

9. Cast Correction • Done to allow the fabrication of a device that is both functional & comfortable • Technique is based on the casting method used: • CAD/CAM Software for laser scans, and contact digitization • By hand, using plaster of Paris for Plaster, Foam and wax casting • Plaster, foam and wax can also be scanned into CAD/CAM software packages

10. Orthosis Manufacture/Milling • Creation of the orthosis using the corrected 3D foot cast, or milled directly from manufacturing material • Must be made from the patients casts or scans, and made from raw materials to be truly “custom made” • No “Library Devices” or Prefabricated devices that are simply modified

11. Grinding and Finishing • Grinding of orthosis to the appropriate shape to fit in shoe; done by hand • Addition of posting, padding and topcovers are the final stages before the patient’s dispensing appointment

12. Dispensing Appointment • Booked for 15-30 minutes • Educate patient on function of devices, break-in process etc. • Fit devices to footwear • Further gait analysis to ensure device efficacy and function

13. Footwear; An entire presentation on it’s own • Patient Measures • Heel to toe • Heel to ball • Width • Girth • Last shape • Midsole construction • Closures • Upper Design

14. The Goal

16. Thank You! On behalf of the Pedorthic Association of Canada, the College of Pedorthics of Canada, thank you for this opportunity to inform you of the practice of Pedorthics in Canada. www.pedorthic.ca