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Lower Limb Orthoses : Shoe, Ankle-Foot Orthosis

Lower Limb Orthoses : Shoe, Ankle-Foot Orthosis. University of the Philippines Manila College of Allied Medical Professions PT 150 Orthotics and prosthetics Prof.Mitch B. Encabo Edited for instruction by Aila Nica J. Bandong , PTRP. Describe the components of a shoe

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Lower Limb Orthoses : Shoe, Ankle-Foot Orthosis

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  1. Lower Limb Orthoses:Shoe, Ankle-Foot Orthosis University of the Philippines Manila College of Allied Medical Professions PT 150 Orthotics and prosthetics Prof.Mitch B. Encabo Edited for instruction by AilaNica J. Bandong, PTRP

  2. Describe the components of a shoe • Describe possible modifications in a shoe • Discuss the indications for each modifications • Describe the different parts of an Ankle-Foot Orthosis • Describe the different types of Ankle-Foot Orthosis Learning Objectives

  3. Theoretical Basis

  4. THE SHOE

  5. Functions • To minimize pressure on sensitive, deformed structures • To redistribute weight towards pain-free areas • To serve as foundation of an orthosis Shoes

  6. Sole Heel Lining Upper Components of a Shoe Reinforcements

  7. Lies under the anatomic heel • The higher the heel, the more weight is shifted to the forefoot • Leg length discrepancy • Less than 2.5 inches - internal heel elevation • Greater than 2.5 inches - external heel sole elevation HEEL

  8. Proximal HEEL Distal

  9. Heel Breast Pitch

  10. Military (10/8”) Spring (1/8”) Oxford (6/8” – 8/8”) Cuban (12/8”) TYPES OF HEEL HEIGHTS

  11. SOLE • Outer Sole • Contacts the floor • Resilient outer sole to cushion impact • Inner Sole • Lies under the foot • Filler: separates the inner from the outer sole • Midsole – for athletic shoes

  12. Toe Spring SOLE Ball Shank

  13. UPPERS Vamp Quarters

  14. VAMP Aglets Lace stay Throat Tongue Eyelets

  15. Lace-to-Toe Bal / Balmoral Throat Styles Blucher

  16. Closures Helps keep feet inside the shoe Adjustable vs non-adjustable

  17. Elastic Webbing Insert Non-adjustable Closures Zippers

  18. Cotton laces Elastic shoe laces Velcro Flaps Adjustable Closures

  19. Low High QUARTERS

  20. Counter Toe Box Reinforcements Shank Piece

  21. “Shoes are very sexy” Balls Breasts Throat Tongue

  22. Lasts • Model over which the shoe is made

  23. Types of Lasts Outflared Straight Inflared

  24. Transfer forces from sensitive to tolerant areas • Reduce friction and shear on sensitive areas • Modify weight transfer patterns • Correct flexible deformities • Accommodate fixed deformities • Limit motion of painful, inflamed or unstable joints • Internal vs External Shoe Modifications

  25. ADVANTAGE DIS- ADVANTAGE Shoe Modifications

  26. External Shoe Modifications Heel Modifications Sole Modifications Combination Heel and Sole

  27. Heel Modifications Cushion Heel

  28. Medial Heel Flare Heel Wedge Heel Modifications

  29. Heel Modifications Extended (Thomas) Heel Reversed Extended (Thomas) Heel

  30. Heel Elevation Heel Modifications

  31. Metatarsal Bar Rocker Bar Sole Modifications

  32. Sole Modifications Sole Wedge

  33. Sole Modifications Sole Flare

  34. Steel sole bar • Inserted between the inner and outer soles • Approximately 0.2cm thick, 1.5 cm wide, and extends from a point 1cm anterior to the posterior edge of the heel counter to 1 cm posterior to the anterior edge of the toe box • Prevents motion of the anterior portion of the sole  reduce stress on the phalanges and metatarsals • Used with a rocker bar to promote rollover Sole Modifications

  35. Internal Shoe Modifications Heel Modifications Sole Modifications Foot Orthoses (inserts/inlays)

  36. Medial/Lateral Heel Wedge Heel Cushions Heel Modifications

  37. Heel Modifications Interior laced ankle support

  38. Arch Support Toe Crest Sole Modifications

  39. Sole Modifications Metatarsal Pad

  40. Inner Sole Excavation • A portion of the inner sole under one to three painful MT heads may be removed • Reduced load on the MT heads and provide greater area • Excavation is cushioned to protect tender bony prominence Sole Modifications

  41. UCBL Insert Heel Seat/ Heal Cup Foot Orthoses (inserts/inlays)

  42. Sesamoid Platform • Stabilizes the first metatarsal • Reduces excessive pressure on the head of the first metatarsal by transferring some of the load to the MT shafts Foot Orthoses (inserts/inlays)

  43. Principles • Note problems • Determine objectives • Give appropriate modifications • Evaluate fit of the shoe Shoe Modifications

  44. Adequate room for foot to expand upon weight-bearing • At least ½“ (1cm) longer than the longest toe • The widest part of the shoe should coincide with the broadest part of the foot • The shoe should be snug from heel to the ball of the foot • Quarters should not gap excessively • Expect slight gapping at heel strike but this must disappear at midstance • Check if the modified shoe has achieved its purpose Evaluation of Fit

  45. Pes Planovalgus • Arthritis • Flexible equinovarus • Ankle instability • Hammer toes • Leg length discrepancy of 2 cm • Arthrodesis • Metatarsalgia SEATWORK!!! Identify appropriate shoe modifications for the following conditions.

  46. ANKLE-FOOT ORTHOSIS Leather and Metal AFO Plastic AFO

  47. Ankle-Foot Orthosis • Controls the alignment and motion of the foot and ankle • Applies a three-point pressure system

  48. Leather and Metal AFO 1. Non-articulated • Edema • Sensory impairment • Paralysis 2. Articulated • Same as above except • Weakness brought about by an orthopedic or neurologic problem Plastic AFO • No edema • No sensory impairment • Paralysis Indications for specific types of AFO

  49. Leather andMetal AFO

  50. Components • Shoe attachment • Ankle joint • assists/stops • Varus/valgus correction straps • Uprights • Bands/cuffs

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