3. Footwear modification & foot Orthosis
Made by: Armghan Anjum
Orthotist & Prosthetist
King Edward Medical University
Lahore

4. Why we wear shoes??? Protection of foot
Prevention from corns and calluses

5. Parts of shoes Upper part: Lower part: Quarter Sole Heel counter Shank
Ball
Toe Spring
Heel
Upper part:
Quarter
Heel counter
Vamp
Toe box
Tongue
Throat

6. Foot orthosis The effectiveness of orthosis depend upon:
Proper diagnosis of condition
Selection of appropriate orthotic material
Proper molding

7. Pes planus (flat foot) Reduction of medial arch May be planovalgus
Consist of pronation and abduction at subtalar joint
Pronation can be controlled by keeping subtalar joint in neutral position

8. Types of flat foot Flexible Rigid Foot wear modification
Medial arch collapse only in weight bearing
Results in pronated foot and longitudinal arch strain
Foot wear modification
Thomas heel shoe
Medial arch support
Custom made orthosis: UCBL
Thomas heel with medial heel wedge*
Rigid
Medial arch collapse both in weight bearing & non weight bearing
Should be filled with arch support or Thomas heel
Shoe modification is done only for pain relief, not for correction
Foot wear modification
Polyurethane foam backed by microcellular rubber provide comfort to sole
* Only for children 1/16 inch wedge up to 2 years, 1/8 inch up to 5 years & 3/10 inch after 5 years

9. Pes cavus
High arched foot which leads to excess pressure on heel and metatarsal head areas

10. Foot wear modification
Cavus without supination:
Longitudinal arch support to fill space between shoe and arch
Extended to metatarsal heads
Cavus with supination:
Custom made foot orthosis with subtalar joint in neutral position is used

11. metatarsaligia
Painful metatarsal heads due to uneven weight distribution
Pain can be relieved by distributing proximal to metatarsal heads
Can be done by internal or external modification
Internal modification: metatarsal pad
External modification: metatarsal bar

12. Heel pain- plantar fascilitis
Due to stretching of plantar fascia at anteromedial calcaneum
Minor discomfort without hyperpronation or high arch can be managed by
Heel pad in sole
Calcaneal bar distal to painful area
Scooped cushion heel
Hyperpronation with decreased medial arch
Custom made orthosis with subtalar at neutral joint position
High arched foot
Elevated arch support

13. Pain behind heel
Retrocalcaneal Bursitis* Enthesopathy** is commonest cause
Treated by raised heel thus reducing weight bearing and relieving pain
*Two bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles tendon and the calcaneus
**an enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the entheses. If the condition is known to be inflammatory, it can more precisely be called an enthesitis.

14. Toe pain Pain can be reduced by:
Extending the shank distally to reduce mobility of the joint
Metatarsal bar partly immobilize and reduce pain

15. Limb length discrepancy
True length:
From ASIS to tip of medial malleolus
Apparent length:
From umbilicus to tip malleolus
True length may be normal but shortening may occur as a result of pelvic obliquity secondary to scoliosis or contractures
½ inch discrepancy doesn’t need correction- left for ground clearance
1 inch is corrected by raising insole
More than 1 inch is corrected by raising both heel and sole

16. Knee osteoarthritis
Foot orthosis can alter ground reaction force thus is useful in management for problems in proximal joints
Lateral heel wedge ¼ inch thick can reduce pain in OA with Genuvarum

17. Insensitive foot
Loss of sensation in foot can occur due to lesions like:
Peripheral nerve lesion
Spinal cord injuries
*Myelodysplasia
On weight bearing it lead to:
Concentrated pressure on bony areas
Scarred plantar surface due to trauma
Bony deformity
*The myelodysplastic syndromes (also known as MDS or myelodysplasia) are hematological (i.e., blood-related) medical conditions that cause ineffective production (or "dysplasia") of all blood cells. Patients with MDS can develop severe anemia and require blood transfusions

18. Footwear modifications
For Concentrated pressure:
Microcellular insole to distribute weight over wide area
Extra deep shoe
For Scarred plantar surface: any one combination of insole
Molded polyethylene foam backed by microcellular rubber (MCR)
Molded polyethylene foam with latex cork
Plastazote with or without added microcellular rubber (MCR)
For Bony deformity:
Molded insole of Polyurethane foam with area of relief over bony area

19. Club foot boot
Congenital talipes equino varus deformity can be corrected by manipulation with strapping or surgery
Correction is maintained by club foot boot
May or may not associated with cavus
Sequence of CTEV correction:
Cavus if any
Forefoot adduction
Invesion/varus
equinus

20. correction CTEV is corrected as follow: Fore foot adduction:
Medial border of boot is made straight
Varus/Inversion
Lateral border of foot is raised that keeps the foot in eversion
Equinus
No heel
Front ankle straps that keep the heel down

21. Boots for amputation Toe filler spacer in toe amputation
Chopart’s boots in chopart’s amputation

22. Any question??

23. Thanks You 