Prescription

Casting Methods
Semi-weight bearing
•
•
•
Design,fabrication and
trouble shooting of FFO
Foam Impression
STJ neutral at Semi-weight bearing
Accomodative Foot Orthoses
Non-weight bearing
•
•
•
Anthony Shum CPO(HK)
Prosthetist-Orthotist
Kwong Wah Hospital
anthony.shum@hkscpo.org
Plaster / Balloon casting
STJ neutral at Non-weight bearing
Functional Foot Orthoses
Full-weight bearing
•
not accepted in foot orthotic treatment.
!
"
Rearfoot Posting
Prescription
• Extrinsic
• Grind the posting material (EVA) or palster
to the desired angulation after adhered to the
plantar aspect of the heel
• Heel height
• Inverted / normal casting
• Intrinsic/ extrinsic forefoot post
• shell material & thickness
• Top cover material
e.g. Blake Inverted, Kirby Skive
• Intrinsic
• direct grinding the desired angulation to the
shell (Max. degree is 3-5 due to limitation by
the thickness of the shell)
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$
Rearfoot Posting
•
When rearfoot posting >3 degree is needed =>
Extrinsic Posting
•
When forefoot varus/valgus posting >5 degree is needed
=> Extrinsic Posting
•
Extrinsic Posting is advised for patients with
•
•
•
•
Inverted Positive Cast
Over-weight
Rigid foot structures
varus/valgus degree is high
Shoes have enough inter space/toe box to be
fitted in (laced shoes are better)
%
&
'
(
Blake Inverted
Kirby Skive (medial heel skive)
• modification to the +ve
cast and casting technique
remain the same
•
removing selected portions
on the plantar media heel
of the corrected +ve cast
•
adds varus wedging to the
inferior heelcup of an
orthosis allowing for more
effective control of sutalar
joint pronation
)
!*
Intrinsic Forefoot Posting
Extrinsic Forefoot posting
Add plaster platform to the plantar forefoot so that
the arch of the shell is made sharper for controlling
forefoot deformity
Advantage
Reduce the thickness of the insole, which is an
important factor for successful fitting in the
patients’ shoe
Add a wedge (EVA) to the distal plantar surface of the
shell
Advantage
Allow for more even pressure distribution on the
plantar surface of the foot
but.........
fitting shoes may find diffculties (e.g. OL shoe), laced
or sport shoes are preferred.
!!
!"
measurement
Subtalar joint neutral
Exam position
!#
!$
!%
!&
Relax Calcaneal Stance Position
Hind foot angle
•
On weight bearing
•
With subtalar joint neutral
•
with appropriate base and
angle of gait
•
Measure the angulations
between :
•
Angulations between the
calcaneal bisection & floor
•
bisection of lower third of
leg and
•
calcaneal bisection
Tibial Stance
•
Angulations between the leg
bisection & floor
!'
!'
Fore foot angle
•
With subtalar joint neutral
•
Measure the angulations
between :
•
calcaneal bisection and
•
forefoot
ROM on plantarflexion &
dorsiflexion of 1st ray
!'
!'
Child RCSP
Orthotic Materials
Ideal RCSP= 7 degrees - child’s age (in years)
Shell -polypropylene
- carbon graphite thermoplastic
composite ( expensive )
Posting -High density EVA
-acrylic resin ( difficult to handle )
Covering material -spenco
- PPT + pig skin
-Peron
(by Ron Valmassy)
? A 4 year boy with 4 degrees hind foot
!(
!)
"*
"!
Orthotic Shell Materials
Patient Weight (kg)
Material thickness (mm)
Below 45
3
45 to 75
4
Above 75
5
""
"#
"$
"%
FFO should check when:
•
•
•
•
•
Orthosis reaches the
midshaft of metatarsal
Soft tissue around the
calcaneus is not properly
seated in the heel cup
Complains of pain by the
orthosis
Parents or Orthotist notes
an alternation in gait pattern
Return of the original
Symptoms
"&
"'
Treatment Procedure
Treatment Procedure
Ax & Casting
Ax & Casting
Within 2/52
Within 2/52
Fitting
Fitting
1/52 – 2/52
1/52 – 2/52
Post fitting f.u.
Post fitting f.u.
Routine f.u. / check at foot clinic
Pead. 3/12- 6/12
Adult - PRN
Routine f.u. / check at foot clinic
Pead. 3/12- 6/12
"(
1. Proper shoe selection
2. Allow break-in period e.g.
two hours on 1st day &
deliver instruction note
3. Selected muscle /
strengthening exercise
Adult - PRN
"(
Vacuum / In-shoe Casting Technique
Vacuum / In-shoe Casting Technique
(Brown et al 1992)
(Brown et al 1992)
•
For FFO worn in a high
heeled ( >1in. ) fashion
shoe
•
Any extremely tightfitting or “atypical shoe”
e.g. ice or roller
Subtalar jt neutral maintained by:
• Midtarsal jt “locked” via pressure
directly planter to the 5th MT head
• Visualization of the curvature of
lateral malleolus
• Fit the slope, shape and width of
shoe
")
#*
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Reverse Morton’s Extension
To compensate for rigid plantarflexed 1st ray
deformity, and thus redurce pressure on 1st MT head
#"
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#$
#%
Books
•
Foot & Lower Extremity Biomechanics
A ten year collection of Precision Intricast, Inc. Newsletters Kevin A. Kirby D.P.M. MS.
•
FOOT AND LOWER EXTREMITY BIOMECHANICS II:
PRECISION INTRICAST NEWSLETTERS, 1997-2002.
Kevin A. Kirby, DPM, MS
HA library- KWH-L Books WE880.K48 2002
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#'
#(
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Strapping for Plantar Fasciitis
Strapping – for Plantar Fasciitis (Ralph Dye 1939 )
• Skin adherent – compond Benzoine Tincture
• Zinc oxide adhesive plaster & Elastoplast
• Perforated adhesive – weaker tensile strength
in evaluating biomechanical methods prior
• Effective
to orthotic therapy
the 1 ray reduce tension of plantar
• Plantarflex
fascia when the foot attempts to elongate on weight
st
bearing
$*
$!