Orthotic Therapy using chairside orthotics.

Presentation aims:

• Improve orthoses outcomes & patient satisfaction
• Link chair-side orthoses modifications to the FFO prescription form
• Increase podiatrist confidence when prescribing FFO

Why chairside orthoses?

• Prescription aid for customised orthoses
• Immediate intervention in painful presentations
• Longer effectiveness than strapping
• Temporary devices / fallback while FFO are being fine tuned / refurbished
• More realistic biomechanical change than strapping (Sx relief mainly)
• FFO not needed for various reasons

When to go orthoses?

• Symptoms – short term (heel pain) or long term (OA, TP dysfunction)
• Signs – bunions? Hallux limitus? Long 2nd met?
• Severity – how poor are the foot biomechanics?
• Family History – foot, knee, back problems

What to consider?

• Short term need–

–Sx relief – one off temporary heel pain etc.

• Long Term need–

–Chronic Sx e.g. OA of midfoot, TP dysfunction

–Preventative

• Trial basis-

–Trial for knee, back pain – will orthoses help?

–Shoe requirements/restrictions

Where do you start?

• Determine foot type
• What do you want to achieve

–Biomechanics – forces/pressure/change where?

–Pain relief – tension/relief where? Sometimes you will do the opposite to what you want long term.

• Trial with chair-side orthoses
• Initial and f/up reviews
• Decide if FFO needed – better outcome with custom-made, cost saving etc.

Foot Type:

• Pronated, Neutral, Supination
• Severity
• NB Take into consideration – age, other potential problems such as weak ankles, severe back pain etc…

Types of modifications:

• Wedging

–Medial or lateral,

–Extrinsic or intrinsic (e.g. Kirby skive)

–Rearfoot or forefoot,

–Amount – degrees

• Padding – eva/felt etc.

–Medial or lateral

–Midfoot or forefoot

–Amount  – how many layers?