what-when-how
In Depth Tutorials and Information
shoes, although in the face of significant knee pain and the prospect of
surgery, many patients are willing to reconsider their footwear choices in
order to accommodate the orthosis.
Foot orthoses for the at risk foot
Feet that are at risk of ulceration, infection and gangrene, and ultimately
amputation, require particular care if orthoses are to be used to redistri-
bute abnormal pressure and loading. The main groups of patients are
those with high-risk foot disease associated with diabetes, peripheral
vascular disease and advanced rheumatoid foot deformity. Additionally,
patients with deformity associated with Charcot-Marie-Tooth disease
(hereditary motor and sensory neuropathy) and spina bifida will fall under
this category.
There are no unique objectives when using foot orthoses for the at risk
foot, as the aim is still to control foot motion if the joints of the foot are
flexible, and to reduce foot pressures; however, the implications of getting
the prescription wrong are significant, if not catastrophic, and the role of
footwear in orthosis choice becomes even more relevant. The benefits of
a very thick orthosis to provide excellent plantar cushioning are negated
if it forces the dorsal surface of the toes against the shoe upper. The use
of a very rigid material for the
entire
orthosis should be avoided if the aim
is to control heel and arch motion; instead, these rigid materials should
be used under the heel and arch only, and a forefoot extension added
using soft, compliant materials. The choice and siting of the forefoot
layers, and additional padding such as domes, should be informed by the
contact pattern under the foot, not just the shape of the foot. Footwear
design features can further reduce foot pressure (rocker sole, stiff forefoot
flex line, and high toe spring). It is also the case that monitoring the
orthosis' performance and degradation over time is critical. This will tell
you whether the orthosis is being used as often as it should be, and when
it requires replacement or modification.
Foot orthoses for people with rheumatoid arthritis
Foot orthoses are provided to two main groups of patients with RA: those
with foot problems associated with early disease and those with more
established foot problems. There is an inextricable relationship between
the foot, foot orthoses and the footwear that houses them both. The use
of appropriate footwear (Williams et al 2007, Fransen and Edmonds 1997)
in conjunction with foot orthoses has been recognized as minimizing the
pain and disability associated with RA (
Hodge et al 1999
, MacSween
