Transcript The Office Foot & Ankle Assessment

Filling the prescription…
the Pedorthic Assessment
 History
 Non-Weight
Bearing Seated Assessment
 Weight Bearing Observation
 Supine Physical Assessment
 Prone Physical Assessment
 Weight Bearing Assessment
 Gait Analysis
Filling the Orthotic Prescription
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Detailed lower limb
history
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Current SSx
Previous SSx
Surgical interventions
Previous Injury
Previous Treatments
Systemic Disease Hx
• Diabetes
• Arthritis
• Venous insufficiency
Physical Assessment
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Seated NWB
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Navicular height
Med. Long. Arch
Digital alignment
Tibial/knee alignment
Weight Bearing
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Δ navicular height
Δ MLA
Δ digital alignment
Δ tibial/knee alignment
Physical Assessment…cont.
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NWB Supine
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Passive ROM at
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Subtalar joint
Midtarsus
1st Ray position
Hallux dorsiflexion
Lesser toes
Resisted Muscle Tests
Palpation of areas of
pain
Physical Assessment…cont.
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NWB Prone
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Subtalar ROM
Symetry in medial maleoli
Landmarking
Biomechanical measures
• Rearfoot alignment
• Forefoot to Rearfoot
• Ankle dorsiflexion
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WB Posterior View
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Relaxed Calcaneal Stance
Tibial Alignment
Gait Analysis
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Barefoot
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Heel Strike
Midstance
Heel off
Propulsion
With Current
Footwear
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Same as barefoot
Fabrication
 Three
Dimensional Volumetric Casting
 Cast Correction/Modification
 Orthosis Manufacture or milling
 Grinding and Finishing
Three Dimensional Volumetric
Casting
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Plaster of Paris
Casting Foam
Direct Laser Scanning
Contact Digitizing
Wax Casting
Currently “Subtalar Joint Neutral” is the
industry standard for casting
Cast Correction
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Done to allow the fabrication of
a device that is both functional
& comfortable
Technique is based on the
casting method used:
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CAD/CAM Software for laser
scans, and contact digitization
By hand, using plaster of Paris
for Plaster, Foam and wax
casting
Plaster, foam and wax can
also be scanned into
CAD/CAM software packages
Orthosis Manufacture/Milling
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Creation of the orthosis
using the corrected 3D
foot cast, or milled
directly from
manufacturing material
 Must be made from the
patients casts or scans,
and made from raw
materials to be truly
“custom made”
 No “Library Devices” or
Prefabricated devices
that are simply modified
Grinding and Finishing
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Grinding of orthosis to
the appropriate shape
to fit in shoe; done by
hand
 Addition of posting,
padding and
topcovers are the final
stages before the
patient’s dispensing
appointment
Dispensing Appointment
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Booked for 15-30
minutes
 Educate patient on
function of devices,
break-in process etc.
 Fit devices to
footwear
 Further gait analysis
to ensure device
efficacy and function
Footwear; An entire presentation
on it’s own
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Patient Measures
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Heel to toe
Heel to ball
Width
Girth
Last shape
 Midsole construction
 Closures
 Upper Design
The Goal
Thank You!
On behalf of the Pedorthic Association of
Canada, the College of Pedorthics of
Canada, thank you for this opportunity to
inform you of the practice of Pedorthics in
Canada.
www.pedorthic.ca