ATHLETES AND ORTHOTICS January 29, 2014
TOPICS TO COVER TODAY Why use an orthotic? What athlete would benefit from wearing orthotics? What device should I use: Custom versus off of the shelf orthotics? How does my athlete obtain orthotics?
LE BIOMECHANICS DURING LOADING Normal: Tibia aligns over the foot, knee translates forward over the second toe, no dynamic knee valgus, hip stays level Abnormal: Foot pronates, tibia and femur medially rotate resulting in dynamic knee valgus/hip drop. Creates unwanted stress/loading on soft tissues/joints up the kinetic chain More important to look at timing of pronation and how much is occurring Jumping activity versus running Remember that some pronation is normal, it is all about if it is occurring at the right time, and how much is occurring. 4-6 degrees of calcaneal eversion is normal during stance
SQUAT MECHANICS
SQUAT MECHANICS
ABNORMAL BIOMECHANICS Pronation may occur secondary to any of the following: Rearfoot: (ie calcaneal varus leads to STJ dysfunction) Midtarsal Joint: Hypermobililty Forefoot: Varus or Unstable First Ray Weak proximal muscles Skeletal Anomalies at the knee joint Tibial Varum** Supinated Foot: Rigid without any shock absorption abilities
REARFOOT! Rearfoot Control for that athlete who lands in pronation at heel strike/foot contact Medial Post (Lift up) the Calcaneous into Varus or rectus (rare for valgus) Controls the STJ (Talus on Calcaneous) from moving into too much pronation at foot contact; better loading/weight acceptance posture of foot Usually post 60-80% of the deformity. **Does nothing for a forefoot striker during running
MIDFOOT Midtarsal Joint is composed of the Talonavicular and Calcaneocuboid Joint Referred to as the Oblique Axis joint and needs to be able to adapt to the terrain during loading but also lock up for propulsion. CC joint more relevant at push off. Should see navicular drop if TN joint is unstable; Break in lateral border of foot if CC joint is unstable TN joint hyper mobility is controlled with medial posting and/or a medial flange. Depends on the foot posture Can add modifications to an orthotic to lock up the joint ( cuboid pad). May have to address both of the OA joints to stabilize foot.
UNSTABLE CC JOINT
FOREFOOT Forefoot: Forefoot varus or unstable first ray First ray has to be balanced across the 1st/5th met heads to provide a stable forefoot from mid stance to push off. Can be stuck in Plantarflexion creating an instability. Disrupts the transverse arch of the forefoot. Create a first ray cut out to allow the first ray to drop down like it wants to but stabilize it up under the metatarsal. Forefoot varus: Medial post to balance foot for stable platform for loading and push off Met Pads/Met Bars: If metatarsal heads are dropped planetary Sesamoid: Offload with balance pad to allow it to not bear weight Hallux Limitus/Rigidus (Turf toe): Morton s Extension
TIBIAL VARUM Normal Tibial Varum is 2-4 degrees. Excessive varum results in pronation at the foot in order to get the medial border of the foot in contact with the ground. Is not a osseous foot dysfunction, but one that comes from up above the foot Do not correct the foot with the orthotic, only bring the ground up to the medial border by CANTING the device
SUPINATED FOOT Lack of shock absorption during gait leads to more stress up the chain and metatarsal issues Need cushion/shock absorption (soft device) May need a valgus post or lateral CANT to get the medial border down Lateral flange to keep the foot from rolling to the outside (similar with recurrent ankle sprain)
ITB WHO WOULD BENEFIT Medial Knee pain: control rearfoot or MTJ Shin Splints: Tibial Varum Metatarsal Stress Fractures: Offload ITB Syndrome: 50/50 Plantar Fasciitis: 50/50 Posterior Tibialis Tendon Pain Peroneal Tendonitis
BENEFIT CONT D Achilles Tendonitis Sesamoiditis Turf Toe Low Back Pain Severe pesplanovalgus feet (flatfeet)
QUICK SCREENING Evaluate foot in prone, STN to see where the foot rests Check for callus Standing foot posture Dynamic test: Squat, observe how the foot moves Jack s Test Walking scan
CUSTOM DEVICES Cast molded to feet. Custom prescription based on foot/gait and dynamic evaluation Takes 2-3 weeks to receive Durable: shell 5-7 years, top covers minimum 1 year. Sport Specific Devices: Jumping Sports, Running, Cycling, Football, Skiing, Tennis Can be very creative in designing, add many modifications Expensive: $350 pair
SOCCER DEVICES
AEROBIC/JUMPER DEVICES
REARFOOT CONTROL
MIDFOOT CONTROL/LATE PRONATOR
OFF OF THE SHELF ORTHTOICS Heat Moldable. Based on foot/gait evaluation Can add posts/pads by using heat glue Durability is not as good: average 1 year, less if participating in a loading sport (basketball) Comfortable, easy to break in Excellent as a trial basis to see if benefit from a custom Young athletes who are still growing, more affordable program Cost effective: $40-68 May lose control with the devices that are in low volume shoes
VASYLI DANANBERG
VASYLI GENERAL
VASYLI EXTENDED FIT
VASYLI SOCCER
ORTHOTIC PRESCRIPTION Conduct a quick screening Try taping first to see if it provides any relief If successful, refer to MD for prescription for orthotic evaluation and fitting If parent does not want to go through insurance, they can see us directly.
QUESTIONS??? Cathy Irwin PT, OCS, MHS IBJI Rehab 847-724-4791 cirwin@ibji.com 27