Orthotics and their modifications
Modified Root – Standard orthotic device - forefoot balanced with a natural arch in line with corrected rearfoot. Posted at NCSP. Mid-foot control
A Medial Skive (Kirby) – Increased supinatory movement around STJ axis to control excessive pronation. Shaving plaster off the medial plantar surface of the heel section of the positive mold. This in effect adds extra medial intrinsic wedging to the device. Shells are ground at varying depths from 2 - 8 mm. A higher than normal heel cup is advised. Must take into account heel width thin heels pads don’t tolerate large amounts of skive. Rear-foot control Indicated for pts who need additional pronatory control, difficulty resupinating the foot, paed flexible flat foot, post tib dysfunction, lower limb pathology caused by excessive stj pronation. Contraindicated in pts with lateral heel pain- may increase pain due to shape of skive, lateral ankle instability and thin heel pad.
The Inverted Technique (Blake) is balanced as per modified root devices but to a far greater degree of inversion (starting at 15 degrees). A 1-5 ratio is generally used to prescribe these devices i.e. for every degree of correction required you should request 5 degrees of inversion. Recent studies suggest that the ratio is closer to 1-3. Majority of control at medial calcaneus, with minimal arch control. Rear-foot control Provides increased force on medial side of plantar heel to resist pronation occurring. Indicated for lig laxity, internal femoral torsion, pt that requires extra pronatory resistance, tib post rupture, ankle equines, runners with RF pronation. Contraindicated in excessive inversion problems, lateral ankle sprains, ankle spurs, painful tailors bunion, poor shock absorption (rigid foot type), genu recurvatum. Additions- plantarfascial groove, increase lateral heel cup, fat pad splays, extrinsic RF post. Good for sporty pts , increases shock absorption. RCSP + NCSP= X...
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