INJURY MANAGEMENT AND THEIR ROLE IN INJURY MANAGEMENT By Nat Padiar, MSc FCPod (surg)

Holywell Brace - combined functional foot orthosis and ankle brace

Abnormal biomechanical factors are widely considered to play a contributory role to the development of musculoskeletal condi- tions of the lower limb. Foot orthoses have become a popular adjunct in the manage- ment of some of the conditions associated with functional variations of the foot.

TuliGel heel cup - polymer-based, used for high impact activities

For example: ● patella femoral dysfunction ● ilio-tibial band stress syndrome ● medial tibial stress syndrome ● Achilles tendonitis ● chronic plantar fasciitis

Foot orthoses are meant to resist the severe deforming forces produced by biomechani- cal compensation. They are usually made of rigid material and are uniquely made to fit to the individual’s foot structure.

The mechanisms by which foot orthoses are effective aren’t fully understood but there is plenty of research to support their effectiveness in the management of stress type injuries.

There are three main biomechanical con- cepts concerning the control of abnormal biomechanical compensation with func- tional foot orthoses:

Flexor pad - metatarsal sup- port with cushion

Sorbothane accomodative heel pads - central cavity relieves pressure

1. The subtalar joint is as close to its neu- tral position as possible just before the foot enters the propulsive phase of gait ie. just prior to heel raise

FOOT ORTHOSES

2. The midtarsal joint is fully pronated during midstance of gait, thus locking and stabilising the forefoot on the rearfoot 3. The first metatarsal is allowed to plan- tarflex during the propulsion phase

Custom made foot orthoses These orthoses are made from a non- weight bearing negative Plaster of Paris cast of the foot. The cast is usually taken with the subtalar joint maintained in its neutral position while the mid-tarsal joint is maximally pronated. Individual labora- tories adhere to their prescription and fabrication protocol for negative cases.

Customised foot orthoses offer better con- trol of the abnormal biomechanical factors and accommodate individual differences in functional characteristics. There is some evidence that highlights a consider- able variability in the subtalar joint range of motion and neutral position (1) .

This inherent variability means a general approach to management is difficult and highlights the importance of individual examination to provide optimum perfor- mance for prescribed orthoses.

‘Off the shelf’ foot orthoses Given this inherent variability in individu- als, ‘off the shelf’ orthoses may be of lim- ited use as they provide a ‘standard’ con- trol of abnormal biomechanical factors of all conditions. However they are conve- nient and cheap and useful for people who fit in this standard category.

MATERIALS USED FOR FOOT ORTHOSES Root functional (rigid) orthoses – classically made of rigid carbon fibre materi- al which is essentially a non-flexible thermoplastic. It is most suitable for walking and endurance related activities

Talar Shock range - silicone foot orthoses for relief of foot pain

WITH THANKS TO TALAR MADE 6 SportEX

Semi-flexible orthoses – made from less rigid thermoplastic material, usually vitrethene which by the virtue of its flexible properties is most suitable for multi-directional sport

Flexible orthoses – made from EVA (ethyl vinyl acetate) material – thermoplas- tic but extremely flexible. It is most suitable for sports such as football, ath- letics or rugby, where space in the appropriate footwear is compromised