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PMID: 18316713 J Am Acad Orthop Surg. 2008 Mar;16(3):152-8. ABOS WLA'19

2

post

B - ESSENTIAL

L 2

Shoe modification and the use of orthoses in the treatment of foot and ankle pathology.

Janisse DJ Janisse E

Janisse DJ, JAAOS 2008

Pubmed

Shoe modification and foot orthoses can play an important role in the nonsurgical management of foot and ankle pathology. Therapeutic footwear may be used to treat patients with diabetes, arthritis, neurologic conditions, traumatic injuries, congenital deformities, and sports-related injuries. These modalities may improve patient gait and increase the level of ambulation. They also may be used to treat acute problems such as plantar fasciitis or metatarsalgia and as preventive tools in patients with diabetic neuropathy. Shoe selection is primarily based on the condition of the patient, the foot shape and type, and the patient's daily activities. Modifications include flares, which provide stability; extended shanks to reduce bending stresses; rocker soles to rock the foot from heel strike to toe-off; and relasting, or reshaping, shoes to accommodate deformities. The four main types of custom orthoses are the accommodative, which cushions and protects the foot; the semi-rigid, which cushions and protects as well as provides support, control, and weight redistribution; the rigid, which offers arch support; and the partial foot prosthesis, which addresses partial amputations and helps protect the foot.

Polls results

¹

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change

BIG change

84% Article relates to my practice (203/240)

11% Article does not relate to my practice (28/240)

3% Undecided (9/240)

²

Will this article lead to more cost-effective healthcare?

58% Yes (142/242)

22% No (55/242)

18% Undecided (45/242)

³

Was this article biased? (commercial or personal)

7% Yes (17/240)

84% No (203/240)

8% Undecided (20/240)

⁴

What level of evidence do you think this article is?

5% Level 1 (14/248)

10% Level 2 (27/248)

30% Level 3 (76/248)

24% Level 4 (61/248)

28% Level 5 (70/248)

Cards

1 of 0

(SBQ18FA.11) For which of the following pathologies would the orthotic shown in Figure A be most appropriate?

QID: 211220

FIGURES:

A

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Hallus rigidus

3%

(50/1624)

Supple adult pes cavus

60%

(971/1624)

Mild midfoot arthritis

2%

(31/1624)

Pes planovalgus

24%

(387/1624)

Rigid pes cavovarus

11%

(178/1624)

Select Answer to see Preferred Response

SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic

(OBQ12.107) A 65-year-old male with insulin-dependent diabetes and chronic kidney disease presents for follow-up care for issues in his right lower extremity. He has been treated for the past four months with the modality seen in Figure A (Panel A) for the condition seen in Figure A (Panel B). He has currently has no ulcerations on his foot. Which shoe modification, shown in Figure B-F, is most appropriate to prevent potential future skin breakdown by offloading the affected area in this patient?

QID: 4467

FIGURES:

A
B
C
D
E
F

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Figure B

7%

(287/4312)

Figure C

3%

(120/4312)

Figure D

50%

(2138/4312)

Figure E

16%

(692/4312)

Figure F

24%

(1034/4312)

Select Answer to see Preferred Response

SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic

(OBQ11.177) A 32-year-old man has difficulty walking 5 months after having an amputation as shown in Figure A. Gait analysis reveals a shortened stance phase and irregular toe off on the operative extremity. Which of the following would most likely improve his ambulation?

QID: 3600

FIGURES:

A

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Solid ankle ankle-foot orthosis

7%

(284/4090)

Hip-knee-ankle-foot orthoses

1%

(31/4090)

University of California Biomechanics Laboratory (UCBL) insert

4%

(169/4090)

Full-length steel shank shoe modification

12%

(495/4090)

Full-length steel shank and rocker sole shoe modification

75%

(3075/4090)

Select Answer to see Preferred Response

SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic

(OBQ11.10) The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology?

QID: 3433

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Midfoot prominences associated with Charcot arthropathy

18%

(559/3054)

Severe toe-tip ulcerations

8%

(250/3054)

End-stage tibiotalar arthritis with limited motion

60%

(1836/3054)

Fixed ankle dorsiflexion deformity

9%

(266/3054)

Fixed planovalgus deformity

4%

(126/3054)

Select Answer to see Preferred Response

SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic

(OBQ09.271) You are caring for a 72-year-old male with diabetes and peripheral neuropathy with a non-healing forefoot ulcer as shown in Figure A. To reduce the plantar pressure on his forefoot, which of the following shoe modifications would you suggest?

QID: 3084

FIGURES:

A

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Polyethylene foam insole

9%

(230/2681)

Open toe sandals

0%

(7/2681)

Rocker sole shoes

64%

(1710/2681)

Custom indepth shoes

25%

(681/2681)

Hard postoperative shoe

2%

(45/2681)

Select Answer to see Preferred Response

SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic

(OBQ09.32) What is the preferred orthotic device for a symptomatic adult foot deformity that is shown in Figure A, has no arthritis on radiographs, and responds to Coleman block testing as shown in Figure B?

QID: 2845

FIGURES:

A
B

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Short walker boot

0%

(12/3630)

Accommodative custom orthotics

6%

(203/3630)

Lace up soft ankle brace

1%

(31/3630)

Medial hindfoot posting with arch support

17%

(613/3630)

Lateral hindfoot posting with recessed first ray

76%

(2751/3630)

Select Answer to see Preferred Response

SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic