Steve Manning 2/10/2011

Transcription

1 Utilising Footwear Modification as a Treatment Modality Steve Manning Intraining Running Injury Clinic, Milton BHlSc Podiatry (Hons), Level IV Coach Athletics SMA Qld President, QUT Sports Medicine Clinic 2010 APODA Qld Conference Steve Manning - Footwear Modification 2010 APODA Qld Conference Steve Manning - Footwear Modification 2010 APODA Qld Conference Steve Manning - Footwear Modification 2010 APODA Qld Conference Steve Manning - Footwear Modification 2010 APODA Qld Conference Tutorial Presentation 1

2 2010 APODA Qld Conference Steve Manning - Footwear Modification 2010 APODA Qld Conference Steve Manning - Footwear Modification Podiatry in Australia: Different from Canada and the US? Specialty Areas like Pediatrics, High Risk, Diabetes, Surgery and Sports Sports Medicine Clinic 4 th year University Primary Provider for Sports Injuries Diagnostics Extensive Scope of Practice Our Clinic specialises further to Runners and Sports Biomechanical Factors contributing to causes of injuries and their resolution 2010 APODA Qld Conference Steve Manning - Footwear Modification Causes of Injury: Structural Abnormalities Pathological Gait Patterns Change in Training Environment or Activity Overtraining * Trauma Footwear Footwear Treatment Options: 1. Prescription 2. Orthotics 3. Modification Tutorial Presentation 2

3 When Footwear Modification is Needed Other treatment modalities have not worked Maximum Orthotic control is insufficient No shoe can be found to suit needs To accommodate unusual fit requirements Asymmetrical biomechanics between feet Modification involves: Removal of some part of the shoe Addition of a new material Change to the structure of part of the shoe UPPERS: Remove support strapping Cut Heel Tab Modify tongue shape Add or remove eyelets Shoe Fillers and padding INSOLE: Orthoses Semi-Compressed Felt EVA additions under insole Shoe Fillers MIDSOLE: Heel Lifts Full length Lifts Heel Wedges Reduce Flaring Adjust Stability Adjust arch profile Rocker Soles OUTSOLE: Configuration of outsole lugs Gait Plates Rocker Sole Heel Wedging Modify Traction Midsole Modifications Most important part of the shoe to modify Problem with extra cushioning devices Types of Modifications: Full length Lifts - Leg Length Discepancy Heel Lifts - Ankle Equinus (reduced Dorsiflexion) Varus or Valgus Heel and FF Wedges Reduce Flaring - Slapping & pronation * Adjust Stability - bars and pillars Adjust arch profile - 1st Ray blisters Rocker Soles - smooth transition Upper Modifications Make the shoe fit better Remove support strapping Cut Heel Tab for Achilles irritation Modify or remove tongue Add or remove lace eyelets that t dig into foot Shoe Fillers and pads for difference in depth/heel width Inshoe padding for lesions Heel counter cavity * Metatarsus Adductus Bars for infants* Outsole Least frequently needing modification Most Common Modifications: Configuration of outsole lugs Gait Plates and Thomas Heel Rocker Soles Heel Wedging Modify Traction Insole Modifications and Orthotics Orthotics are form of modification replacing insoles Semi-Compressed Felt EVA additions underneath insole Shoe Fillers, Wedges and Lifts Purpose of the Insole is customisation ti not cushioning i Modifications can be diagnostic prior to orthoses prescription There can be problems with fitting orthotics into footwear Tutorial Presentation 3

4 Case Studies - Sagital Plane Theory A Deficit in the Sagital plane ROM (Dorsiflexion) Eg. Ankle Equinus, Anterior Equinus (Pseudoequinus), Hallux Limitus Leads to compensation in the other planes or at other joints Biomechanical Signs of compensation: STJ Pronation, MTJ pronation and MLA collapse, Early Heel lift with resultant increase in GRF Abductory or Adductory twist at HO Genu Recurvatum, Rotation of the Hip - Abductory gait and apropulsion The complication with treatment is that blocking pathomechanics will reduce available compensation leading to injury. Eg. Late phase pronation and FHL Howard Dananberg - Functional Hallux Limitus the Kinetic Wedge and Brooks Nexus Kevin Kirby - First Ray cut-out CASE STUDY: Kinetic Wedge CANDIDATES FOR KINETIC WEDGE: Plantar Flexed First Ray Functional Hallux Limitus Sesamoiditis Need more than orthotic CASE STUDY 1: Avascular Necrosis of Tibial Sesamoid with aversion to Sx in a Recreational Runner CASE STUDY 2: Functional Hallux Limitus in an Elite Sprinter CASE STUDY 3: Pain in 1 st Metatarsal Phalangeal Joint in and adolescent soccer player Case 1: Recreational Runner Step 1: Mark out the area to be modified With Sesamoiditis and avascular necrosis of tibial sesamoid Referred by orthopaedic surgeon because of aversion to surgery 3 year Hx of symptoms Step 2: Remove EVA from Shoe Step 3: Prepare the Poron wedge Tutorial Presentation 4

5 Step 4: Glue wedge to shoe and grind level Step 5: Seal the wedge with shoe goo Case 2: Elite Sprinter Functional Hallux Limitus Callus at IPJ hallux Limited STJ and MTJ ROM Hx of Tibial Stress Fx Step 1: Remove Insole and Board Last Spikes will not exhibit transverse plane motion as they are fixed to the ground with too much traction thereby eliminating compensation for sagittal plane deficiencies Challenge to Modify Spikes. Step 2: Remove wedge from Board and prepare Poron Insole Step 3: Glue Poron to Board Last and Shoe Tutorial Presentation 5

6 Step 4: Under grind Insole at 1st MPj and Glue Step 5: Remove Spike and Grind Setting Step 6: Prepare Low Density EVA Bar Step 7: Glue to Shoe and Blend Case 3: Young Soccer Player With Pain under the first Ray and proximal 1 st MPj Pain only present while in soccer shoes 3 week Hx of symptoms Ground down one cleat by 2mm under 1 st ray Immediate cessation of symptoms When Modification is Needed: When other treatment modalities fail When maximum orthotic control is insufficient or not possible When no shoe can suit needs To fix minor aggravating factors with fit When feet are asymmetrical and need different types of support Important Factors to Consider: Modify Shoes in good shape only Consider all modification options think outside the square Work with Podiatrist/Podorthist or learn to DIY Always cut away from yourself - fingers, hands and legs. Keep blade flat to surface you are trying to trim. Tutorial Presentation 6