|Medical Indications for Foot Orthoses|
Delaney’s Laws of Foot Orthotics
Dr A J Delaney RFD MB BS FACSP
Properly prescribed and made orthotics correct the underlying biomechanical causes of most overuse and many acute injuries of the lower limb. The use of correction for leg length discrepancy, rear, mid and forefoot alignment, plantar fascial grooves, metatarsal domes, MTH rockers, sesamoid, and calcaneal relief will customise an orthotic for most injuries. Full length orthotics are best for sports and walking. Thinner ¾ length orthotics may made for fashion/ high heel or even ballet pointe shoes. Softer padded materials are suitable for elderly, diabetic or PVD affected feet.
Orthotics may be as light as 10-15 gm/pair for elite athletes. Orthotics can be designed to improve athletic performance ( track, field, snowsports etc).
An appropriate orthotic should lead to complete or significant rapid relief of symptoms. An orthotic should be comfortable and reduce the patient’s pain immediately, or within a few weeks. Orthotics should not require annual replacement. Refurbishing or correcting an appropriately performing orthotic is often a more efficient, comfortable and less expensive alternative to making a new set.
Orthotics should be a prime part of the management of;
Foot Sesamoiditis; Hallux valgus, limitus, rigidus; Interdigital neuroma/impingement; metatarsalgia, bone stress, Dorsal TMTJ impingement, stress fractures, plantar fasciitis and plantar fascial strains, painful pes planus/ cavus, Sever’s syndrome, blisters.
Ankle : anterolateral impingement, posterior impingement, FHL, Tib post, fibularis (peroneus) brevis, Achilles, tendinosis/tenosynovitis, talar dome contusions/lesions.
Leg Medial tibial traction enthesitis (shin splints), tibial/fibular bone stress/fracture, STFJ sprains, medial head gastroc strains, some exertional compartment syndromes.
Knee PFJ syndrome, ITBFS, Unicompartmental OA, degenerative meniscal tears, pes anserinus bursitis, Biceps femoris bursitis, Osgood-Schlatters, Sinding Larsen Johannson S, patellar tendinosis.
Hip Trochanteric, gluteus medius, Tensor fascia lata bursitis/tendinosis, hamstring tears /tendinosis, acetabular labral tears, limited area OA, otherwise THR/resurfacing.
L/S spine; facet arthralgias, some discogenic pain (via leg length and postural correction).
Foot and Ankle surgery. Full length orthotic to improve stability and comfort of ORIF, osteotomy, fusion, osteochondroplasty, tenoplasty etc in a walking boot or long term.
Attention to appropriate shoes, training errors, cross training, coexistent disease.
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