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Pedorthics - the practice of an orthotist focused treatment of the foot and ankle (conditions distal to talocrural joint) Types of foot orthoses - rigid semi-rigid accommodative 3 types of trim lines for foot orthoses - Full length Sulcus 3/4 length or metatarsal Full length trim line - -good starting length -terminates distal to toes Sulcus trim line - -needed for certain shoes (pointy toe) -terminates distal to MTP joints 3/4 or metatarsal trim line - -terminates proximal to MTP joints Components of hallux valgus - -Increased pressure on medial surface met head while in shoewear/callous -Valgus nature of 1st phalange> Affect pushoff/TST>PSw -Bursal inflammation -1st metatarsal abducted Causes of of hallux valgus - -genetics, structural- born that way -Shoewear? Women:men 9:1-Pes planus Management of hallux valgus due to pes planus - -full length orthoses Controls pronation and hence, medial rotation Management of hallux valgus due to footwear - Wider toe box Longer shoe Reinforced heel cup Hallux Rigidus - OA/DJD of 1st MTP resulting in decreased DF and PF -osteophytes may be painful Management of hallux rigidus - -Respect- limit motion- roll over without great toe extension -Shoe with rocker bottom -Rigid sole shoe to minimize toe break -Orthoses: full length orthoses, rigid or semi rigid, control pronation Sesamoiditis - localized irritation of 1-2 sesamoid bones -pain at plantar 1st MTP- during late stance Cause of sesamoitisis - -fx -loss of padding under area -1st MTP deformities -DJD -1st MTP often seen with turf toe (propulsion injury-hyperextension)Management of sesamoiditis - -full-length orthoses with dancer pad (redistributes weight to more pressure tolerant areas-MLA, mets 2-5) -offload plantar 1st MTP -adequate width shoe -stiff sole (minimize extension) -rocker sole Mortons neuroma - inflammation and thickening of digital nerve (usually digits 3 and 4) painful Management of Mortons neuroma - -teardrop met head pad -full length orthoses -offload irritated area -rocker bottom shoe, roomy wide toe box, stiff sole shoe -manual therapy Plantar fasciitis - inflammation of the plantar fascia at its insertion to the medial calcaneus "bone spur" Symptoms of Plantar fasciitis - pain with first steps in AM or rising after sitting Causes of Plantar fasciitis - -Overuse injury- sudden increase in mileage for walking or running -Tight gastroc- RX- stretch low load long duration -High BMI>25 -Loss of MLA OR elevated archManagement of Plantar fasciitis - -Gel heel cup (think control) -full length, semi-rigid orthosis -Strong arch support -footwear should have adequate length, shock absorption, and heel lift, cushion heel, rocker sole