Orthotic treatment can be adjusted in a functional position, which is possible to more or less passively emend by the leg defects. Using the orthotic braces by heavily fixed leg defects that cannot be passively fixed, leads only to lowered credibility of these methods. Common ambulant practice offers the option of correction of the improper position of any of the toes of the foot, including the big toe, further correction, functional ability of the foot in both longitudinal and transversal direction - flat foot. By incomparably lower percentage we can then with an average ambulant option try to recover the more complexive disorders on the basis of cognitive defects, injuries or trophic disorders (affecting the nutrition of the tissues and their growth).
LEG DEFECTS BY CHILDREN
Especially children in preschool age are usually diagnosed with metatarsus primus varus or metatarsi adducti (toes are directing inwardly, the foot is shaped into a C shape). Here it is prefered to wear specials shoes, which can be supplemented by a children’s supination orthotic insole (legs are in an X shape) which helps to correct the burdened position of the foot in the sense of pronation and supination (legs are in O shape or X shape). It is important to have the whole insole inserted in the standard passive children shoes with a firm heel part supplemented by the support.
Especially in preschool children, the metatarsus primus varus or metatarsi adducti (toes are directing inwardly, the foot is in a C shape) are not exceptions. Here is preferred so-called orthopedic footwear, which can be supplemented with a child's supine (X-leg) orthopedic insole. In the case of burdened and overloaded painful calf and front edges of the tibia, a child's supine insole (legs in X shape) is suitable for correcting the load on the leg in the sense of pronation-supination (legs in O shape or X shape). It is necessary to have a whole child's orthopedic prosthesis supplemented with a standard, passive children's footwear with a fixed heel. Children who are treated conservatively due to complicated congenital defects such as congenital talipes equinovarus = club foot and congenital vertical talus = rocker bottom foot, are recommended at the beginning of the treatment to wear adjusted orthopedic footwear. With gradual improvement in case of children with conservative treatment after surgery, it is possible to recommend children's medical footwear with a fixed heel and a well-designed orthopedic insole due to the type of defect. It is always necessary to pay attention to the correct size of the shoe. The orthopedic insole must be properly constructed and shaped according to the type of defect, preferably on the basis of a corrected gypsum model.
THE MOST COMMON LEG DEFECTS IN ADULTS
The most common problem in adulthood are various undesirable and unnatural positions of the toes, deflecting big toe, and problems with flat feet. Less frequent are residues (leftovers) of congenital defects or consequences of injuries. For correction of the toe position you can use various types of correctors, which are inserted into the shoe and they are made especially from foam and latex foam. For deflecting big toe you can use mass produced positioning bandages overnight. In case you are going to use some device to help you, you need to realize that it’s only adjusting the symptoms, not treating the problem and the cause of it.
By incorrect position and the way how to foot is lifted up from the ground, you can use orthopedic insoles. Special orthopedic insole is used in cases of trophic (related to tissue nutrition and its growth) changes of the soles of the feet, for example by diabetics. It is important to realize, that in adulthood the goal of using the orthopedic insoles is only to improve the action between the foot and surface. It is important to insert a correct size of the insoles into the shoes, definitely don’t use bigger or smaller insoles. Similarly as it is by children’s footwear, the insole works best with a quality shoe, from the view of construction the product should be ideally made from the corrected gypsum model. The insole should be strong enough and at the same time flexible, enabling the foot to lift correctly from the ground, it should not increase the height of the heel against the ground.
By more complex static defects of the feet we need to choose orthopedic shoes. According to the type and character of the foot we use the orthopedic individually sewed shoe. The type of the shoe is given by the option of using lasts (mechanical forms in shape of human foot), standard last without any adjustments can be used, or if it’s needed special lasts with adjustments are used instead. The orthopedic shoe of any type has to be in a certain position, in order for it to tolerate the anatomical differences of the affected foot, and at the same time it would transfer the weight of the body on the ground similarly as during physiological condition, that is, transferring the weight from heel to forefoot. In cases where you cannot adjust the insole, and most of the burden will not be transfered on the ground through the heel, but it is transferred through forefoot or even toes, using orthopedic insoles will become inappropriate and it is necessary to treat the damaged foot in a different way.
Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: MUDr. Michal Matějíček, CSc., Orthopedic clinic IPVZ, FN Bulovka, Prague