Orthotics in Sports Overview (03:31)
Dr. Tim Dutra thanks sponsors and describes starting as a high school athletic trainer before becoming interested in the biomechanical aspects of podiatry and orthotics. He approaches lectures from a practical perspective.
Podiatry in Sports Medicine (01:30)
Muscle dysfunction from footwear contributes to injuries. Dr. Dutra treats athletes with chronic, biomechanical based injuries.
What is an Orthotic? (01:20)
An orthotic is a device used to support or improve function of the foot and ankle. The mechanism of achieving treatment effects is debatable, but there is 70-80% of patient satisfaction. Podiatrists now treat all types of athletes.
Orthotic Options (02:06)
Over the counter types are softer to fit various foot types. Prescription types are accommodative and semi-rigid; custom orthotics offer the most functional control. Podiatrists train in biomechanics, gait analysis, orthotic modifications, and prescriptions. Learn about custom types and materials.
Orthotics in Sports (02:54)
Podiatrists aim to improve biomechanical control. Orthotics are used to treat heel pain, lateral ankle instability, patella femoral pain syndrome, medial tibula stress syndrome, and shin splints. Shoe types are Dr. Dutra's biggest challenge in treating different sports.
Casting Techniques Review (01:09)
Dr. Dutra outlines the neutral suspension, prone, vacuum, semi-weight bearing or foam box, and computer scanning casting techniques. With negative casting, the subtalar joint is placed in a neutral position; placement errors affect results.
Rearfoot Posts (01:13)
Rearfoot posts increase orthotic control via deep heel cups and rigidity. Most athletes do not want to be back on their heels. Dr. Dutra commonly makes a four degree varus rearfoot post with four degrees of motion.
Troubleshooting for Common Orthotic Problems (04:01)
Athletic trainers should ensure athlete compliance in wearing orthotics. Custom orthotics are easy to adjust, but constructing an orthotic to fit a shoe is difficult. Dr. Dutra explains how to correct plantar fascial irritation, anterior edge, and lateral edge irritation.
Heel Slippage (01:40)
Heel slippage is a common problem during the propulsion gait phase. Dr. Dutra uses calipers to measure the heel weight bearing pattern to cast a deep heel cup. Shoe design can also be responsible; Dutra recommends fitting shoes to orthotics.
Anterior Orthosis Irritation (03:43)
Dr. Dutra recommends skiving the anterior edge of the orthotic. Learn about managing heel cup irritation, lateral edge irritation, dorsal first MPJ pain, and fifth metatarsal head pain. Positive casts should reflect negative casts with the desired fill amount.
Pre-Fabricated vs. Custom Orthotics (02:47)
Pre-fabricated insoles are flat, contoured or biomechanical with a heel cup and arch. They are relatively inexpensive but fit a limited range of feet. Custom insoles allow for greater control, but diverse athlete weights and types are a challenge.
Sports Orthotics Challenges and a Step-Wise Approach (04:02)
Challenges include durability, control, comfort during sporting activity, fit in athletic shoe, and modifications. Dr. Dutra recommends identifying patterns; establishing goals; and evaluating available options for type and chronic injury use. He always seeks to decrease symptoms and increase function.
Recognize Patterns (02:01)
Medial column overload leads to medial tibia stress syndrome, posterior tibial tendinitis, or plantar fasciitis. Lateral column overload results from a cavus foot type. Increased metatarsal head pressure leads to pain or sesamoids. Dr. Dutra discusses appropriate orthotic responses.
Medial Column Overload (01:36)
Medial heel skives and deep heel cups are effective for pronation injuries. Athletic podiatry challenges include individual biomechanics, sports, and shoes.
Lateral Column Overload (02:27)
Stabilizing shoes are important for peroneal tendonitis and iliotibial band syndrome. Flanges help lateral ankle instability, provided there is room in the shoe. Increased metatarsal head pressure athology includes pes cavus pressure, equinus, and hallux abducto valgus caused by pronation.
Common Orthotics Goals (01:25)
Orthotics attempts to address biomechanics and transfer pressure more evenly over the foot. Podiatrists should evaluate options, including topcover refurbishment.
Cast Work Options (03:30)
Orthotic options include heel cup depth, cast fill, width, skive, inversion, sweet spot, and plantar fascia groove. Fill depends on patient age, weight, and medical history. The right shoe is crucial to orthotic effectiveness.
Posting, Topcover and Forefoot Options (01:42)
Most forefoot posting is intrinsic. Material is important for heel cushioning. Cobra orthotics allows the heel to contact the insole, and are ideal for sprinting shoes. Topcover options include nylene, leather, vinyl, EVA and hybrids.
Orthotic Prescription Summary (01:40)
Orthotic prescription should be as detailed as possible, take specific sports into account, and be tolerated by the athlete. Response to athletic taping and biomechanical and gait evaluations help predict success. View a list of custom options.
Orthotic Adjustments (03:31)
Allow for a break in period before initial adjustments; in case of multiple adjustments, podiatrists may want to re-cast orthotics. Athletes may need multiple pairs for different shoes. Trainers should ensure compliance and monitor orthotics periodically.
Goals and Expectations (02:13)
Athletes should avoid using orthotics in broken down shoes. View a list of common uses for semi-rigid orthotics. Orthotics increases function for optimal performance and decrease symptoms or injury; they are not a cure-all and do not replace rehabilitation.
Casting Orthotics Overview (02:43)
Dr. Karen Langone discusses the importance of making a correct casting and explains the neutral alignment concept.
Taking a Foam Orthotic Impression (01:10)
See a video on achieving neutral alignment when casting in Bio-Foam. Patients must achieve good seated alignment during the process.
Taking a Plaster Orthotic Impression (01:57)
Most podiatrists take impressions with plaster. Dr. Langone discusses pros and cons of taking impressions in off weight versus semi-weight bearing positions. See a video of plastering a patient's foot.
Concluding Thoughts on Orthotics (03:39)
Dr. Langone discusses advantages of using digital scanning to take orthotic impressions. Getting the correct impression is crucial for compliance and results. She recommends Matt Werd's "Athletic Footwear and Orthoses in Sports Medicine."
Credits: Orthotics in Sports (00:24)
Credits: Orthotics in Sports
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