Flat foot,smo, supra mallelor Orthosis

1. An orthotic clinical case
presentation on flat foot
Presented by - Amisha Bharti
Bpo-2019

2. Introduction
•Flat foot, also known as pes planus, is a condition where the arches of the
feet collapse, causing the entire sole to come into contact with the ground.
• It can be congenital (present from birth) or acquired later in life due to
various factors such as injury, aging, or repetitive stress on the feet.

3. Types
-
flexible
-
This type of flat foot is characterized by a visible arch when
the person is sitting or standing on tiptoes, but the arch
flattens when weight is placed on the feet.
Rigid
-
Rigid flatfoot is less common and more severe. In this type,
the arch remains flat even when the foot is not bearing weight.
Rigid flatfoot can lead to foot pain, stiffness, and difficulty
with mobility.

4. Causes-
•Achille's tendon injuries
•Broken bones
•Cerebral palsy
•Diabetes
• Down syndrome
•High blood pressure
•Obesity
•Rheumatoid arthritis

5. Medical history
Past medical history
-
Present medical condition
-
Vitamin D deficiency
She is taking medicine for Vitamin D deficiency and
UTI
Physical therapy is not performed by patient
Previously no any orthotic device is used by patient
Theruapatic history -
Orthotic history -

6. On observation
• Affected side- Both side foot involvement.
• Patient is walking on the medial border of
foot.

7. Dorsiflexion
(rt.)
Plantar
flexion
(rt.)
Ankle
Dorsiflexion
(lt.)
Plantar
flexion (lt.)
Active Passive
Range of motion
10
°
65
°
15
°
50
°
12
°
15
°
70
°
75
°

10. Manual muscle testing
Ankle dorsiflexion -4+
Ankle plantarflexion-4+

11. • The Feiss line test, also known as the navicular drop
test, is a clinical assessment used to evaluate the
flexibility of the foot arch and to determine the flat feet
condition.
Special test

12. • Marking the navicular tubercle, medial malleolus, and the first
metatarsophalangeal (MTP) joint with a marker.
• Drawing a straight line from the medial malleolus to the MTP.
• If the navicular sits below the Feiss line then the test is Positive.
Feiss line
test

13. • Jack's test is performed in a weight bearing/ standing condition.
• The patient is to stand in a normal, relaxed position.
• The clinician then passively flexes the 1st metatarsal joint (big
toe).
• The "Jack test" is a clinical
assessment used to evaluate
the flexibility of the foot arch
and to diagnose flat feet.
Jack test

14. Wet foot print
test
• The wet foot print test is a method
used to determine an individual's
arch type (flat, normal, or high).
• To perform the test, one simply
wets their foot, then steps onto a
piece of paper that will leave a
visible footprint.
• By examining the shape of the
footprint, it is determine whether
their arch is low, normal, or high.

16. Problem identified
• Pain and discomfort in the foot, especially after standing or walking for
long period of time .
• Reduced stability and balance of the foot.

17. Orthotic prescription
Bilateral supramalleolar Orthosis
Orthotic goal:-
•Provide support to the arches of foot.
•Align the foot and ankle in neutral position.
•Reduce Pain and Discomfort.
•Improve the stability and balance of the foot,

18. Fabrication process
•Circumferential measurement
Maximum calf
•Linear measurement
foot length
Medial malleoli to lateral malleoli
Medial malleoli to heel to lateral malleoli
Meta tarsal width
Measurement:
-

19. cont
.
• Take 4 layer bandage of plaster of paris deep it in water squeeze it.
• Cover the foot piece properly and take the impression.
• The foot must maintain plantegrate position.
• Wrap overall surface by another bandage.
• Make a semi liquid mixture of water and plaster of paris powder And
pour it in negative cast.
Pouring-
Casting-

20. Check the postive mould is according to the taken measurement or not.
Add or remove material from the surface where it required
Modification
-
Moulding -
Take 4mm polypropylene sheet & put it on oven for 20-30 minutes
then wrap over the positive mould.
Strapping and padding
-
After taking trial of patient,Apply the velcro strap and evathin foam
on required area.Lastly, cover the edges by Nappa leather.

21. Modification Moulding

22. Supramalleolar Orthosis

23. Orthosis with patient

24. Gait analysis

25. Checkout
• Orthosis is as per the prescription.
• Donning and doffing easily.
• Satisfactory appearance or cosmesis.
• Satisfactory general workmanship.

26. Wearing schedule
• During weight-bearing activities or when additional
support is needed, such as during walking or standing for
extended periods.

27. Follow up
• The first follow-up visit after 1 month
.

28. Thank you