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Foot Orthoses Notes

Metatarsal bars and rocker bottoms are shoe modifications used to treat various foot conditions. Metatarsal bars reduce pressure at the metatarsal heads during push-off, while rocker bottoms redistribute forces and facilitate a smooth gait. Forefoot posting techniques realign skeletal structures using intrinsic or extrinsic corrections to address deformities like valgus or varus. Heel cushions and metatarsal pads provide cushioning and relief for conditions involving fat pad atrophy or painful calluses.

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Sangeetha Gnaneswaran
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44 views

Foot Orthoses Notes

Metatarsal bars and rocker bottoms are shoe modifications used to treat various foot conditions. Metatarsal bars reduce pressure at the metatarsal heads during push-off, while rocker bottoms redistribute forces and facilitate a smooth gait. Forefoot posting techniques realign skeletal structures using intrinsic or extrinsic corrections to address deformities like valgus or varus. Heel cushions and metatarsal pads provide cushioning and relief for conditions involving fat pad atrophy or painful calluses.

Uploaded by

Sangeetha Gnaneswaran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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• Metatarsal Bars and Rocker Bottoms 


A metatarsal bar is a block of stacked leather or rubber pieces.



It is attached to the sole of the shoe. 

PLACEMENT:  Just Proximal to metatarsal heads 

USE: significantly reduces pressure at the metatarsal heads during the push-off
phase of 

the gait cycle.

CONDITIONS: Patients with transmetatarsal amputations, Fixed arthritic
deformities, diabetes, forefoot deformities such as hallux rigidus, and neuromas. 

MECHANISM: 

Facilitates push-off by simulating forward propulsion in the absence of metatarsal
flexibility. 

Rocker bottoms

Made of either lightweight crepe or leather 

These modifications are flush with the heel and toe, in an arch 

USES: 

1. The rocker bar redistributes body forces over the entire plantar surface of 

the foot while in weight bearing.

 2. It facilitates a smooth roll during the stance phase of gait by reducing sheer
stress and trauma to the midfoot and forefoot. 

3. Helps with forward progression of tibia during mid and late stance

CONDITIONS:

partial foot amputations, arthritis, and diabetes. 

It is also used for patients who have any lower 

extremity orthosis that limits forward progression of the tibia 

over the foot and toes during mid- and late-stance phases. For 

patients with diabetes, a rigid rocker sole (a steel-spring heel

to-toe with the toes extended and a rocking axis near the cen

ter of the foot) can be used to help distribute body weight and 

compel knee flexion at toe-off, reducing the length of stride 

and sheer stress on the metatarsal heads. 

 

Thomas Heels 

USES: Helps to achieve neutral subtalar joint

1.  Improve foot balance and relieve excessive pressure on the shank portion of the
foot

wear. Applied as either a lateral or a medial flare of the heel, its 

goal is to increase stability during gait by assimilating subtalar 

neutral. A laterally flared heel is used with a rearfoot varus to 

decrease the incidence of inversion injuries. A medially flared 

heel is used with a rearfoot valgus to decrease the incidence 

of eversion injuries For instance, a medial flare 

from the heel to the sustentaculum tali prevents excessive 

pronation of the foot during gait.

 

Forefoot Posting 

Two techniques can be used to provide orthotic correction 

for forefoot deformity. Both are based on modification of the 

positive cast impression. The first, a traditional Root func

tional orthosis, uses an intrinsic correction. A plaster plat

form is applied to the positive cast at the level of the MTP 

joints to balance the abnormal forefoot to rearfoot relation 

(Figure 8-25). A lateral platform corrects forefoot valgus, and 

a medial platform corrects forefoot varus.

45


When the shell is 



pressed over the modified positive mold, it creates a convexity 

at the distal anterior border of the orthosis. This posting tech

nique achieves correction by effectively realigning the skeletal 

structure of the foot.

89


The intrinsic posting technique is often 



selected when shoe volume is limited, as in some women's 

footwear.

A second forefoot posting technique involves a variation of 

Root's original design, referred to as a standard biomechani

cal orthosis. In this technique, a neutral platform is formed 

on the positive mold, but the existing valgus or varus posi

tion of the forefoot is maintained. An extrinsic forefoot post or 

wedge is attached to the bottom of the orthotic shell to support 

the forefoot in its position of deformity. Unwanted compensa

tory motion is prevented by stabilizing the distal border of the 

orthosis (Figure聽8-26). Although an orthosis with an extrinsic 

correction takes up more space inside the shoe than an intrin

sically corrected orthosis, it can more easily be modified if 

the individual has difficulty tolerating the original posting 

prescription. 

.

 

 


HEEL CUSHION

Heel cushion Placed in the heel cup of the orthosis to enhance heel
cushioning and shock absorption. Often made of the soft 

tissue–supplementing material Poron (Rodgers Co., Rogers, Conn.)
or a viscoelastic polymer. 

USES: Used when irritation or atrophy of the infracalcaneal fat pad
is present or for calcaneal stress fracture.

 

 


METATARSAL PAD:

A U-shaped pad positioned beneath a rigid plantar flexed metatarsal head to relieve pressure
from a painful callosity. Often used for hammertoe deformity

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