Module 7 Subtalar Control Foot Orthosis Overview Definition

Module 7 Subtalar Control Foot Orthosis

Overview • Definition of Subtalar Control Foot Orthosis (SCFO) • Fabrication of SCFO • Patient evaluation/assessment • Indications for use of a SCFO • Negative impression techniques

SUBTALAR CONTROL FOOT ORTHOSIS Defined A SCFO is defined as a custom device designed to manage the function of the anatomy distal to the ankle joint by primarily controlling the ROM of the subtalar joint.

SUBTALAR CONTROL FOOT ORTHOSIS, 2 • The Proximal Height is determined by the musculotendinous junction of the gastrocnemius and the Achilles tendon.

SUBTALAR CONTROL FOOT ORTHOSIS, 3 • PLASTIC-IN-LEATHER GAUNTLET STYLE ANKLE FOOT ORTHOSIS: • Patient specific considerations 1. Closure: Laces vs. Velcro 2. Plastic inner: Flexible vs Rigid 3. Full length vs. partial 4. Soft interface or not

PATIENT EVALUATION/ASSESSMENT • History • Patient Assessment : § MMT § ROM § Joint Stability § Observational gait analysis

INDICATIONS FOR USE OF A SCFO • Chronic ankle instability • Posterior tibial tendon dysfunction (PTTD) • Charcot disease of the foot • Degenerative joint disease (DJD) • Arthritis (Osteo, Rheumatoid, Gout, etc. ) • Foot and ankle trauma • Partial foot amputation

Taking a Negative Impression Alignment and positioning is critical for control of a body segment with an orthosis or prosthesis. This means that an accurate cast must be taken.

Negative Impression Techniques • Conventional negative impression techniques that utilize plaster or synthetic resin tape • Require a barrier of stockinet to protect the skin and provide a mechanism to contain soft tissue • Latex tubing is used as a cut strip for cast removal with a cast saw and the bony landmarks are indicated with an indelible (water-based pencil) • Here a limb is prepped for the application of the molding material

Negative Impression Techniques, 2 • Fiber resin tape is a applied by wrapping the extremity circumferentially • To avoid excessive tissue displacement from the application of the material minimal tension is applied • Note that a special foot plate board is used to emulate the shoe interface • Maintain the foot and ankle at 90 degrees if possible and cast a minimum of 1 inch higher than the proximal trim line of the gauntlet.

Negative Impression Techniques, 3 • After the molding material has set the negative impression is removed • A cast saw is used to create an opening for removal • The limb is protected by the latex tube applied in the preparation phase

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