Comprehensive Two-Day Course on Foot Orthoses Theory, understanding and Practical

Introduction

• The primary objective of this course is to provide a comprehensive understanding of all aspects required to enhance and maintain high-quality foot orthosis practice. While biomechanics plays a central role, the course also emphasizes the critical importance of material selection, cost considerations, necessary equipment, footwear integration, scanning techniques, gait assessment, patient communication, psychological aspects of care, practical adjustments, troubleshooting, and the variability inherent in clinical practice as integral components of effective orthotic therapy.

• The course will be divided into two components: theory and practical. The practical component will focus on hands-on skills such as gait assessment for walking and running, scanning techniques, grinding, modifications, adjustments, covering, posting, heating, and other invaluable tips and tricks not typically found in textbooks. This will constitute approximately 30% of the total course time.

• Foot orthosis care is both proactive and reactive in nature. Understanding how to adjust to the ever-changing patient is essential.

The vision & why do we need to do it.

• Education targeted to one of our core treatment options was lacking.

• We service the MSK community and want to be better.

• You don’t know what you don’t know. Years of experience in the nuanced application of foot orthosis is unmatched by any paper. Documenting that is a must.

• Pods have to play this role for this MD team. We own this space uniquely.

• If you aren't efficient/confident, you won’t do it. (do the mods, make it for yourself and learn the interactions)

There will be three distinct areas the course will run through

1. Grinding Area: Equipped with Namrol units that include their own dust extraction systems for a clean and safe working environment.

2. Material Area: Features benches practical instruction and demonstrations.

3. Theory area: Screen for theory.

We will rotate between these areas over the two days to ensure a comprehensive learning experience. Some topics will be covered by guest presenters, such as lab owners or technicians, who will provide insights into specific processes like modeling.

Sponsors: Sponsors will include orthosis manufacturers and equipment providers, ensuring participants have access to high-quality tools and materials. The cost of the course will include all necessary equipment and materials.

Practical Component: Participants will break into groups to practice the skills covered in the theory sessions. For example:

• Marking up forefoot deflections and positioning valgus wedging based on theoretical principles.

• Applying these techniques hands-on in a collaborative group setting.

• Assessing the foot and conducting gait analysis

This approach ensures participants can directly apply their learning in a supportive and interactive environment.

Course Content

Day 1

Principles and theory of lower limb Biomechanics and foot orthosis

• Learning Objective: Understand the foundational principles and biomechanics underpinning foot orthoses and the lower limb to apply them effectively in practice. Understand the kinetic chain, its variability, and the current theory of function.

• Understand foundational principles:

  • Kinetics

  • Kinematics

  • Levers

  • Axis position

  • Foot posture

  • Forces (tensile, compression, etc),

  • Joint Angle and Function of the lower limb

• Current theories of foot function (2024 perspective vs. historical views): Preferred Movement Pathway, STJ Axis Location/Rotational Equilibrium Theory of Foot Function, Kinetic chain theory, etc.

• Why do theories work? Understanding the window of effectiveness and how to use that to our advantage

• Understanding how different tissues tolerate stress (Bone, tendon, cartilage, etc)

• Understand Tissue Stress Theory

Assessing the Foot and Lower Limb (Practical)

• Learning Objective: Develop the ability to assess the lower limb to guide orthotic prescription.

• Learn what tests are indicated, such as:

  • Forefoot to rearfoot relationship: Forefoot varus, supinatus, valgus.

  • Navicular drop and drift.

  • Leg length differences.

  • Supination resistance.

  • Stance position

  • First ray and lateral column

  • Lunge test

  • Leg length differences.

• Techniques for:

  • Evaluating flatfoot and cavus foot types.

  • Using weight-bearing and non-weight-bearing assessments.

• Understanding how assessments inform foot orthosis prescription:

  • Linking assessment outcomes to specific orthotic design features.

  • Adjusting orthotic prescriptions based on individual foot mechanics and pathology.

Material Selection, Design Features, and Equipment

• Learning Objective: Learn how to choose appropriate materials and tools for orthotic prescription. We will touch on almost all potential features.

• Understand the possible orthosis features:

  • Posts (rearfoot posting, inverting, and everting).

  • Heel cups.

  • Shell thickness.

  • Flexibility vs. rigidity: What factors influence this?

  • How to assess what someone can tolerate.

  • Different shell materials - Poly vs. EVA (soft, medium, dual density), P11.

  • Adding to the cast.

  • Arch contouring.

  • Lateral and medial flares.

  • Medial buttress.

  • Shell width.

  • Accommodations for bony prominences.

  • Tissue expansion.

  • Deflections

  • PMP/metatarsal pads.

  • Covers.

  • Cuboid notch.

  • Skives.

  • Top cover materials: How to select the appropriate type for different clinical needs.

• Understand different material properties and their applications. This includes a take-home cheat sheet on durability, use cases, fitting, moisture resistance, etc.

• Essential tools for prescription and modifications:

  • Grinders, pens, scissors, foam boxes.

• Materials needed in clinical practice: Costing and sourcing

Foot orthosis type and selection

• Understanding and selecting the right type of device.

• Foot orthosis and AFO types.

• Functional vs. accommodative.

• UCBL.

• Richie brace.

• Other off-the-shelf braces that can provide frontal and sagittal plane stability.

• Prefabricated, heat-molded, milled, 3D printed.

The argument against foot orthoses:

• Long-term use.

• Foot intrinsics changes

• Do they make feet weaker?

• How to communicate long-term vs. short-term use and assess which this person is most likely to fall into.

• Discussing long term foot orthoses with your key referrers.

Understanding Specific Pathologies

• Learning Objective: Identify and understand the biomechanics and orthotic management strategies for common pathologies.

  • Adult-acquired flatfoot

  • 1st MPJ pathologies (sesamoid, joint)

  • Tarsometatarsal injuries

  • Osteoarthritis (1st MPJ, Ankle, Midfoot, knee)

  • Plantar fasciitis (compressive v tensile)

  • Tibialis posterior tendinopathy.

  • Achilles tendinopathy.

  • Lateral forefoot issues.

  • Peroneal tendinopathy.

  • Stress fractures.

  • Patellofemoral pain.

  • Lower back pain.

  • MTSS

Scanning and Casting Techniques (Mix of practical and theory)

• Learning Objective: Understand scanning and casting techniques, differentiating between methods to capture accurate impressions for orthotic design.

• How does the scan influence your foot orthosis

• Overview of methods:

  • Weight-bearing vs. non-weight-bearing. The benefits and negatives.

  • Good vs. bad scans: Criteria and examples.

  • Handling tricky scans with unique feet.

• Tools and technologies:

  • Foam boxes.

  • Flatbed scanners.

  • 3D scanning

  • Plaster

  • Optical and photogrammetric scanning.

Footwear Influence on Orthoses

• Learning Objective: Understand how different footwear affects orthotic function and learn to adjust prescriptions for specific types of shoes.

• Impact of shoe types on foot orthosis

• Creating foot orthosis for open-toed shoes

• Fitting narrow shoes such as spikes and court shoes.

• Adjusting prescriptions for specific footwear:

  • Football boots.

  • Joggers.

  • Dress shoes.

  • Sneakers

  • Minimalist shoes

  • Maximist shoes

  • Racing shoes

Fitting Foot Orthoses into Shoes

• Learning Objective: Learn practical techniques for cutting, sizing, and fitting orthoses into different types of footwear.

• Techniques for:

  • Cutting and sizing orthoses.

  • Ensuring proper fit within footwear.

  • How to evaluate orthosis features for specific shoes.

  • Adjusting to common problems patients report - heel slippage, top of foot pain, secureness, room in the shoe.

Gait Analysis (Mix of practical and theory)

• Learning Objective: Develop skills in gait assessment techniques for walking and running, including treadmill and overground analysis.

• Fundamentals of gait assessment:

  • How the information you get influences foot orthosis and footwear advice.

  • Walking assessment set up.

  • Filming of walking - what angles and positions

  • Shod v not shod

  • Running assessment

• Techniques:

  • Treadmill vs. overground assessments.

  • Recording and interpreting gait data.

Day 2

Prefabricated foot orthosis (Mix of practical and theory)

• Learning Objective: Evaluate the indications for prefabricated and custom orthoses to make evidence-based clinical decisions.

• Debate: Indications for prefabricated.

• Types to use and stock:

  • Firmer

  • Softer

  • Contoured

  • How to assess which to use.

• Practical applications and examples.

• Settling the prefab vs. custom debate through clinical reasoning.

Practical Adjustments and Modifications (Mix of practical and theory)

• Learning Objective: Gain hands-on experience with key orthotic modifications, including arch adjustments, forefoot deflection, and more.

• Adjust and mark up different components of foot orthosis modifications.

• How to increase required force (supinatory, pronatory, etc)

• Techniques for:

  • Forefoot deflection.

  • Arch adjustments.

  • Heel posting.

  • Lateral wedging

• Specific modifications:

  • Medial and lateral posting

  • Understand what material to use

  • Increasing stiffness

  • Adjusting for footwear and comfort

Orthosis Labs

• Learning Objective: Understand the processes and communication strategies involved in working with orthosis labs to achieve optimal outcomes.

• Understanding modeling processes:

  • Negative and positive model methods.

  • Plaster, milling, and direct molding.

• Communicating effectively with labs:

  • Specifying custom requirements.

  • Explaining what you’re trying to achieve to the lab

Self-Auditing

• Learning Objective: Develop strategies for self-assessment and reflective practice to continuously improve clinical outcomes.

• Practical strategies for evaluating orthotic outcomes.

• Metrics for assessing patient satisfaction and clinical effectiveness.

• Continuous improvement through reflective practice.

Cost and Communication

• Learning Objective: Learn to effectively communicate and manage discussions around the costs of orthoses, addressing patient concerns and expectations.

• Topics include:

  • How to explain the cost of materials and charging for orthoses.

  • Strategies for discussing how orthoses work and their benefits.

  • Approaches for handling common patient frustrations related to cost or expectations.

  • Techniques for evaluating whether an orthosis is effective and providing reassurance to patients.

Psychological Aspects and Communication in Orthotic Practice

Learning Objective: Effectively communicate the role and benefits of foot orthoses to patients and health professionals, addressing concerns, setting expectations, and fostering collaboration.

Explaining Orthoses:

• Clearly explain the purpose and benefits tailored to the patient’s condition.

• Use evidence to show how orthoses address biomechanics and relieve pain.

Addressing Barriers:

• Reassure and educate to manage skepticism or resistance.

• Address concerns about dependence or foot weakening.

Setting Expectations:

• Communicate timelines for improvement and adjustment periods.

• Highlight long-term benefits while preparing for short-term discomfort.

Building Trust:

• Listen to concerns and involve patients in decisions.

• Build confidence with transparency and collaboration.

Collaborating with Professionals:

• Explain how orthoses fit into broader care plans.

• Educate referrers on when and why to refer.

• Use shared language for alignment on care goals.

Clarifying Misconceptions:

• Address myths about long-term use or foot weakening.

• Differentiate between functional and accommodative orthoses.

Case Management:

• Show how orthoses integrate into multidisciplinary care.

• Maintain communication with other professionals for cohesive treatment.