ABSTRACT
CONTENTS I. Introduction ...................................................................................................................... 423
A. Prefabricated vs. Custom-Molded ............................................................................. 424
B. Mechanical Function and Control Mechanisms........................................................ 424
1. Arch Support Mechanisms.................................................................................. 424
2. Wedges ................................................................................................................ 425
3. Heel Lifts and Elevations .................................................................................... 425
C. Orthotic Principles and Biomechanical Considerations ............................................. 425
D. Diagnostic Tests to Determine Pain Reduction Potential.......................................... 426
1. Medial Column Load-Bearing Test..................................................................... 426
2. Lateral Column Load-Bearing Test .................................................................... 426
3. Hindfoot Load-Bearing Test ............................................................................... 428
E. Negative Impression Technique Considerations ........................................................ 428 II. Orthotic Treatment of Fractures ....................................................................................... 429
A. Phalanges................................................................................................................... 429
B. Metatarsals ................................................................................................................ 430
1. Stress Fractures ................................................................................................... 430
C. Sesamoid Bones of the Great Toe.............................................................................. 430
D. Navicular, Cuneiforms, and Cuboid.......................................................................... 431
E. Talus .......................................................................................................................... 432
F. Calcaneus................................................................................................................... 433
G. Ankle ......................................................................................................................... 433 III. Conclusion ........................................................................................................................ 436 References .................................................................................................................................. 437
I. INTRODUCTION
Certain fractures of the foot and ankle can be treated through external support with various types of orthoses. They are primarily used to immobilize and hold the injured segment following reduction of the fracture. Stabilization and maintenance of the fracture reduction is accomplished with a variety of materials such as plaster of Paris, fiber resin tape, metals, and plastics. Despite the variety of materials used, the three-point force system, hydrostatic pressure, and total-contact fit are common principles employed in orthotic fracture devices. While techniques for orthotic
management of long bone fractures are well established [1], their applicability for fractures of the foot and ankle often require different considerations. Moreover, there are few studies that have assessed the effectiveness of fracture orthoses specific to the foot. Accordingly, this chapter reviews clinically accepted orthotic principles for fracture management and provides a practical guide for orthotic treatment of specific types of fractures.
