dr. jack dolbin session 71 orthotic evaluation: dynamic evaluation: internal tibial rotation most...

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 11

Orthotic evaluation:Orthotic evaluation: Dynamic evaluation: internal tibial rotation Dynamic evaluation: internal tibial rotation

most signifigant.most signifigant. Palpatory exam of foot and ankle: Pain on Palpatory exam of foot and ankle: Pain on

navicular, lateral talus, medial knee jointnavicular, lateral talus, medial knee joint Navicular Drop: Unloaded/loadedNavicular Drop: Unloaded/loaded Angle between anterior tibia-1Angle between anterior tibia-1stst metatarsal metatarsal

Orthotic Prescription Orthotic Prescription

Orthotics and Plantar Orthotics and Plantar FascitisFascitis

The use of foot orthotics in patients with The use of foot orthotics in patients with plantar fascitis appears to be associated plantar fascitis appears to be associated with reduced pain and increased functionwith reduced pain and increased function

Exercise and Sports Injury Laboratory, Exercise and Sports Injury Laboratory, Sport Management program, University Sport Management program, University of Virginia. Epub, 2008 Nov. 20of Virginia. Epub, 2008 Nov. 20

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 22

Plantar FascitisPlantar Fascitis

Foot orthotics is the best choice for initial Foot orthotics is the best choice for initial treatment of plantar fascitis.treatment of plantar fascitis.

Dept. of Orthopedics, Lund University, Dept. of Orthopedics, Lund University, Lund, Sweden. Foot Ankle Int. Aug. 27, Lund, Sweden. Foot Ankle Int. Aug. 27, 20062006

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 33

Effect of different Effect of different Orthotics as first line Orthotics as first line treatment of PFtreatment of PF

Foam covered rigid orthotics are superior Foam covered rigid orthotics are superior regarding pain reduction and pain free regarding pain reduction and pain free time when compared to thin non time when compared to thin non supporting or soft supportive orthotics.supporting or soft supportive orthotics.

Department of foot and ankle surgery: Department of foot and ankle surgery: Jun: 19, 2013.Jun: 19, 2013.

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 44

PatelloFemoral PainPatelloFemoral Pain

Custom made foot othotics were found to Custom made foot othotics were found to be an effective conservative treatment to be an effective conservative treatment to reduce the symptoms of PF pain.reduce the symptoms of PF pain.

Prosthet Ortho Int. 2011, Dec. Epub 2011 Prosthet Ortho Int. 2011, Dec. Epub 2011 Sep 26.Sep 26.

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 55

Patellofemoral Pain Patellofemoral Pain SyndromeSyndrome

Foot orthotics provide immediate Foot orthotics provide immediate improvement in functional performance improvement in functional performance associate with pronation.associate with pronation.

Br. Journal of Sports Medicine: 2011 Br. Journal of Sports Medicine: 2011 Mar.Mar.

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 66

Orthotics and Low Back Orthotics and Low Back PainPain

Abstract: Hyper pronation plays a Abstract: Hyper pronation plays a fundamental role in the development of fundamental role in the development of low back pain.low back pain.

Foot orthotics improved symptomsFoot orthotics improved symptoms

Prosthe Ortho Inter. 2013 Jan, 17Prosthe Ortho Inter. 2013 Jan, 17

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 77

Patient compliancePatient compliance

70% were able to return to previous level 70% were able to return to previous level of activity with the use of foot orthoticsof activity with the use of foot orthotics

94% still wearing Orthotics after a year.94% still wearing Orthotics after a year. 52% : not leave home without them52% : not leave home without them 96% reduced pain96% reduced pain JOSPT 1988; 10 (6)JOSPT 1988; 10 (6)

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 88

Dancers with Dancers with hyperyperpronationhyperyperpronation

Dancers in this study demonstrated a Dancers in this study demonstrated a high rate of compliance and experienced high rate of compliance and experienced a significant reduction in pain.a significant reduction in pain.

J Dance Med Sci: 2013; 17J Dance Med Sci: 2013; 17

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 99

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1010

Posterior Tibial TendonPosterior Tibial Tendon

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1111

Flexor Hallucis LongusFlexor Hallucis Longus

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1212

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1313

Orthotic PrescriptionOrthotic Prescription

InspectionInspection Observation: Static-DynamicObservation: Static-Dynamic Palpation: Navicular, Cuboid, Talus, Palpation: Navicular, Cuboid, Talus,

Calcanius, Cuneiform, Metatarsals, Calcanius, Cuneiform, Metatarsals, Phalanges. Phalanges.

Stability: Navicular DropStability: Navicular Drop

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1414

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1515

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1616

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1717

Corrective insertsCorrective inserts

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1818

Inserts Cont.Inserts Cont.

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 1919

Calcaneal Calcaneal Inversion/EversionInversion/Eversion

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2020

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2121

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2222

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2323

Effects of Pronation

Pronation, internal tibial Pronation, internal tibial Rotation, Valgus KneeRotation, Valgus Knee

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2525

PronationPronation

Medial Tibial stress SyndromeMedial Tibial stress Syndrome Lateral Compartment SyndromeLateral Compartment Syndrome Medial Jt. Line painMedial Jt. Line pain Piriformis syndromePiriformis syndrome Medial Collateral Lig. BursitisMedial Collateral Lig. Bursitis L5-S1 Facet SyndromeL5-S1 Facet Syndrome Atlas side bent to side of pronationAtlas side bent to side of pronation Bone edemaBone edema

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2626

Running PronatonRunning Pronaton

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2727

Extremity AdjustmentExtremity Adjustment

TalusTalus CuboidCuboid NavicularNavicular Head of FibulaHead of Fibula KneeKnee HipHip SI JointSI Joint

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 2929

Talo-Navicular AxisTalo-Navicular Axis

Line Up;Line Up;

Talus-Nav.-Ist Cune- !st metatarsalTalus-Nav.-Ist Cune- !st metatarsal

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3030

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3131

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3232

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3333

ProcessProcess

AlignAlign

MarkMark

MeasureMeasure

CorrectCorrect

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3434

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3535

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3636

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3737

Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3838

Exercize PrescriptionExercize Prescription

Mobilize: Roll the BallMobilize: Roll the Ball

F-H-L: Great toes flexion: Curl the towelF-H-L: Great toes flexion: Curl the towel

Tibialis Anterior/Posterior Adduction with Tibialis Anterior/Posterior Adduction with dorsal flexion. 45 degree angle.dorsal flexion. 45 degree angle.

Preceeded by MPT and ME.Preceeded by MPT and ME.Dr. Jack Dolbin Session 7Dr. Jack Dolbin Session 7 3939