High arch foot orthopedic insole treatment
The insole treatment plan should be designed according to the different conditions of each patient. Mild deformities, such as simple and valgus high arch feet can be treated with orthopedic shoes. Moderate to severe deformities, such as calcaneal and plantar flexion high arched feet, are often treated with tendon transfer and lengthening, plantar fasciotomy, wedge osteotomy of the middle tarsal joint, or three-joint fusion of the foot.
1. High arch foot orthopedic insole design
The biomechanical problem of the high arch foot is that the lateral longitudinal arch of the foot is not fully supported, and there is often a hollow feeling directly under the foot when standing. When standing, not only the stability is poor, but the ability to absorb the impact from the ground is reduced. The production of high arch foot insoles considers the following principles:
a. General principles
The foot has three main functions: cushioning, support and rolling, so the high arch foot orthopedic insole must first meet the three major functional requirements. Patients with high arch feet often show excessive pressure on the outside of the foot, decreased support and cushioning capacity of the outside arch, and abnormal patterns of the center of gravity line moving out too much when the sole rolls. When designing the insole, strengthen the support of the entire lateral arch of the heel and the forefoot. At the same time, avoid excessive pressure support on the medial arch or midfoot, increase the chance of pronation of the midfoot and forefoot, and transfer excessive pressure on the forefoot and hindfoot. Concentrate, guide the center of gravity to move to the inside, reconstruct the normal transfer line of the center of gravity and the normal rolling of the soles, and avoid secondary damage to the lower limbs and spine.
b. Principles of skeletal correction
For simple high arch feet that can be corrected by manipulation, a pair of forces can be supported on the heel back and forefoot metatarsals to reduce the arch height, and reduce the anterior inclination angle of the calcaneus; for companions Forefoot, varus or valgus, forefoot pronation and pronation deformity, high arch feet, should be performed based on correcting the deformities of the hindfoot and forefoot. If you can put downward force on the midfoot while wearing shoes, the effect will be even greater.
c. Principles of muscular nerve stimulation
For patients with the high plantar fascia and posterior calf muscle tension, in the design of the insole, proprioceptive stimulation is applied to the plantar muscles and posterior calf muscles at the stop point of the metatarsal head to relieve the stress of the plantar muscles and aponeurosis. Tension creates opportunities for lowering the arch height.
d. Buffer principle
When designing the insole, consider the use of certain elastic materials such as EVA to improve the overall cushioning capacity of the high arch foot, and use materials with elastic cushioning properties to relieve the local concentrated pressure of the hind and forefoot; attention should be paid to maintaining the appropriate support of the arch. The arch of the foot is elastic to reduce the impact on the joints of the lower limbs and the spine and avoid injury.
e. The principle of gait rolling adjustment
When the human body walks, the sole completes the four supporting rolling processes of heel landing, foot flattening, metatarsophalangeal joint rolling and toe kicking on the ground, and an arc transfer process of the center of gravity.
For high arch feet, it often shows that the hindfoot varus is too large when rolling with the ground, the foot is flat and the lateral weight is too much during the midfoot rolling process, the forefoot is in the varus position, and the forefoot pronation is too much, causing the four toes to suffer. Increased force; At the same time, abnormal phenomena such as excessive force when the big toe rolls on the ground and the shifting of the center of gravity line are too outward. When making insoles, the effects of the hindfoot, midfoot pronation, and forefoot supination should be increased, and the center of gravity transfer line should be adjusted to move inward. However, for the so-called high arch feet that exhibit high arches when the soles are rolling, pronation of the midfoot, insufficient pronation of the forefoot, and high arches in the static state, they need to be treated differently.
For high arch feet with relatively stiff deformities, to improve plantar rolling and reduce plantar pressure too much concentration, and improve the treatment effect of high arch feet and walking gait, personalized customized orthopedic shoes can be used to improve the treatment of high arch feet. This personalized orthopedic shoe is designed to raise the heel to reduce the pressure on the heel while reducing the heel angle to maintain the tendon and soft tissue traction on the arch of the foot. By changing the angle of the rolling edge, it reduces the pressure on the metatarsophalangeal joints. At the same time, with the forefoot upturning, it can better improve the sole rolling and improve the walking ability.
2. Indications and clinical application of orthopedic insoles
a. According to types and indications of insoles for treatment of high arches and the pathological characteristics of high arches, high arches insoles are often divided into supportive and corrective insoles.
(1) Supporting insoles are mainly based on maintaining the height of the arch, dispersing the excessive concentration of the plantar pressure, reducing the stretching force of the plantar muscles and soft tissues, adjusting the curve of the center of gravity movement, and increasing the overall cushioning capacity of the plantar. It is mainly suitable for high arch feet whose bony structure is difficult to correct due to bony and muscle reasons. For heel foot and plantar flexion high arch foot, it is also necessary to cooperate with personalized orthosis and shoes to improve foot deformity, plantar rolling, and change the position of rolling edge to better improve the treatment effect.
(2) Corrective insoles commonly include three-point force corrective insoles and body irritating insoles. The three-point force corrective insole can correct the patient mainly by adapting to the bone structure. Proprietary stimulating insoles are mainly suitable for patients with high arched feet caused by high muscle tension. Its main principle is to reduce muscle tension by giving pressure stimulation to the attachment of the hypertension muscles, thereby correcting the arch of the foot.
b. Insole design
The lower layer of the first metatarsal head is decompressed, and the calcaneus and the fourth and fifth metatarsal heads are decompressed. Pre-selection of the midfoot and forefoot of the hindfoot is to raise the lateral side of the foot to increase the support and correction of the lateral arch of the hindfoot and the forefoot. The medial bow is lowered, and rigid support and elastic cushioning materials are used to make the insole.