Helping Practitioners to Make Good Footwear Choices

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From left: Richard Schnaittacher, CPed, and Frank Caruso, CO, conduct an Aetrex Matrix workshop in Dubai, United Arab Emirates.					Photograph courtesy of Aetrex Worldwide.
From left: Richard Schnaittacher, CPed, and Frank Caruso, CO, conduct an Aetrex Matrix workshop in Dubai, United Arab Emirates. Photograph courtesy of Aetrex Worldwide.

Aetrex Worldwide, Teaneck, New Jersey, has developed a resource to help foot care professionals sort through the broad and sometimes confusing array of available footwear and orthotic options to provide the best choice for each individual patient. The company's educational course and chart formulathe Aetrex Matrixwere developed by Frank Caruso, CO, Boas Surgical, West Chester, Pennsylvania, and Richard Schnaittacher, CPed, vice president of sales for Aetrex Worldwide.

"The concept of the Matrix was developed to assist orthotists and prosthetists in selecting the appropriate products for the most common foot problems they encounter in their practice," explains Schnaittacher. "From my own experience attending numerous seminars, most people present a particular foot issue and then show the device without necessarily explaining the logic behind the treatment. So the Matrix was conceived as a conceptual approach that would facilitate the choice of footwear and foot orthotics for treating a specific condition. We tried to make clear the logic behind product selection."

The Matrix looks at common patient characteristics and explains how to differentiate them. Also included are some of the more common foot conditions and recommendations for footwear and orthotics based on those variables. The rationale for each choice is also provided in the Matrix.

Caruso presents the Matrix course at O&P educational meetings. The course is free of charge and is a full-day program, but can also be presented as a half-day course, according to Caruso. The Matrix is also available in table format to facilitate identifying the correct product for each condition and as part of a PowerPoint presentation, Schnaittacher adds.

Miki Fairley

Suggested Formula for Treating Common Foot Problems


Exerpts from the Caruso-Schnaittacher Matrix

The Aetrex Matrix offers footwear and foot orthotic options based on key patient variables including weight, range of motion, activity level, and nerve sensation. The common foot problems addressed in the matrix are flat feet, cavus feet, and partial feet. Variables and foot-condition rationales are described below.

Variables

Range of motion: flexible or rigid?
Examine the arch height in both the open and closed chain. A rigid foot would never change between the two.

Activity level: low/moderate or high/active?
Determine if the patient is a household/community ambulator, and whether or not he or she participates in an exercise program.

Nerve sensation: normal or impaired?
Determine if the patient has protective sensation, per the Semmes-Weinstein test, through the prescribing physician.

Algorithm Condition Rationale

Flat Foot
Activity level: Higher active patients will require a shoe with a good stable counter and midfoot sole. Orthotic base materials need to be more supportive, especially as the patients weight increases; e.g., Thermocork® instead of Thermocork Lite.
Range of motion: A rigid foot will require a shoe with more depth in the toe box to accommodate toe deformities and will almost always need a custom orthotic. A flexible foot will tend to lengthen when walking or performing higher activity and should be fit with a half-inch length to the longest toe.
Nerve status: Feet with impaired sensation will require more toe-box height and soft seamless liners.

Cavus Foot
Activity level: The higher active patient will require a shoe with good pressure reduction and a rocker sole. Custom orthotic materials need to be accommodative and pressure reducing. ThermoSKY®, PPT®, and Plastazote® are all good choices.
Range of motion: Rigid foot will require shoes with soft, accommodative toe boxes.
Nerve status: Feet with impaired sensation will require more toe-box height and soft seamless liners.

Partial Foot
Activity level: Higher active patients will need more dynamic response and balance. Rocker soles and carbon spring plates should match to weight and activity.
Range of motion: Rigid foot will require shoes with soft accommodative uppers. Orthotics with soft-top covers balance the residual limb, and a rigid spring plate supports forefoot dynamics.
Nerve status: Feet with impaired sensation will require shoes with a high toe box and soft, seamless linings and orthotics with extra-firm Plastazote base and Sky/PPT mid-layer with Plastazote on top and soft material against the residual foot.

The full matrix first addresses individuals of light to moderate weight and then demonstrates how the footwear and orthotic options might vary.

For more information, contact Josie Genovese; 800.526.2739;jgenovese@aetrex.com

Editor's note: The O&P EDGE does not endorse any products or vendors. The material in this article is intended for informational purposes only.

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