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Kinetic Wedges: Question

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Sammo, Aug 4, 2009.

  1. Sammo

    Sammo Active Member


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    Hi All,

    I have a question regarding kinetic wedges that has been bugging me for some time!!!!! :confused:

    I understand that this modification to an orthoses is designed to place a cut out underneath the area of the 1st MPJ to reduce GRF and in turn allow the 1st MPJ a greater ability to dorsiflex in the latter stages of stance phase.

    My ponderings are thus: I believe this forefoot modifications are generally made in conjunction with some rearfoot control, for arguments sake let it be a poly prop shell and 4 degree rearfoot varus wedge.

    How much of the reduction in GRF under the 1st mpj comes from the rear/midfoot control, which could (again for the sake of argument) reduce the amount of pronation in the foot during gait, leaving the foot in a less pronated position after heel lift, thus reducing the GRF under the 1st MPJ and how much can possibly come from the Kinetic Wedge?

    If the kinetic wedge works as it is proposed to work, would you see any benefit from just a simple, flat 5mm eva/polyprop plate, with a 1st mpj cut out and no rear foot control?

    Is there any research showing reduction in pressure under the 1st MPJ, or perhaps an increase in 1st MPJ DF with the use of kinetic wedges added to a FFO vs a purely rear-midfoot control FFO?

    Kind Regards,

    Sam
     
  2. Have a look at http://www.health.uottawa.ca/biomech/lab/docs/isb19_kr.pdf
     
  3. DSP

    DSP Active Member

    Hi Sam:

    It all comes down to what information you gained from performing the Jacks test i.e. how much force was required to dorsiflex the hallux and was the timing immediate or delayed? When dispensing your orthoses, get your patients to stand on the devices and redo the Jacks test. In theory, windlass function should improve.

    IMO, you don't necessarily need forefoot mods in order to improve windlass. However, it depends on the foot your treating. Some feet may require more mods than others in order to improve windlass function.

    As a rule of thumb, I generally redo Jacks test with the pt standing on the devices in order to get an idea of whether windlass function has improved. If it hasn't, then I may readjust the devices if necessary.

    Regards,

    Daniel
     
  4. Sammo

    Sammo Active Member

    Thanks Simon.

    So that paper shows no significant change in trunk angle.

    and the paper EFFECTIVENESS OF THE KINETICWEDGEFOOT ORTHOSIS - MODIFICATION TO REDUCE RELATIVE PLANTAR PRESSURE shows a 15% (roughly) decrease in plantar pressure over both the 1st MPJ and Plantar surface of the Hallux with the addition of a kinetic wedge. to a CFO.

    Still a little confused as to whether Kinetic Wedges are really useful or if it is one of those things that practitioners just like the idea of?

    any personal thoughts?

    Regards,

    Sam
     
  5. Sammo

    Sammo Active Member

    Thanks daniel..
     
  6. Lawrence Bevan

    Lawrence Bevan Active Member

    What information does the Jacks test truly give you?
    Is there any evidence a change in the Jacks test indicates an improved windlass in gait?
    Is there any evidence on what is a bad windlass and what is a good one?
     
  7. Sammo

    Sammo Active Member

    Just to try and bring the point back to the questions.. and taking aside the pros and cons of the jacks test... what are your thoughts on kinetic wedges and their effect on dynamic foot function? Do they create a significant improvement in 1st ray function during gait? Or does it give only a fractional improvement in an orthotic that people like to prescribe cos it sounds technical?
     
  8. Lawrence Bevan

    Lawrence Bevan Active Member

    Sam

    A kinetic wedge is a forefoot extension that is otherwise known as a 2-5 metatarsal pad. I and many of the Podiatrists I know use this modification extensively particulary to adress functional and/or early structural hallux limitus.

    Its not that technical but calling it a "kinetic wedge" is a nice attempt to make it sound technical.
     
  9. Admin2

    Admin2 Administrator Staff Member

  10. Asher

    Asher Well-Known Member

    I use these often - sometimes FF valgus extension 2-5 on its own, sometimes a pad under the hallux on its own and sometimes in combination (kinetic wegde). I don't know if it helps because I haven't tested it to prove it. But I can see the theory behind it and it sounds plausible that these things facilitate the windlass mechanism. If it fits in the shoe and doesn't cause any other problems, I'd have it.

    Rebecca
     
  11. Sammo

    Sammo Active Member

    thanks guys.. I just reread my last post.. I hope noone was offended by my choice of words with regards to the "prescribing because it sounded technical" bit. Not quite what I meant. I just wanted a few peoples opinions.

    Admin, thanks for the links.. I'll go through the archives and stop being a pest now :-D
     
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