Conventional AFO

Fit

Can have the ideal fit 3 mm of skin clearance and 5 mm of malleoli but alignment is off

Anatomical congruity

Does it look good on a patient? Not hit any bony landmarks?

Alignment

Fit as well as the patients gait patterns

Angular relationship - intersegmental

Femoral ante/retro version

Trunk and femur relationship

Anteverted hip = internal rotation

Angular relationship - ground

Closed chain during stance phase

How GRF is affecting the patient

Mid-Sagittal

Reference for alignment

Line of progression/angle of gait

COM goes through

Indications

- Previous history of metal/leather AFO

- Fluctuating edema

- Heat retention

O MS, ALS and RSD patients

Conventional AFO should contact the patient at the ____ if it utilizes at-strap and their footwear. Should ___ contact them anywhere else

Cuff; NOT

Fluctuating edema

The fluctuating part is the important part of why we choose to make this orthotics. If their swelling suddenly the only contact they would have is at the uprights. If they lose a large amount of volume then you just need to make sure the cuff will fit.

Heat retention

Custom fit carbon AFOs help with this because they are also minimal contact

Contraindications

Cosmetics

Difficult to interchange shoes

Cosmesis

As long as you make justification to your patient and help them understand you think this will work best most of the time they will agree

Difficult to interchange shoes

- the uprights are attached in a certain way so it is hard to change the shoes

- sometimes insurance will cover the cost of the shoes

- there are different uprights which you can discuss with your patient to determine what will work best for them

Anatomy of conventional

- Stirrup

- T-Strap

- Ankle joint

- Calf band

o 38 mm (1.5") ->peds

o 50 mm (2") -> adults

- Uprights - single, double

Design options

- Single uprights (L1980)

- Double uprights (L1990)

-Coil Spring orthotics (L1900)

Coil spring orthotics

- predecessor to custom fit carbon

- doesn't do much in transverse plane

- really just helps provide swing phase clearance

- Don't see much

T-strap

- attached to shoe and used to control varus or valves deformity at the ankle

- L2270

- helps with coronal plane deformities

- Pulls the foot in the opposite direction to create a moment

- Valgus - medial placement; ankle would hit lateral upright

- Varus - lateral placement; ankle would hit medial upright

Attachments

- Solid stirrup

- caliper box

Solid stirrup

- heavy duty, one piece

- L2260

- Not interchangeable - cut sole in half then drill holes into the shoe and then put sole back together

Caliper box

- allows for removable uprights and interchanging of shoes (split stirrup)

- L2230

Tang

The longer it is the stiffer the sole will be

_____ degrees of foot progression angle comes from the ____

5-7; pelvis

Ankle joints

- Klenzak joint

- Bi-channel joint

- Simple single axis joint

Klenzak joint

- dorsiflexion assist

- low profile

- L2210

- spring

- anterior channel

Bi-channel joint

- very adjustable, ideal for patient with changing clinical presentation

- L2220

- very bulky

- has a vertical spring

- posterior channel

Simple single axis joint

- grind head of stirrup in front or back to set ROM

- L2200

- free motion

- Rigid in coronal plane though

Trim lines

- 20mm from fib neck

Tibial torsion

- A lateral or a medial twisting rotation of the tibia on its longitudinal axis

- Transverse relationship

o femoral condoles

o bi-malleolar axis

Foot progression angle (toe in/toe out)

- Transverse relationship

o longitudinal axis of foot

- 2nd and 3rd ray

o line of progression

Gait assessment

- Start with orthosis off

- Determinants of gait

- knee stability

o Frontal plane - static and dynamic

o Sagittal plane

- limb advancement

- swing clearance

- energy efficiency

Gait alignment

- Muscular weakness/tightness

- Poor gait habit

- Skeletal alignment/abnormalities

Skeletal alignment

-femoral neck

-tibial torsion

-talar angle

-forefoot ab/adduction

* toe out would come from any of these 4 things

Foot thigh angle

- patient prone

- knee at 90 degrees

- Stationary arm: long axis of femur

- Mobile arm: bisect calcaneus through 2/3 ray