Orthotics Final

AFOS, KAFOs, HKAFOs, TLSOs

dynamic AFOs

increase subtalar and midfoot stability while allowing some talocrural mobility

ex. SMOs, hinged AFOs

supramalleolar orthosis (SMO)

provide proprioceptive input and support to subtalar and midfoot joints

rigid ankle (solid) AFO

constrain motion at talocrural, subtalar, and forefoot joints

struggle to support the medial-longitudinal arch

patellar tendon bearing AFO

transfers weight bearing to patellar tendon to offload foot

pretty rare (way easier to be fully NWB)

assisting AFOs

dynamic AFOs that provide some energy return and/or assist in active control

posterior leaf spring AFO

assists with eccentric DF at heel rocker and eccentric PF at ankle rocker

minimal support in transverse or frontal planes

side strut AFO

over-the-counter assisting AFO

lighter and slimmer appearance increases patient compliance

dorsiflexion assist AFO

mechanical hinge offers more aggressive DF/tibial advancement assist

good for pts with strong knee hyperextension bias

*requires >=5 degrees of passive DF to use

Klenzak hinge

has posterior channel with spring for DF assist

double action (dual channel) hinge

has posterior channel with spring for DF assist, anterior channel with stop to limit PF

articulating thermoplastic AFOs

made of rigid plastic to increase stability, but hinged to allow mobility

trim lines and joint type determine balance of stability and mobility

overlap joint

most stable AFO joint, sacrifices some mobility

rarely used

Oklahoma joint

allows for pt-driven mobility, but limits ROM

Tamarack joint

has rubber ROM stop that allows for some energy return

very adjustable

intrepid dynamic exoskeletal orthosis (IDEO)

patellar tendon bearing AFO with a posterior leaf

offers increased energy absorption and return

used for high-level athletes and high-demand occupations

Craig-Scott orthosis

KAFO with a posterior offset hinge

moves axis of rotation posterior to ground reaction force to allow some quad activation while preventing knee flexion

conventional KAFOs

made of metal double uprights and leather straps

Pros: durable, easily adjusted

Cons: heavy, pressure concentrated under straps, only one shoe option

thermoplastic KAFOs

made custom for pt’s unique anatomy

Pros: lighter, total contact offers better control and pressure distribution

Cons: bad with obesity, fluctuating limb size, impaired sensation

HKAFOs

offer pelvic stabilization

hinged for sagittal motion, prevent frontal motion (ABD/ADD)

robotic assisted exoskeletons

Pros: very motivating, can match/supplement patient effort (trace mm activation can trigger exoskeleton movement)

Cons: bulky, very specific height requirements

rehabilitation knee orthoses

protect knee from excessive loads/ROM during tissue healing

intended to be temporary!

functional knee orthoses

protect knee from loads in specific direction(s)

address permanent mechanical problems —> long-term use

intended to be task-specific (ex. sports, not grocery shopping)

valgus loading functional knee orthosis

applies valgus load to offload medial compartment

used for medial compartment OA

lateral buttressing functional knee orthosis

applies force in medial direction to promote appropriate tracking

research does not show kinematic changes but supports Sx relief

Pavlik harness

used for early intervention tx of developmental hip dysplasia (0-6 months)

holds hips in maximum congruency (120 degrees flex, 40 degrees ABD)

hip abduction orthosis

used for later tx of developmental hip dysplasia (>6 mo)

prefabricated, but very adjustable

Scottish Rite brace

used to tx LCPD

maintains 45 degrees hip ABD while allowing flex/exten

typically worn as night brace

SI belt

provides external support for pelvic ring

thoracolumbar corset

provides support and security to abdomen and lumbar spine

chairback orthosis

TLSO

offers sagittal plane control (decreases flex/exten)

rigid plastic shell with adjustable elastic straps

Knight orthosis

TLSO

offers sagittal and frontal plane control (broad bands offer lateral support)

Williams orthosis

TLSO

offers sagittal and frontal plane control

primarily limits exten and encourages posterior pelvic tile

lateral bars prevent side bending

Jewett brace

TLSO

offers sagittal plane control

primarily limits flexion

allows some side-bending

CASH brace

TLSO

offers sagittal plane control

primarily limits flexion

lighter than Jewett brace = better for long-term use (ex. non-surgical candidates)

thermoplastic TLSOs

typically used for older/osteoporotic women or s/p kyphoplasty

Pros: total contact = better control and distribution of pressure

Cons: harder to don/doff, significantly impairs mobility and balance

Rainey flexion jacket

thermoplastic TLSO

prevents flexion

(I can’t find a picture of it anywhere. Kinda confused, tbh)

Boston overlap brace

thermoplastic TLSO

supports lumbar exten

single piece is easier to don, but only works for slimmer pts

soft cervical collar

offers no true support or limitation of motion

more for comfort

rigid reinforced cervical collars

offer sagittal plane control

very effective, need tight fit under mandible to control upper cervical motion

ex. Philadelphia collar, Aspen collar

Philadelphia collar

rigid reinforced collar to control sagittal plane cervical motions

lighter, but harder to clean

Aspen collar

rigid reinforced collar to control sagittal plane cervical motions

heavier, but removable pads are easier to clean

Minerva orthosis

a sterno-occipitomandibular immobilizer (CTSO)

stabilizes C4 to cranium to limit upper cervical motion

cervical halo

provides absolute restriction of cervical motion

used for high-level and severe cervical fxs

can add spacers to create traction

risk of infection, pressure under yoke

HIGH FALL RISK

Milwaukee brace

over-the-counter scoliosis brace

longest superior-inferior lever arm (mandible to pubis)

rare now b/c custom is easy

Boston brace

rigid thermoplastic TLSO for scoliosis management

ground reaction AFO

promotes knee and hip extension in stance phase