2️⃣ LE Orthotics

What are the goals of lower limb orthoses? Ideal properties?

Functional ambulation:

• Stabilize weak or paralyzed segments

• Support damaged or diseased joints

• Unload distal segments

• Control abnormal or spastic movement

• Limit motion across joints

What are the functions of a foot orthosis (FO)?

• Evenly distribute the weight-bearing stresses over the entire plantar surface of the foot.

• Reduce the stress and strain on the ankle, knee, hip and spine.

• Alleviate pain from sensitive and painful areas of the sole.

• Support the various foot arches.

• Correct congenital foot deformities.

• Equalize foot length discrepancy.

Indications for foot orthosis?

• Plantar fasciitis

• Heel spurs

• Degenerative joint disease

• Pes planus (flat feet)

• Posterior tibial tendonitis

• Metatarsalgia (inflammation of the ball of the foot)

Name this orthosis. Uses?

Rocker sole

• Assists in the heel-off and toe-off phases of the walking cycle.

• Effective in relieving various causes of metatarsalgia:

  • Hallux rigidus

  • Hammer toes

  • Claw toes

  • Arthritis

  • Metatarsal fractures

Name this orthosis. Uses?

Medial heel out-flare sole

• It increases the size of the base of support of the shoe and helps to support the longitudinal arch.

• Used to treat a severe flat foot caused by diabetic Charcot's foot, rheumatoid foot and chronic rupture of the posterior tibial tendon.

Name this orthosis. Uses?

Lateral heel out-flare sole

• A wedge is inserted into the lateral aspect of the sole and heel to pronate the foot or to accommodate the Varus foot deformity.

• Used to treat a clubfoot or a varus foot.
  

What orthosis can be used to target leg length discrepancies?

• If the discrepancy is 1 inch or less, a lift is placed under the heel of the shorter leg to equalize the leg length.

• If the discrepancy is much greater, lifts should be added to both the sole and the heel.

Name this orthosis. What is the difference between A and B?

Thomas Heel (A) & Reverse Thomas Heel (B)

Thomas Heel:

• Extension of the standard heel on the inside to add rearfoot or midfoot support medially.

• Provides support for excessive pronated foot.

The function of ankle-foot orthoses? Considerations for use?

Function:

• Helps to lock the ankle when there is weak musculature, spasticity or absent proprioception.

• Controls the ankle complex and influences the knee joint directly.

Considerations:

• AFO should not be tight.

• Spastic muscles should be stretched before placement.

Indications for ankle-foot orthoses?

• Foot drop

• CVA/stroke

• Arthritis

• Posterior tibial tendon dysfunction

• Ankle instability

• Paralysis

• Ankle fusion

• Multiple sclerosis

Name this ankle-foot orthosis.

Foot plate and split stirrups

Name this ankle-foot orthosis.

Solid stirrups

Name this orthosis. Uses?

Low profile - prefabricated?

• Used for the rehabilitation of ankle sprains and minor fractures.

• Offers less support and stability.

Name this orthosis?

Ground reaction AFO

• Offers great control of the foot and ankle.

• Helpful for knee extension.

• Made up of polyethylene or polypropylene plastic.

Name this orthosis. Indications? Disadvantages?

Conventional AFO

Indications:

• Conditions with fluctuating edema or fluid retention.

• Patient preference.

• Heat sensitivity (e.g. some MS patients cannot have their leg casted or scanned).

Disadvantages:

• Higher pressures on the skin due to the forces being applied to a relatively small surface area.

• Less control is available due to reduced surface area.

• Joints and uprights tend to be heavy.

• Cosmetically unappealing.

Name this orthosis. Indications? Contraindications?

Total surface bearing orthosis

Indications:

• Foot drop

Contraindications:

• When significant changes in volume are anticipated (fluctuating edema).

Advantages and disadvantages of total surface-bearing orthosis?

Advantages	Disadvantages
Increases stability	Does not accommodate changes in volume (as well as conventional)
Reduces pressure on the skin
Comfort
Lighter
Higher durability
Easy to clean/hygiencic
Can easily be changed to different shoes

What are the advantages and disadvantages of a dynamic type AFO?

Advantages:

• Controls medial/lateral stability at the ankle.

• Controls the endpoints of the dorsiflexion/plantarflexion range.

• Excellent orthosis during the post-trauma rehab period due to being multi-adjustable.
  

Disadvantage:

• Difficult to apply with severe spastic varus or valgus deformity at the subtalar joint.

Name this orthosis. Indication, advantages and disadvantages?

Solid AFO/posterior spring leaf

Indication:

• Individuals lacking medial/lateral control or active dorsiflexion and plantarflexion or low stability or have very limited or no range of motion.

Advantages:

• Decreases tone by maintaining a stretch on calf muscles.

• Assists push-off by not collapsing into dorsiflexion.

Disadvantages:

• Blocks range of motion.

• Knee flexion/foot flat moment produced at heel strike.

• Fair quadriceps strength is required if set in dorsiflexion.

What is the purpose of using a knee-ankle-foot orthosis (KAFO)?

A knee-ankle-foot orthosis consists of a shoe, a pair of upright metals or a plastic calf shell that connects the foot/ankle components to the mechanical knee joint.

• It provides knee control in one or more planes.

• Helps to lock the knee if there are weak hip and knee extensors, impaired proprioception or the resulting extension thrust during a single-limb stance.

Indications for a KAFO?

• Instability of the knee and ankle

• CVA or stroke

• Paralysis knee replacement

• Weak quadriceps

• Genu recurvatum (hyperextended knee)

• Post-polio

• Cerebral palsy

Suggested wearing schedule for a KAFO?

Days	Time
1-3	1/2-1 hour
3-5	1-2 hours
5-7	2-4 hours
7+	As required

Name this orthosis. Advantages and disadvantages?

Total surface bearing/thermoplastic orthosis

Advantages:

• Increases control

• Reduces pressure on the skin

• More comfort

• Considerably lighter

• High durability

• Easy to clean/hygienic

• Can be used easily with different shoes

Disadvantages:

• Does not accommodate changes in volume

Indications for a total surface bearing/thermoplastic orthosis?

• Poliomyelitis

• Spinal cord injury

• Peripheral nerve injury

• Severe knee osteoarthritis

• Multiple Sclerosis (MS)

• Trauma

What is the free walk stance control knee/ankle system?

• The automatic lock is initiated by knee extension (provides stability and prevents unwanted knee flexion in the weight-bearing stance).

• It is only released to swing freely when a knee extension moment and dorsiflexion occur simultaneously in the terminal stance (allows for a seamless transition from the stance to the swing phase of walking).

• The result is a more secure, efficient gait that also reduces the incidence of typical gait compensations.

Indications of free walk stance control knee/ankle system?

• Isolated quad weakness

• Polio/post-polio

• Multiple Sclerosis

• Trauma

Indication for the Craig-Scott KAFO? Advantages?

• Most commonly prescribed bilaterally for patients with complete paraplegia.

Advantages:

• Functional and comfortable gait by maximizing stability in stance.

• It is lightweight and easy to put on and take off.

Use of hip-knee-ankle-foot orthosis (HKAFO)?

• The addition of the hip joint and pelvic section provides control to selected hip motions (front to back, side to side, and rotation).

• One reason the hip section is added to a KAFO is to reduce or minimize the risk of the hip moving out of proper position or dislocating.

• To stabilize the hip and lower spine in cases where the patient is weak or paralyzed.

Give an example of a HKAFO? Advantages?

Reciprocating gait orthosis (RGO)

• Provides support and mobility to the hip, knee, ankle and foot.

• Improves body alignment and posture.

• Increases bone and muscle strength.

• Enhances independence and self-esteem.

Indications for an RGO?

Used when there is a lack of stability and control of the pelvis and lower limbs:

• Cerebral palsy

• Myelomeningocele

• Poliomyelitis