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PTA 230 Final > 15. Orthotics > Flashcards

15. Orthotics Flashcards

1
Q

What do shoes do?

A

Distribute weight bearing for comfort

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2
Q

What are 2 additional functions that orthopedic shoes provide?

A
  • Reduce pressure on sensitive/deformed areas to pain free areas - Provide a foundation for AFO’s and extensive bracing
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3
Q

What are the major portions of a shoe?

A
  • Upper - Sole - Heel Reinforcements
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4
Q

What does the upper portion of a shoe consist of? What variations are within these?

A
  • The Vamp (Blucher/Balmoral) - The Quarter (High/Low)
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5
Q

What should a shoes sole consist of? What should they be made of?

A
  • Outter: external and Inner: internal sole (leather) - Metal Reinforcement in between with rivets
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6
Q

If shock absorption is needed, what type of additions should be added?

A

Resilient (strong but flexible)

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7
Q

What does a 1 inch heel in adults that shifts the COG anteriorly aid in? What does it not significantly disturb?

A
  • Aids in Transition through stance phase - Normal hip and knee alignment
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8
Q

What reasons or conditions would we want to build up a persons heel for (up to 3 inches)?

A
  • Achilles Repair/Accommodate short Achilles - Balance issues (to shift cog anteriorly)
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9
Q

What type of issues does a toe box reinforcement in the vamp provide for (internal/external)?

A
  • Vertical trauma (internal) - Stubbing toes (internal) - Hammer Toes (internal) - Diabetes (external) - Neuropathy (external) - Arterial/Wounds (external)
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10
Q

A longitudinal piece that reinforces the shoe is called ______.

A
  • the Shank
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11
Q

A _____ stiffens the quarter. A person with severe ____ should have a ___________ that prevents the foot from ________.

A

Counter; pes valgus (collapsed medial longitudinal arch) ; long medial counter; rolling inwards

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12
Q

What type of foot can be accommodated or corrected?

A

A flexible mid/forefoot

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13
Q

What is a Last considered to be in Orthotics and Prosthetics?

A

The mold over which a shoe is made (shape of soul)

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14
Q

What is the first thing we should consider when selecting a style of shoe?

A

Last

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15
Q

What type of shoe opening is easier to put on? What type of patient conditions would this accommodate?

A

Blucher - CVA (vascular issues) - Diabetic ( neuropathy issues) - Paralyzed Leg (prevents sheering) - Edema (swelling issues)

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16
Q

Why would we need to add an internal correction to the heel or foot?

A
  • Calcaneus correction (medial/lateral; pronation/supination - Support of longitudinal arch - Posture correction - Heel Spurs (give back fat pad) - Pressure Relief (weight shift)
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17
Q

Why would we need to add a pad to an internal correction?

A
  • Heel Spurs - Pain relief - Shift or relieve high pressure areas (1st/2nd metatarsal weight bearing)
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18
Q

How does the shape of a heel spur insert reduce pain?

A

Slopes anteriorly

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19
Q

What are internal corrective inserts made of?

A
  • Soft material - Hard Plastics
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20
Q

What type of condition would need metatarsal pads glued into an inner sole to transfer stress from metatarsal heads to the metatarsal shafts to reduce plantar pressure?

A
  • Diabetic Neuropathy - Pes Cavus (pain relief) - Mortons Neuroma
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21
Q

What is the minimum support used for pes planus? What does it support?

A

Scaphoid Pad - Longitudinal Arch

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22
Q

The alignment of the calcaneus can be corrected Internally or Externally. T/F

A

True

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23
Q

Where are external corrections typically built in?

A
  • Heel - Inbetween Inner/Outter soles
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24
Q

Why would we choose an external correction over an internal correction? What is the disadvantage of an external correction?

A
  • Does not reduce shoe volume - Will erode as the patient ambulates
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25
Q

What are the disadvantages of an internal correction? What type of patient conditions would be at a disadvantage?

A

Can reduce shoe volume (make shoe tighter) - Edema - Abrasions/Sheering * all reasons for using a Blutcher over Balmoral

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26
Q

What is a frequently prescribed external modification that alters the alignment of the calcaneus?

A

Heel wedge

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27
Q

What type of wedge is incorporated into a Thomas heel? What this combination help support?

A

Medial Wedge - Longitudinal arch

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28
Q

The ____ border of a _____ heel extends _____ on the _____ side to augment the effect of the _____ wedge in supporting the _____.

A

Medial; Thomas; Foward; Medial; Medial; Longitudinal Arch

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29
Q

What type of external correction is intended for pes valgus?

A

Thomas Heel with a medial wedge

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30
Q

What type of support would you want to give to a patient that needs more external support of the entire midfoot and ankle? What type of patients are these?

A

Thomas Heel and Medial Wedge - Obese - Arthritic - Plantar Fasciitis * Any that need more support

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31
Q

What other joints can correcting a pes valgus help with up the kinetic chain?

A
  • Knees (valgus) - Hips
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32
Q

What is the purpose of a sole wedge?

A
  • Alter Metatarsal Alignment (encourages lateral to medial foot alignment)
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33
Q

A ________ _______ is flat strip of _______, placed ________ to the ________ _________. At ________ _______, the bar transfers stress from the ________ heads to the shafts.

A

Metatarsal bar; Leather; Posteriorly; Metatarsal Heads; Late Stance; Metatarsal

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34
Q

What is the convex strip attached proximal to the metatarsal heads? What does it improve?

A

Rocker bar - Late Stance

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35
Q

What does the curve in the rocker bar do?

A

Encourages lateral to medial as foot goes from heel strike to late stance

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36
Q

How much of a leg length discrepancy is indicated for an external and internal modification?

A

External: Over 3/8 inch Internal : Under 3/8 inch

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37
Q

What is used for a leg length discrepancy with an internal modification?

A

Heel lift

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38
Q

Why would someone choose a steel stirrup over a plastic or insert AFO?

A
  • doesnt want plastic in their shoe - doesn’t break as easy
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39
Q

What are the advantages and disadvantages of a solid stirrup?

A

Advantages: - Maximum Stability - Lighter/Less Bulky than Spilt Stirrup - Less likely to detach with activity Disadvantages: - Complex donning - Can’t detach upright at shoe level - Isn’t interchangeable with shoes

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40
Q

What are the advantages and disadvantages of a split stirrup?

A

Advantages: - Can be modified - Simplified Donning - Can detach upright at shoe level - Interchangeable with shoes (if central piece riveted) Disadvantages: - Heavier/Bulkier than Solid Stirrup - More likely to detach with heavy activity

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41
Q

What type of shoe is best for an internal AFO?

A

Balmoral

42
Q

What are most AFO’s prescribed to control? How do they achieve this?

A

Ankle Motion ( ankle control) - By limiting plantar flexion and/or dorsiflexion

43
Q

What type of dorsiflexion does a posterior leaf AFO provide?

A

Passive Dorsiflexion

44
Q

What does a posterior leaf spring AFO assist AND allow?

A

Dorsiflexion

45
Q

Why does the spring assist in AFO yield slight plantarflexion at heel contact?

A

To protect against inadvertent knee flexion (buckling)

46
Q

During gait dorsiflexion likes to translate into knee ______ and plantarflexion likes to transition into knee ______.

A

Flexion; Extension

47
Q

What assistance is provided by a posterior leaf spring that arises from a plastic inset AFO?

A

Dorsiflexion

48
Q

If you can’t plantarflex, how will it affect a persons swing phase?

A

It will shorten it (can’t toe off, less extension)

49
Q

What is added to a Plastic Solid AFO?

A

Trim lines (Anterior Malleoli)

50
Q

What type of patient condition would benefit from a plastic posterior spring leaf AFO? Why

A
  • Foot drop (CVA) - Back patient * doesn’t provide medial/lateral stability which these 2 patient conditions can still have.
51
Q

What is the best plastic AFO type for a person who needs medial/lateral ankle stability?

A

Solid AFO

52
Q

What two are conditions that an AFO plantarflexion stop prevent?

A
  • Toe drag - Genuine Recurvatum
53
Q

Why would we want an AFO dorsiflexion stop/limit?

A

Prevent Buckling

54
Q

What will you have to check with a Solid Plastic AFO?

A
  • Lateral and medial malleolus
55
Q

What is the term BiCAAL stand for?

A

Bi Channel Adjustable Ankle Locks

56
Q

What is the difference between a BiCAAL Metal AFO and a Plastic Hinged AFO?

A

BiCAAL: - Can block or assist through springs/pegs (posterior/anterior) Hinged AFO: - Can block only (posterior)

57
Q

What does a hinged AFO allow? How can you increase this?

A

Dorsiflexion - Build up posterior portion (blocks plantar flexion)

58
Q

What is a Toe Off AFO good for? What is it contraindicated for?

A

Mild to Severe Foot Drop ( assist dorsiflexion) Mild to Moderate Ankle Instability - Moderate to severe spasticity or edema (contraindicated)

59
Q

What is a Carbon Fiber Ypsilon AFO good for? What is it contraindicated for?

A

Mild to Severe Foot Drop (assist dorsiflexion) Ankle Freedom - Unstable ankle joint (contraindicated) - Moderate to severe spasticity or edema (contraindicated)

60
Q

What are the benefits of carbon AFO’s?

A
  • Lightweight - Newest type
61
Q

What type of AFO consists of one or two uprights, and a shell, band, or brim called a T-strap that controls inversion of the foot?

A

Superstructure

62
Q

Which single upright AFO moderately controls but doesn’t eliminate motions in all planes?

A

Spiral (Superstructure)

63
Q

Which AFO provides variety of control, but are not cosmetic?

A

Metal AFO’s

64
Q

What is one drawback to Metal AFO’s?

A

Heavy (but there are pt that love them)

65
Q

______ orthoses are ______ AFOs designed for children with ______ ______ ______ and adults with ______ ______. These are good for ______ deformities.

A

Tone reducing; Plastic; Spastic Cerebral Palsy; Spastic Hemaplegia; Flexible

66
Q

What type of KAFO joints are at the knee? What does the 2nd achieve?

A

Hinge Joint Offset Hinge Joint - stabilizes the knee in extension

67
Q

What type of locking mechanisms can be at the knee hinge joint? How do they work?

A

Drop Ring - ring drops down in extension Pawl lock with bail release - posterior lock that releases both hinges when pulling up on bail Computer Assistance - like the prosthetic C leg (processor controlled. lithium battery)

68
Q

HKAFO drop ring locks at the _____ and _____, and has a _____.

A

Hip; Knee; Pelvic Band

69
Q

What type of patient would need a THKAFO? What is the drawback?

A

Spina Bifida Spinal Cord Injury (What level???)

70
Q

What device consists of a broad base, posterior nonarticulated uprights extending from a flat base to a midtorso chest band, and a posterior thoracolumbar band with anterior leg bands contribute to stability?

A

Standing Frame Walker

71
Q

What similar orthosis to a standing walker which is made in both child and adult sizes? What is the major difference?

A

Swivel Walker - It has two distal plates that rock slightly to enable a swiveling gait.

72
Q

What are 3 options that can place a paraplegic in standing? Which one allows sitting?

A
  • Standing Walker - Swivel Walker - Parapodium (allows sitting)
73
Q

What type of AFO is designed for adults with paraplegia, molded to conform to the patient’s legs and feet with a foot plate angled at approximately 15° plantarflexion to shift the wearer’s center of gravity anterior to the ankles?

A

Stabilizing Boots

74
Q

What type of KAFO is prescribed for patients with paraplegia with shoe reinforced transverse and longitudinal plates, BiCAAL joints, solid ankle section, and a pretibial band? What type of gait does this allow and why?

A

Craig Scott Orthosis - swing-to or swing-thru gait pattern (pt still has control of hip)

75
Q

Which orthoses has hip joints that are connected by one or two metal cables or rods, the knees stabilized with knee locks, and the feet encased in a solid ankle orthoses?

A

Reciprocating Gait Orthoses (THKAFO)

76
Q

_____ orthoses such as a _____ increase _____ pressure. They are made for people with _____.

A

Trunk; Corset; Abdominal; LBP

77
Q

What are rigid orthosis good for?

A

Controlling motion ( especially after surgery)

78
Q

A _______ is a rigid orthoses includes a pelvic band, which should provide firm anchorage over the midsection of the buttocks, and a thoracic band, intended to lie horizontally over the lower thorax without impinging on the scapulae. (Lateral flexion resisted). What is it known as?

A

Lumbosacral Flexion Extension Lateral Control Orthoses - Knight Spinal Orthoses

79
Q

What type of Orthoses is a Taylor Brace for kyphosis?

A

Thoracolumbar flexion extension lateral control orthoses (similar to Knight)

80
Q

What collar has a mandibular and occipital extensions and a rigid anterior? What is it sometimes used for?

A

Philadelphia Collar - upper cervical injuries

81
Q

Which collar usually has two anterior adjustable posts joining a sternal plate to a mandibular plate and two posterior uprights connecting a thoracic plate to an occipital plate (moderate control). What is the draw back?

A

Four Post Cervical Orthosis - if not fitted properly, motion restriction is compromised

82
Q

Provides maximum stabilization of the head and Cervical spine and is invasive?

A

Halo Orthosis

83
Q

A nonsurgical and oldest scoliosis orthotic management is a ______ _______ and it is most effective for curves less than __ degrees.

A

Milwaukee Brace; 35

84
Q

What does a rod or a spring do in the posterior channel of a biCAAL joint?

A

Rod - Block Plantarflexion Spring - Assist in Dorsiflexion

85
Q

What does a rod/spring do in the anterior channel of a biCAAL joint?

A

Rod: - Block Dorsiflexion Spring: - Spring Assist Plantarflexion

86
Q

Which BiCAAL setting is best for a patient with foot drop?

A
  • Posterior Block
87
Q

Can an AFO control the knee? What will prevent genu recurvatum?

A

Yes - Posterior Stop/ Increased Dorsiflexion

88
Q

Which of the AFOs available in lab will prevent knee buckling? Support your answer.

A
  • Anterior Block (Prevents Dorsiflexion)
89
Q

Should a person with kidney disease use a plastic AFO?

A

No (due to edema) Internal

90
Q

Should a person with congestive heart disease use a carbon fiber AFO?

A

No (due to edema) Internal

91
Q

What type of patient conditions are contraindicated for carbon AFO’s?

A
  • Unstable ankle - Moderate/Severe Spasticity - Edema
92
Q

Can you name seven attributes of a Craig Scott orthosis?

A
  • BiCAAL - Dorsiflexion Assist - T-Strap - Pre-Tibial Band - Pawl Lock/Bail Release - Transverse/Longitudinal Plates - Thigh Band
93
Q

What level of patient with SCI may be able to ambulate with a craig scott orthosis in home?

A

T10-T12

94
Q
  1. What level of patient with SCI may be able to ambulate with a craig scott orthosis in the community?
A

L1-L3

95
Q

What is the difference between a knight, Taylor and Milwakee brace?

A

*All control flexion/extension/lateral flexion/extension Taylor: Thoracolumbar Sacral Support (Kyphosis) Knight: Lumbosacral Support Milwaukee Brace: (Scoliosis)

96
Q

What motion will a posterior leaf spring orthosis prevent? What condition(s) is it prescribed for?

A

Plantarflexion - Dropfoot

97
Q

Would a posterior leaf spring be good for a person with medial/lateral instability?

A

No (No trimlines - go with Solid AFO)

98
Q

What does a T strap do? Be able to identify it.

A

Controls Foot Inversion (Suprastructure)

99
Q

What is a Spiral AFO and who is it contraindicated for?

A
  • Controls but doesn’t eliminate motion in all planes (light stability)
100
Q

What does a hinged AFO with a posterior stop do? Be able to identify it.

A

Block Plantarflexion

101
Q

A patient with paralysis to the triceps surae benefits from what characteristics in a brace?

A

Anterior Block

102
Q

What is the angle that is most indicated for a Milwaukee Brace?

A

Less than 35 degrees

PTA 230 Final (8 decks)

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