31 - Evaluation of FOs and AFOs

Question 1

Types of orthoses

Answer 1

• Functional
• Accommodative
• UCBL
• SMO-Supramaleolar Orthosis
• Partial Foot Toe Filler

Question 2

Functional orthoses - uses

Answer 2

• Control Motion
• Correct Deformity
• ***Relieve Pain – this is something we will always be focusing on

Question 3

Accommodative orthoses - uses

Answer 3

• Accommodate non-correctible deformity
• Relieve Pressure
• Off-load Ulcers
• Add Cushion (fat pad atrophy, off-loading)
• ***Relieve Pain– this is something we will always be focusing on

Question 4

UCBL - uses

Answer 4

• Control Motion
• Higher Heel Cup and Medial/Lateral (the higher the heel cup, the better the rearfoot control)
• Correct Deformity
• *** Control Pain

Question 5

SMO- Supramaleolar Orthosis - uses

Answer 5

• Increased Motion Control for Moderate Medial/Lateral Instability
• Goes proximal to maleolus on medial and lateral sides – to get more control of the foot
• Correct Deformity
• *** Relieve Pain

Question 6

Partial foot toe filler (after amputation) - uses

Answer 6

• Hallux Filler (common)
• 5th Digit (not as common)
• Transmetatarsal (common) – can also incorporate an AFO with this
• Carbon Plate To Stabilize (so the top of the shoe doesn’t curl up where there is no toe, can also be used for bunion to control motion in the painful joint)
• Floor Reaction AFO for Toe Lever – full lever from heel strike to toe off

Question 7

Ankle foot orthoses - uses

Answer 7

• Ritchie Brace
• Leather Ankle Lacer
• Solid AFO
• Hinged AFO
• Carbon AFO-Floor Reaction
• CROW Walker

Question 8

Ritchie brace - uses

Answer 8

• Moderate to Severe Pronation
• Motion Control ML (medial-lateral)
• ***Pain Relief
• Does not have a substantial foot plate, but comes up the sides of the leg (medial and lateral)
• Can get more stability if you have plastic straps around the back of the leg, not just Velcro

Question 9

Leather ankle lacer

Answer 9

• Moderate to Severe Instability (degenerative joint disease)
• Motion Control AP and ML (anterior-posterior and medial-lateral)
• Immobilize
• ***Pain Control
• Can come with laces or Velcro – if you do laces you can get it a lot tighter and more controlled

Question 10

Solid AFO - uses

Answer 10

• Moderate to severe Instability (degenerative joint disease)
• Motion Control AP and ML (anterior-posterior and medial-lateral)
• Immobilize
• ***Pain Control
• If you have a patient with DJD, it is a toss-up if you will use a leather ankle lacer or a solid AFO

Question 11

Hinged AFO - uses

Answer 11

• Motion Control Medial Lateral (medial-lateral)
• Plantarflexion Stop
• Dorsiflexion Assist
• Control Knee Hyperextension (program in a “stop” so the knee can’t hyperextend)

Question 12

Carbon floor reaction AFO - uses

Answer 12

• Used for moderate knee extension
• Extend Toe Lever for Partial Foot –Use With a Partial Foot Toe Filler
• Mild Dorsiflexion Assist (needed for muscle weakness from MS) – lightweight, some push-off

Question 13

CROW walker - uses

Answer 13

• Specifically designed for Charcot foot deformity
• Immobilize Foot and Ankle - Total immobilization for the foot and ankle is accomplished
• Can also be used for ankle fractures in non-surgical candidates (non-union) or a non-healing ulcer on the plantar surface of the foot that needs to be off-loaded
• If you have a rocker-bottom deformity that is getting too much pressure, you can take off some of the padding
• It is a little heavy, which can be hard for some patients