Chapter 26: Lower Limb Orthoses Flashcards
What are the three categories of foot orthotics?
Accommodative or soft devices
Intermediate or semirigid devices
Corrective or rigid devices.
Accommodative FOs are used to what?
Cradle and protect rigidly deformed, insensate, or dysvascular feet.
When can intermediate or semirigid foot orthotics be used?
Mild problems such as metatarsalgia without ulceration
Corrective foot orthotics are used when?
for slight flexible biomechanical deformities
When are metal orthoses used?
A previous wearer of the AFO
Unusally large or heavy individuals
Need for minimal contact (Edema, heat-sensativity, can’t tolerate contours)
The floor reaction AFO does what?
The extended rigid forefoot section accentuates the knee extension moment at midstance and prevents tibial collapse from absent or weak gastrocnemius.
Which patient population is indicated for a floor reaction AFO?
Patient has paralyed ankle/foo complex but good or better quadriceps and balance.
Myelodysplasia
Spinal cord injury
Peripheral nerve injury
Poliomyelitis
Gastrocnemius-soleus trauma or dysfunction.
What is a common lower limb deficit?
Flaccid equinus
Flaccid equinus can result from what?
Charcot-marie-Tooth disease,
Cerebrovascular accidents with mild residual symptoms
Muscular dystrophy
Peroneal palsies
What are the orthotic options to compensate for pretibial compartment weakness or paralysis?
Bilateral 2-in heel lifts Piano wire AFO Metal Alloy dorsiflexion assist AFO Flexible plastic AFO Peroneal NMES
What is the justification of a KAFO?
Need to control the knee complex in addition to a need for suspension or control of the ankle and foot.
What are the coronal plane, and sagittal plane controls of the single axis knee joint?
coronal plane: stabilizes Genu varum/valgum
Sagittal plane: Free flexion and extenion
Slight hyperextension stop.
What are the clinical applications of a single axis knee joint?
Mild to moderate genu varum or valgum
What are the coronal plane and sagittal plane controls of an offset knee joint?
Coronal: Stabilizes genu varum/valgum
Sagittal: free flexion/extension
integral hyperextension stop
What are the clinical applications of an offset knee joint?
Moderate to severe genu recurvatum and varus and valgum
What are the coronal plane and sagittal plane controls of the polycentric knee joint?
Coronal: Stabilizes genu varum/valgum
Sagittal: Free flexion extension
Hyperextension stop
What are the clinical applications of the polycentric knee joint?
Self-suspending knee orthoses to reduce pistoning on the leg.
What are the coronal plane and sagittal plane controls of the stance control knee joint?
Coronal: Stabilizes genu varum and valgum
Sagittal: No knee flexion under weight bear, free flexion-extension when un-weighted
Hyperextension stop
What are the clinical applications of the stance control knee joint?
Knee extensor paralysis or paresis
What are the coronal plane and sagittal plane controls of the Bale/Wedge/Ring locking knee joint?
Coronal: Stabilizes genu varum/valgum
Sagittal: Removable hold in full extension during stance and swing phase of gait. Can be relased during sitting.
Hyperextension stop
What are the clinical applications of the Bale/Wedge/Ring locking knee joint?
Knee extensor paralysis or paresis, when stance control is not feasible. (Such as a patient having weak quads.)
What are the coronal plane and sagittal plane controls of the Lock + Variable flexion knee joint?
Coronal: Stabilizes Genu valgum/varum
Sagittal: Removable hold in full extension during stance and swing phase of gait. Can be released during sitting.
Integral, adjustable extension stop.
What are the clinical applications of the Lock + Variable flexion?
Spastic paralysis with reducible knee flexion contracture.
When might hip orthoses be prescribed?
Isolated problems in the acetabular region, which may be a result of dysplastic disorders, Traumatic injury or surgical procedures (total hip replacement).
What are examples of hip orthoses to treat dysplastic hips?
Pavlik harness
Custom made HOs for Calve-perthes disease
Who is usually prescribed a HKAFO?
Pediactric patients
Who often benefits from HKAFOs as adults?
Patients with bilateral paralysis from spinal cord injury.
Myelodysplasia
What is a reciprocating gait orthoses?
An HKAFO that is mechanically linked to couple flexion of one hip with extension of the other which premits a reciprocal step-over-step gait.
What are compound orthoses?
Orthoses that cross more than five body segments and composed of two more more devices.
