Exam 4: Orthotics Part 2, Foot Deformities, AFOs Flashcards

Question

Metal vs Plastic: cost Explain the differences

Answer 1

Both metal and plastic can have variable costs, so that is not a clear way to distinguish the categories

Answer 2

Consider sensory issues and how much pts (or family) check * for non-checkers metal may be better

Answer 3

1. Custom orthotic Developed by University of California Biomechanics Laboratory (hence it's name) 2. for subtalar joint instability * Controls * flexible calcaneal deformities (rearfoot valgus or varus) * transverse plane deformitys of the midtarsal joints (forefoot abduction or adduction) * "grabs" the calcaneus and supports the midfoot with hight medial and lateral trim lines * realigns the calcaneus 3. vast majority made for pediactrics 1. something wrong with gait 2. hypotonia (prevent collapsing) 3. Development delay 4. flexible pes planus 4. Allows 1. normal toe off (because of short foot plate) 2. ankle movement (because trim line is below ankle; so not helpful in swing phase) More from pg 231 in book (if interested): improves the angle of pull of the achilles tendon, providing a more stable foundation ofor the articular surfaces of the talus, navicular, and cuboid boines. Also used to improve functional alignment of children and adolecscents with flexible pes planus, a longitudinal arch deformity. The gillete modification, an external post positioned either on the medial or lateral border of the heel cup, can be used to apply additional rotatory moments to the calcaneus during weight bearing. The UCBL shoe insert may improve foot performance during stance for persons with hypotonicity. Not appropriate for persons with swing phase clearance issues (because the trim line is below the ankle)

Answer 4

Dynamic ankle foot orthosis

Answer 5

SMO | (supramalleolar orthosis)

Answer 6

False No moving parts Name is strange

Answer 7

DAFO (dynamic Ankle foot orthosis), figure 9-10 1. Evolved from UCBL 2. Goes up around the malleoli (superior trim line just superior to ankle joint) 3. adds stability in mediolateral plane * locks the malleoli, but still has some ankle rocker (reduced though) * Limits MTP joints more with more anterior foot plate 4. Typically made for pediatric pts * Diplegic CP * helps with **extensor hypertonicity** * helps with foot clearance in swing phase \*\*often pts will not wear DAFO inside shoe (so grippy things are put on the outside of the orthosis so pt can walk on it without slipping)

Answer 8

will be making them all the time because kids grow fast

Answer 9

if an AFO is a solid AFO it won't have moving parts (with one exception) ## Footnote \*\*I think the exception is the Posterior Spring-Leaf AFO because it doesn't have joints or true moving parts, but it is considered dynamic instead of fixed because it has a spring effect. (not sure though)

Answer 10

Will affect most of the rockers * definitely heel and ankle * Heel rocker doesn’t allow plantar flexion (disrupts loading response) * will go forward as we go flat * ankle rocker * doesn’t allow tibial translation * toe rocker may be affected if foot plate goes far enough forward

Answer 11

Solid Ankle Foot Orthosis

Answer 12

The edge of the plastic on a plastic orthosis

Answer 13

Superior medial lateral foot plate

Answer 14

the proximal trim line is the top * flared to prevent pinching * must be correct distance from popliteal fossa * too short, it digs into gasroc * too long, digs into popliteal fossa ( won’t be enough room to sit)

Answer 15

medial and lateral trimlines 1. the further forward they come, the more mediolateral stability we get 2. don’t want them to come in too far or will pinch the tibialis anterior

Answer 16

If the foot plate extendes beyond the metatarsal heads, it will prevent or impede MTP flexion and change the toe rocker * this may or may not be desirable depending on our pt's needs

Answer 17

1. Slight DF ( 5\* or less) 2. Neutral 3. Slight PF (5\* or less) \*\*Dr. brinman has examples of all of these

Answer 18

* basic foot drop (no spasticity, not knee issues, don’t read into it on test if he says they have foot drop) * Majority of trouble in swing phase (but also some in Initial contact to loading response) * Want to assist dorsiflexion during swing, so we put them in a neutral AFO (because there is no spasticity/knee weakness). * Hopefully we have not caused other problems (so neutral is best choice)

Answer 19

Recurvatum * We want to move ground reaction force slightly posterior to create a small flexion moment * What could we do to the ankle to cause this? * put in dorsiflexion so * we want slight dorsiflexion AFO to correct this slightly * at most 5\* (Do not want to much DF or we may cause/exacerbate buckling) * We want to prevent more recurvatum and damage to posterior capsule, etc. * Typical of pt with stroke pt

Answer 20

Buckling * we are getting too much knee flexion * landing in plantarflexion creates more of an extension moment * Put them in slight plantarflexion AFO * they cannot get knee to move any more forward * Makes knee stable, but disrupts gait cycle * GRF stays anterior to knee * Too much PF can cause/exacerbate recurvatum (so at most 5\*)

Answer 21

1. Recurvatum 2. Buckling For both of these, we are making just enough adjustment to move knee to neutral position (not past neutral into the position opposite of what we are trying to correct).

Answer 22

1. Whenever we can control a joint more distally, it is better to not go up higher because you will have less stuff on the leg. 2. Usually people with these knee problems also have foot involvement 3. If you had someone with isolated knee problem (uncommon), you might be able to apply something just to the knee (probably a KO, not a KAFO) but then you would be stuck in knee extension, etc.

Answer 23

“AFO is made with a DF stop at 5\* of PF” (this often relates to Articulating/dynamic AFOs)