Fun wif AFOs! Flashcards
What are the two types of weight bearing brims in KAFOs and what is the brim used for?
- Thomas Ring
- Quad Brim
* these function just like they did in prosthetics
* used to relieve distal WB issues
What kinds of pads and straps are available in KAFO land and what are these used for?
- Knee cap - pulling knee into extension so blocks flexion in stance (attenuates forces)
- Varus / Valgus - added to knee cap
What is a Scott Craig KAFO?
Designed for paraplegics (up to T4) to stand and walk - paraplegics use it to get swing through gait with crutches and they can stand only because they are leaning on their Y-ligaments (but it takes 43% more energy to use these).
What are some issues with traditional KAFOs?
- Energy expenditure (not great for elderly or chronically ill)
- Need for Proximal Functional Strength
- Low Fx (you can only go forward)
- Long Term Use leads to UE overuse
What is the advantage of having a microprocessor KAFO?
Better eccentric control of the knee and a lot more control getting up and down ramps.
If the GRF is anterior to the ankle what external moment occurs at the ankle?
DF
If the GRF is posterior to the hip what is the external moment at the hip? What part of stance does this occur in?
hip extension
mid-stance to terminal stance
If the GRF is medial to the ankle, what is the external moment at the ankle?
inversion / supination
Where is the counter of the shoe?
The area above the heel posterior in the shoe
Where is the shank in the shoe?
It’s the middle of the shoe.
Where is the vamp of the shoe?
Right behind the toe-box but in front of the throat/laces.
Who might use an extra depth shoe?
Patients w/ neuropathy with custom molded orthoses to prevent or accomodate foot deformities.
What is proper fit for a shoe?
- 1/2 inch margin between the end of the longest toe and the end of the toe box
- adequate space medially and laterally
- snug heel counter
- with AFO and KAFO - proper heel height
Who do you give a heel wedge to?
A patient with a PF contracture
What are the two places that you would add padding and why?
- Heel counter - make the fit snug so the patient doesn’t rock medial to lateral
- Tongue - prevents submarining
Where do you place a metatarsal pad?
directly posterior to the wound and not ON TOP of the metatarsal
What is a wedge used for?
To make either the medial or lateral of the foot supported.
What is a lift used for?
- Correct leg length discrepancy (ipsilateral)
2. Promote limb clearance (contralateral)
What is a metatarsal bar used for?
Used to unweight metatarsals
What is a heel flare and what is it used for?
A widening / flare of the heel of the shoe.
- resists motion
- lateral flare resists inversion
- medial flare resists eversion
* adds stability
What is the difference between a heel flare and a buttress?
The buttress extends up the side of a shoe vs. the flare is only on the bottom of the shoe.
What is the function of a SACH heel?
Improve shock absorption. You can also modify these so that one side is softer so you can control pronation or supination.
What is the function of a rocker bottom sole?
Reduce GRF to areas of high pressure and stress (i.e. met heads). ex: ankle fusion (they don’t have any more ankle movement!)
What is the function of a double rocker?
To unweight the mid-foot. Ex: Charcot foot
Who are soft foot orthotics used for?
Those with pain or diabetic foot. These are considered accommodative and do NOT control motions. NOT MOLDED.
Who might use a semi-rigid foot orthotic?
Used to balance the mal-aligned foot, best for someone who you need to control abnormal pro/supination in. MOLDED.
Who might use a rigid foot orthotic?
Someone you’re looking to try to primarily control motion with. These are not primarily used for shock absorption. MOLDED.
What is posting of an orthotic?
Build up created in order to correct alignment. The goal is to try to get the sub talar joint in neutral.
What is a poster appliance?
head and chest
What is the minerva jacket?
Halo incorporated into chest position
What is a chairback orthosis used for?
being pushed into a little bit of extension
Who might a Knight Taylor orthosis be used by?
someone who is in kyphosis
When is a clam shell orthoses typically used?
For spinal fracture, scoliosis,
What does a scoliosis brace such as the Milwaukee brace shown to do?
Prevent, but not correct deformity.
What might a medial unloader be used for?
Patients who should get a knee replacement but are waiting. These have been shown to help with pain and off loading.
