Fun wif AFOs!

Question 1

What are the two types of weight bearing brims in KAFOs and what is the brim used for?

Answer 1

1. Thomas Ring
2. Quad Brim
   * these function just like they did in prosthetics
   * used to relieve distal WB issues

Question 2

What kinds of pads and straps are available in KAFO land and what are these used for?

Answer 2

1. Knee cap - pulling knee into extension so blocks flexion in stance (attenuates forces)
2. Varus / Valgus - added to knee cap

Question 3

What is a Scott Craig KAFO?

Answer 3

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).

Question 4

What are some issues with traditional KAFOs?

Answer 4

1. Energy expenditure (not great for elderly or chronically ill)
2. Need for Proximal Functional Strength
3. Low Fx (you can only go forward)
4. Long Term Use leads to UE overuse

Question 5

What is the advantage of having a microprocessor KAFO?

Answer 5

Better eccentric control of the knee and a lot more control getting up and down ramps.

Question 6

If the GRF is anterior to the ankle what external moment occurs at the ankle?

Answer 6

DF

Question 7

If the GRF is posterior to the hip what is the external moment at the hip? What part of stance does this occur in?

Answer 7

hip extension

mid-stance to terminal stance

Question 8

If the GRF is medial to the ankle, what is the external moment at the ankle?

Answer 8

inversion / supination

Question 9

Where is the counter of the shoe?

Answer 9

The area above the heel posterior in the shoe

Question 10

Where is the shank in the shoe?

Answer 10

It’s the middle of the shoe.

Question 11

Where is the vamp of the shoe?

Answer 11

Right behind the toe-box but in front of the throat/laces.

Question 12

Who might use an extra depth shoe?

Answer 12

Patients w/ neuropathy with custom molded orthoses to prevent or accomodate foot deformities.

Question 13

What is proper fit for a shoe?

Answer 13

1. 1/2 inch margin between the end of the longest toe and the end of the toe box
2. adequate space medially and laterally
3. snug heel counter
4. with AFO and KAFO - proper heel height

Question 14

Who do you give a heel wedge to?

Answer 14

A patient with a PF contracture

Question 15

What are the two places that you would add padding and why?

Answer 15

1. Heel counter - make the fit snug so the patient doesn’t rock medial to lateral
2. Tongue - prevents submarining

Question 16

Where do you place a metatarsal pad?

Answer 16

directly posterior to the wound and not ON TOP of the metatarsal

Question 17

What is a wedge used for?

Answer 17

To make either the medial or lateral of the foot supported.

Question 18

What is a lift used for?

Answer 18

1. Correct leg length discrepancy (ipsilateral)

2. Promote limb clearance (contralateral)

Question 19

What is a metatarsal bar used for?

Answer 19

Used to unweight metatarsals

Question 20

What is a heel flare and what is it used for?

Answer 20

A widening / flare of the heel of the shoe.

1. resists motion
2. lateral flare resists inversion
3. medial flare resists eversion
   * adds stability

Question 21

What is the difference between a heel flare and a buttress?

Answer 21

The buttress extends up the side of a shoe vs. the flare is only on the bottom of the shoe.

Question 22

What is the function of a SACH heel?

Answer 22

Improve shock absorption. You can also modify these so that one side is softer so you can control pronation or supination.

Question 23

What is the function of a rocker bottom sole?

Answer 23

Reduce GRF to areas of high pressure and stress (i.e. met heads). ex: ankle fusion (they don’t have any more ankle movement!)

Question 24

What is the function of a double rocker?

Answer 24

To unweight the mid-foot. Ex: Charcot foot

Question 25

Who are soft foot orthotics used for?

Answer 25

Those with pain or diabetic foot. These are considered accommodative and do NOT control motions. NOT MOLDED.

Question 26

Who might use a semi-rigid foot orthotic?

Answer 26

Used to balance the mal-aligned foot, best for someone who you need to control abnormal pro/supination in. MOLDED.

Question 27

Who might use a rigid foot orthotic?

Answer 27

Someone you’re looking to try to primarily control motion with. These are not primarily used for shock absorption. MOLDED.

Question 28

What is posting of an orthotic?

Answer 28

Build up created in order to correct alignment. The goal is to try to get the sub talar joint in neutral.

Question 29

What is a poster appliance?

Answer 29

head and chest

Question 30

What is the minerva jacket?

Answer 30

Halo incorporated into chest position

Question 31

What is a chairback orthosis used for?

Answer 31

being pushed into a little bit of extension

Question 32

Who might a Knight Taylor orthosis be used by?

Answer 32

someone who is in kyphosis

Question 33

When is a clam shell orthoses typically used?

Answer 33

For spinal fracture, scoliosis,

Question 34

What does a scoliosis brace such as the Milwaukee brace shown to do?

Answer 34

Prevent, but not correct deformity.

Question 35

What might a medial unloader be used for?

Answer 35

Patients who should get a knee replacement but are waiting. These have been shown to help with pain and off loading.