Hip dysplasia and orthotics Flashcards
At birth, the acetabulum covers about ___ of the femoral head
⅓
When is ossification complete in the hip?
13 - 16 years
When does the junction between the epiphysis and bone begin to interlock?
2nd year of life
What are the risk factors for hip dysplasia?
- Mechanical (forces placed)
- Physiological (shallow acetabulum)
- Environmental
Incongruency of the femoral head and the acetabulum leading to increased risk of subluxation and dislocation.
developmental hip dysplasia
What is the most reliable sign for hip dysplasia clinically?
hip abduction ROM
- Normal: 75-90
- Asymmetry of 5-10 degrees with hip abduction
Other indicators: uneven skin folds
Diagnostic tool: 0-6 months = ultrasound, >6 months = xray
Barlow’s Maneuver:
Start in abduction and move to adduction with pressure posteriorly. What is a positive sign?
hip subluxation
- move to ortolani’s
Ortolani’s Sign
Start in adduction and move to abduction with slight traction-hip slides back into place. What is a positive sign?
Positive if one hip is less stable than the other, or if a hip is dislocated
- always start with Barlow
When is Barlow and ortolani tests relevant?
up to 2-3 months
80% resolve without surgical intervention. What is the treatment of choice (ages 0-9 months, >9 months, 18-24 months, >2 years)?
- 0-9 months = Pavlik Harness for treatment
- > 9 months = Abduction Orthosis
- 18-24 months = Traction, Closed reduction surgery with spica cast (hard cast)
- Over two years = Open reduction surgery
- if conservative therapy or closed reduction results in open reduction surgery
- early dx and tx most effective (<7 weeks)
- harness worn all the time, except for bathing every 3rd day
What is the proper position of pavlik harness?
- Hip Flexion - Safe Zone: 100-110 degrees (prevent AVN)
- Hip Abduction - Safe Zone: 40-60
What are risk factors of the pavlik harness?
- Avascular necrosis of the femoral head
- Femoral nerve palsy
- Inferior dislocation
- Erosion of the posterior rim of the acetabulum
- worn 6 wks to 3 months, if not resolved my 3 months, other options considered
Appliances for any part of the body that serve to support, align, prevent or correct deformities of a body part, or improve the function of moveable parts of the body
orthotics
What should you consider when making a foot orthosis?
- Hindfoot - The Foundation
- Forefoot - The Partner
- Ankle - The Mover
Where should the hind foot be positioned for AFOs?
subtalar neutral
- determine how much effort is needed to hold the calcaneus in neutral
After the hind foot, what should you look for with the ankle?
- after hind foot is positioned into subtalar neutral..
1. How much ROM is available? - May want to attempt to achieve more ROM prior to casting
- May need to post externally if DF ROM is not available
2. How much voluntary control of the ankle is available? - This will determine the proximal trim lines of the DAFO
Incorporate design features that are intended to inhibit hypertonia that has resulted from any of the following; Supports the Toes, Longitudinal, Peroneal,and Metatarsal Arch
tone reducing/ inhibitive footplates
- attempts to inhibit plantar grasp
What are the indications for a PF stop, free DF AFO?
- Excessive Plantarflexion
- Consistent Toe Walking
- Little Voluntary Control of the Ankle
- Strong Hyperextension of the Knee
-
**Can use a hinge
- limitation = no active PF
What are the indications for a resist PF AFO?
- Useful Voluntary Ankle Control
- Partial Control of plantarflexion
- Mild Resistance to Crouched Stance
- Limitations - Does Not Control Strong Plantarflexion or Knee Hyperextension
- need grade 2 strength
What are the indications for a free PF/ DF AFO?
- controls eversion/inversion
1. Strong Fixing Patterns of Pronation and/or Supination but adequate control of plantarflexion and dorsiflexion
2. Delayed Development with Low Tone
3. High Level of Floor Activities Requiring Free Ankles - i.e. Infants - Limitations - Does not Control Plantarflexion/Dorsiflexion
- used in Down’s syndrome population
What are the indications for a floor reaction AFO?
- Sink into excessive dorsiflexion through weakness
- Lack Ankle Plantarflexion Strength
- Lack Knee Extension Strength
- Limitations - Do not precisely control foot position; Does not Correct Crouch Due to Tight Hip Flexors or Hamstrings
- contact with patellar tendon to activate quads (pt has weak quads)
- HAVE to have full passive knee extension for this orthosis
What are the indications for a UCB?
- Functional Ambulators with Moderate Pronation
- Excessive Foot Mobility but are Fully Correctable
- Pronation is Due to Low Tone, Delayed Development, Poor Proprioception
- custom submalleolar
- has active inv/ever
What are the indications for a non custom shoe insert?
- Minimal Pronation in Weight bearing
2. Exhibit Delayed Foot Control Skill, but have Voluntary Control Initiated
In kids with CP, orthoses [decreases/ increases] cost of energy expenditure in walking.
decreases
- improves gait energy efficiency for basic gait (not running or jumping)
