Indications/Contraindications for orthosis Flashcards
Actions of UCBL orthosis:
Stabilize subtalar and tarsal joints in stance
Indications of UCBL:
Rearfoot valgus/varus
Flexible pes planus
Pronation control, flexible pes planus, OA of the hindfoot, posterior tib dysfunction, tarsal coalition, rearfoot valgus/varus
Contraindications of UCBL:
Rigid foot deformity
Toe walker, mod-high tone, ankle arthritis (rigid foot deformities)
Actions of DAFO:
Stabilize subtalar and tarsal joints in stance
Indications of DAFO:
Flexible pes planus
Mild-mod spastic diplegia or hemiplegia CP
Hypotonic CP
Contraindications of DAFO:
Rigid foot deformity
Actions of supramalleloar (SMO):
Stabilize subtalar and tarsal joints in stance
Preposition foot for IC by heel
Indications of SMO:
Flexible pes planus
Mild-mod spastic diplegia or hemiplegic CP
Hypotonic CP
Severe Pes Planus, Mild ankle instability, low (hypo) tone, Intermittent toe walkers, mild to moderate CP, tarsal coalition, post tib dysfunction
Contraindications of SMO:
Significant equinovarus hypertonicity high tone (hypertonicity) , sagittal plane, weakness deformity, dominate toe walkers, equinovarus/valgus
Actions of Posterior Leaf Spring:
Assist limb clearance in swing
Preposition foot for IC by heel
Indications of posterior leaf spring:
DF weakness, impaired motor control, LMN flaccid paralysis of DF
Contraindications of posterior leaf spring:
Mod-severe hypertonicity
moderate to severe spasticity, coronal plane ankle instability, ankle dorsiflexion limitations/fused joint, severe knee instability
Action of carbon graphite AFO:
Assist limb clearance in swing
Preposition foot for IC by heel
Indications of carbon graphite AFO:
Paralysis or impaired muscle performance of DF
Contraindications of carbon graphite AFO:
Mod-severe hypertonicity
Action of neuro-orthoses:
Assist limb clearance in swing
Preposition foot for IC by heel
Indications of neuro-orthoses:
DF weakness or low tone
Contraindications of neuro-orthoses:
Flaccid paralysis
Pt intolerance of e-stim
Actions of articulating ankle:
Assist limb clearance in swing
Preposition foot for IC by heel
Permit advancement of tibia in stance
Indications of articulating ankle:
Impaired motor control of ankle muscles
Potential for recovery of neuromotor function
Contraindications of articulating ankle:
LMN paralysis (flaccidity) or hypotonicity as primary problem
Solid ankle AFO actions:
Control ankle position throughout stance
Provide stance phase stability via ankle-knee coupling
Assist limb clearance in swing
Preposition foot for IC by heel
Distal trim line behind metatarsal heads or extended toe-plate
Solid ankle AFO indications:
Significant hypertonicity with seriously impaired motor control at ankle and knee
Ankle instability/weakness in more than one plane
Equino varus
Moderate-severe pes plano valgus
Mild-moderate genu recurvatum
Solid ankle AFO contraindications:
LMN paralysis (flaccidity) or hypotonicity as primary problem edema
Tone inhibiting AFO actions:
Control ankle position throughout
Provide stance phase stability via ankle-knee coupling
Typically extended toeplate
Tone inhibiting AFO indications:
Significant hypertonicity with seriously impaired motor control
Tone inhibiting AFO contraindications:
LMN paralysis (flaccidity) or hypotonicity as primary problem
Anterior floor reaction AFO actions:
Provide stability in stance via ankle-knee coupling
Control ankle position throughout stance
Anterior floor reaction AFO indications:
Weakness or impaired motor control at knee and ankle
Anterior floor reaction AFO contraindications:
Ligamentous insufficiency at the knee
Genu recurvatum
Weight-relieving AFO action:
Protect lower leg and foot during stance by reducing weight bearing forces
Weight relieving AFO indications:
Healing soft tissue, ligamentous, or bone injuries of the lower leg, ankle, or foot
Weight relieving AFO contraindications:
Mechanical instability of the knee, or injury to proximal tibia
Pt intolerance of PTB WB forces (rare)
Bilateral Metal upright (bars) AFO indications:
Foot drop, post-polio, neuropathic feet poor knee control in sagittal plane ankle varus/valgus foot drop with uncontrolled edema poor skin below the knee
Bilateral Metal upright (bars) AFO contraindications:
Pt’s concerns with bulk/weight
limits shoe wear
Free motion/articulated/hinge AFO actions:
Allows sagittal plane motion
Free DF and PF
Limits coronal plane instabilities
Free motion/articulated/hinge AFO indications:
Posterior tib tendon dysfunction
Subtalar or talar joint instabilities
Free motion/articulated/hinge AFO contraindications:
Weak quads, sagittal plane ankle weakness
High impact sports
DF Assist AFO actions:
Assist in clearance of toes while allowing for some PF
Variable DF assist
allows for controlled foot flat stance phase
DF Assist AFO indications:
DF weakness
DF Assist AFO contraindications:
Mod-severe tone levels in pts with altered knee control
Posterior Stops in AFO action:
Immobilize ankle in swing and stance phase
If you only have a PF stop and DF is free, then it facilitates knee flexion in early stance
Posterior Stops in AFO indications:
Structural collapse of the ankle foot, severe spasticity
Posterior Stops in AFO contraindications:
Inadequate hip strength, absent quads, fluctuating edema, fixed/contracted spastic gastrocs
DF stop/free plantar flexion action:
Facilitates knee extension and stiff ankle in late stance
DF stop/free plantar flexion indications:
Weak PF and weak quads
DF stop/free plantar flexion contraindications:
DF weakness
Knee hyperextension
Solid Ankle foot orthosis (non articulated) indications:
Ankle instability/weakness in more than one plane
Equino varus
mod-severe pes plano valgus
mild-mod genu recurvatum
Solid Ankle foot orthosis (non articulated) contraindications:
edema
Spiral AFO actions:
Spiral has unwinding effect
Spiral AFO indications:
Ankle DF weakness and/or PF ALONG with mild-mod ML instability
Spiral AFO contraindications:
inadequate hip strength
mod-severe spasticity
severe ML ankle instability
fluctuating edema
Ground/Floor Reaction AFO actions:
Provide ground forces to the knee which assist in stabilizing the knee during ambulation
For patients with weak quadriceps - it can achieve knee stability while maintaining efficiency by reducing weight and bulkiness
Ground/Floor Reaction AFO indications:
Crouched gait Foot drop with knee instability quadriceps weakness MS Spina bifida
Ground/Floor Reaction AFO contraindications:
Genu recurvatum
ACL
Severely ER feet
Pts that do not have adequate trunk control or flaccid quad strength
