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Prosthetics&Orthotics > L1: Orthotics--INTRO > Flashcards

L1: Orthotics--INTRO Flashcards

1
Q

Orthotics

Purpose:

A

Transfer GRFs and other forces generated by the patient to a balanced parallel force system to control joint motion

  • Force (vectors)→ 3 characteristics:
    1. Magnitude
    2. Direction
    3. Point of Application (POA)
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2
Q

Orthotics use what type of lever system?

A

First class lever system

  • Bw 2 ends of of a segment where the force is occurring
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3
Q

Orthotics

Three Point Loading System

A
  • Prox and Dist force applied in SAME DIRECTION
  • COUNTERBALANCED→ by third force in the OPPOSITE direction somewhere in bw them

*NOTE: If motion control is desired in multiple planes→ may need MORE points. AKA more control needed==more restrictive AFO

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4
Q

More control needed===

A

More restrictive AFO

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5
Q

An orthotic is designed for what?

A
  • Designed to apply force of a particular magnitude at a specific point on a body segment in the presence OR absence of WB
    • NOT JUST FOR STANCE→ keeps ankle neutral in Sw phase
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6
Q

Orthotics problems if too much force or force over a long pd of time ===

A

Tissue deformation and skin breakdown

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7
Q

Pressure==

A

F/A

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8
Q

Orthotics→ Three Point Force System

A
  • The magnitude of the central force (anterior directed force) DECREASES as the posterior directed force moves FURTHER UP the femur and DOWN the tibia
  • Orthotics that cover the majority of a body segment Prox and Dist to a segment provide greater leverage and a more comfy fit
  • The problem is→ LONGER prosth== LESS cosmetic in appearance and more diff. to don/doff
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9
Q

Forces translated to the body thru an orthotic are designed to be distributed over ___________

A

As much surface area as possible

*relief areas, padding, flexible load absorb materials further alleviate forces==comfort

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10
Q

Orthotics:

As a first class lever system, the magnitude of opposing forces must sum to…

A

ZERO !!!!

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11
Q

Force and Counterforce Systems

Sagittal Plane knee flexion vs Frontal Plane knee valgus

A

see pics

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12
Q

No orthotic is perfect!

Cannot mimic exact biomech. anatomical joint

A

Bc diff. bw anatomical joints (triplanar or polycentric axes) and orthotics (single axis)→ there will be a torque or moment translated to joint at some point in ROM

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13
Q

Placement of straps, bands, or pads

Purpose:

A

MINIMIZE forces

INC comfort

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14
Q

Desired Effect of orthotic

A

Stability vs. Mobility

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15
Q

Orthotics: Footwear

3 things suitable footwear does

A
  1. Minimizes stress on all portions of feet
  2. Provides support
  3. Acts as shock absorber for GRFs
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16
Q

Orthotics-Footwear

Sole

A
  • Durable BUT not so rigid to interfere w/ toe rocker (MTP hyperEXT) during TSt
17
Q

Orthotics-Footwear

Upper

2 Styles and preferable style

A
  • Blucher and Bal Oxford styles
    • Blucher closure==preferable w/ orthosis
18
Q

Orthotics-Footwear

Heel (¾ inch is standard)

A

¾ inch is standard

  • Absorbs shock and disperses GRFs @ IC
  • Limtd ankle motion (anatomical) benefit from SOFTER compressible heel (on shoe)
19
Q

Orthotics-Footwear

Counter (top of heel/”back of shoe”)

A
  • Reinforces heel
  • Prevents excessive calcaneal/rearfoot motion
20
Q

Orthotics-Footwear

Toe Box

A
  • Enough height to accommodate for toe deforms (i.e. hammer toes)
21
Q

Orthotics-Footwear

Last

A
  • Determines shape of shoe
    • Straight, medial, outflared
    • MOST shoes have medial last
      • toe box directed inward from heel
22
Q

Orthotics-Footwear

A

see pics

23
Q

Footwear facts to keep in mind

Wt Gain

A

Wt gain as little as 9lbs over a 5yr period INCs foot size by one full size**

  • pregnancy
  • obesity
  • distal edema
24
Q

Orthotics-Footwear

Women love shoes!

Important details

A
  • Rarely assess width→ Results in:
    • calluses
    • corns
    • bunions
    • hammertoes
    • ingrown toenails
  • MOST wear shoes that are too small
25
Q

Proper footwear choice and size CRITICAL in high risk pops:

A

DM→ Charcot Marie Tooth Disease (CMT)

Elderly

Obese

PVD

26
Q

Orthotics-External Shoe Mods

Used when?

A
  • USED WHEN static corrections for fixed foot deformities that are too large or complex for in-shoe corrections like postings or cookies
    • Requires EXT shoe mods
27
Q

External Shoe Mods

Lifts for Leg Length Discrepancies (LLDs)

A
  • >3/8 inch STRUCTURAL LLD== EXT lift indicated
    • aka comes from: congenital anomalies, hip fx’s, scoliosis
  • Heel lifts on EXTERIOR shoe MOST approp.
  • Heel wedges inside shoe also used (1/8” to ¼”)
28
Q

EXTERNAL shoe mods are more for….

A

FIXED deformities

29
Q

External Shoe Mods→ Wedges

A
  • A: Medial heel wedge→ used for flexible ValGus of calcaneus
  • B: Lateral heel wedge→ used for flexible VaRus of calcaneus
  • C: Medial sole wedge→ creates INversion effect forefoot
  • D: Lateral sole wedge→ creates Eversion
  • E: Barton wedge→ supports Navicular and helps INvert calcaneus==shifts bw laterally
30
Q

More external shoe mods→ Wedges

A

see pics

31
Q

External Shoe Mods

Metatarsal bars/Rocker bottoms

*Stacked leather or rubber on sole of shoe under Met heads

4 Functions:

A
  1. Reduces pressure on Met heads during push off
  2. Improves toe rocker for fused toes/ankle jts
  3. Transmet. amps and hallux rigidus
  4. Facilitates forward propulsion in the absence of metatarsal flexibility
32
Q

Footwear- Sports

*Shoe MUST match (complement) persons foot structure

LOW arches vs. HIGH arches

A
  • Pes planus (LOW arches)
    • Need maximum stability @ counter and last
  • Pes cavus (HIGH arches)
    • Need more flexibility (bc they already have rigid foot)
33
Q

Diffs in demand on foot =====

A

changes design of shoe

34
Q

Footwear-Sports

Running shoes

A
  • Designed for high force
    • higher heels and gel
    • honeycomb or air design for shock absorb
      • light, breathable, flexible forefoot/last
35
Q

Footwear-Sports

Basketball shoes

A
  • High tops→ incd med/lat support
  • Added lat. material to prevent INversion sprains
  • More shock absorb
36
Q

Cross training shoes

A

Stability from firm counter (side-side motions)

Med. wt

Good shock absorb

37
Q

Footwear pics

DESCRIBE ALL BENEFITS/DRAWBACKS OF THESE

A

Prosthetics&Orthotics (19 decks)

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