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L2: AFOs Flashcards

1
Q

When we refer to “Traditional” orthotic

Whats that mean

A

Metal bars and leather

Old School!!!!!

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2
Q

Orthotics always go one joint above what you want to control

A

******

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3
Q

Rockers:

3

A
  1. Heel
  2. Ankle
  3. Toe (Forefoot)
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4
Q

Rockers:

Heel

A
  • IC→Foot flat
    • DEceleration of foot→floor
    • Wt Acceptance
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5
Q

Rockers:

Ankle

A
  • MSt as tibia advances over fixed foot
    • Triceps surae eccentrically controls speed of tibia (decelerates)
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6
Q

Rockers:

Toe (Forefoot)

A
  • Tst→ Push-off
    • BW rolls over MTP jts
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7
Q

AFO Terminology

A

NOTE: trimlines, straps, footplates

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8
Q

AFOs

Goals and Gait Prereqs:

A
  • Goal:
    • Safe, energy efficient gait
  • Gait Prereqs:
    • Stability in stance
    • Swing phase prepositioning
    • Clearance in swing
    • Adequate (symmetrical) step length
    • Energy conservation
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9
Q

Note about step length involved vs uninvolved

A

Involved LE will CAUSE shorter step length on contralateral side (good side)

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10
Q

AFOs

Stability in Stance

A
  • AFO controls instability by optimally aligning ankle
    • application and loc of forces in M/L or A/P directions
  • Ideal for pes equinus or ankle vaRus deforms
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11
Q

AFOs

Stability in Stance

Fulcrum vs Counter Forces

A
  • Fulcrum→ Anterior ankle
  • Counter forces→ Plantar surf foot and posterior proximal calf
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12
Q

AFO

Clearance in Swing

A
  • Keeps foot neutral==incd qual of swing due to:
    • Dec DF strength
    • poor timing
    • abnorm EXT synergy
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13
Q

AFO

Swing Phase Repositioning

A
  • Maintains ankle in neutral DF and ev/inv to prep for wt acceptance
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14
Q

AFO

Adequate Step Length

A
  • Maints stability of talocrurcal joint in TSt and PSw→ allows CONTRALAT. LIMB to maint. proper step length
  • effective propulsion of limb in Sw when needed
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15
Q

AFO

Energy Conservation

*CRITICAL in neuro pop.

A
  • Critical neuro pop→ return to IND community amb.
  • Controls ankle and knee jts during St and Sw===Less energy cost
  • *Less compensatory mechs==Less energy !!!
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16
Q

PF + DF associations

A

Excess PF== Knee EXT (PE class**)

Excess DF== Knee FLEX (buckling)

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17
Q

AFO

*rigid solid ankle AFO that fixes ankle in DF prevents

A

Knee HyperEXT

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18
Q

AFO-Force Systems

What all AFO’s do inherently

A
  • Notice where Fc is and what is being controlled!!!
  • Fp= proximal force
  • Fd= distal force
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19
Q

AFO force system

PF control

A

NOTE: Fprimary

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20
Q

AFO controlling excessive PROnation

notice Medial flange

A
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21
Q

MOST AFOs are ________

A

Custom Molded (MAFOs)

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22
Q

MAFOs

Custom Molded

A
  • Intimate fit, light, distributes forces effectively, fits most shoes, modified for relief,
  • Does NOT accommodate for fluctuating edema ***
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23
Q

AFO Types: 2

Classified by function

A
  1. Static Ankle Foot Orthosis
    1. MAX control
  2. Dynamic Ankle Foot Orthosis
    1. Incs DOF→ someone w/ better control
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24
Q

Static AFO’s

4:

A
  1. Solid Ankle
  2. Anterior Floor Reaction
    1. set in PF→ knee hyperEXT bias
  3. Patella Tendon Bearing
  4. Supramalleolar (SMO)
    1. high top→ PEDS
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25
Q

Dynamic AFOs (DAFO)

4:

A
  1. Posterior Leaf Spring (PLS) (Thermoplastic)
  2. Conventional DF assist
  3. Articulating thermoplastic
  4. Hybrid (metal-plastic)
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26
Q

AFOs ex’s

A

see pics

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27
Q

Static AFO’s (max control)

Primary function

A
  • maint. ankle/foot in a fixed pos. @ TCJ, STJ, forefoot
  • Effectively:
    • assist w/ Sw clearance
    • preposition foot for IC
    • EXT stability for knee & ankle t/o stance
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28
Q

Static AFO

Solid (non-articulated) ankle AFO

Drawbacks and what to do about it

A
  • Drawback→ all rockers compromised
  • AFO fabrication→ Shoe mods:
    • Inc cushion heel→ compensates for heel rocker
    • Rocker bottom (entire sole)→ comps for 2nd/3rd rockers=== smooth forward translation t/o Stance
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29
Q

Solid Ankle AFO:

Indications

A
  • Those who need total immob. of ankle/foot complex
  • Controls:
    • Inv/Ev
    • foot drop (but not all need MAFO)
    • Ext tone/synergies→ Mod Ashworth know it!!
    • Knee hyperFLEX (biases to PF)/knee hyperEXT (biases to DF) → you know WHY!!
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30
Q

Solid Ankle AFO

Thermoplastic piece

A
  • Thermoplastic piece encompasses most of lower leg
    • Trimlines→ anterior to malleoli
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31
Q

Solid Ankle AFO

To control for abnorm toe grasp (CP, spastic CVAs):

A

LONGER toe/footplate

Tone inhibiting bar

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32
Q

Static AFOs w/ articulation have ability to max. control:

4 things:

A
  1. Ankle DF/PF
  2. Inv/Ev
  3. Knee hyperEXT
  4. Knee buckling (hyperFLEX)
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33
Q

Static AFOs w/ articulation have ability to max. control:

Ankle DF/PF

HOW?

A
  • A/P force coupling→ 3pt system
  • Length of foot plate
  • Thickness of foot plate
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34
Q

Static AFO’s w/ articulation have ability to max. control:

Inv/Ev

HOW?

A
  • Med→Lat force coupling
  • Ankle/foot trimlines**
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35
Q

Static AFOs w/ articulation have ability to max. control:

Knee hyperEXT

HOW?

A

Ankle/foot set in slight DF

bc DF associated w/ FLEXION**

36
Q

Static AFOs w/ articulation have ability to max. control

Knee Buckling (hyperFLEX)

HOW?

A

Ankle/foot set in slight PF

bc PF assoc’d w/ EXTENSION***

37
Q

Static AFO:

Anterior Floor Reaction

*protects against buckling

A
  • Harnesses GR moment/force (GRF) and converts into sagittal plane stability for the knee jt during stance
  • *Set in slight PF to create EXT moment @ knee
    • → Bias towards keeping knee in EXT→ controls knee buckling/flex
38
Q

Anterior Floor Reaction

More on PF role and setting:

A
  • Amt of PF, rigidity, length of toe plate== degree of knee control
  • PF-knee EXT force couple
  • padded anterior shell @ prox anterior tibia→ absorbs EXT moment
39
Q

Anterior Floor Reaction

What is actually happening when set in neutral or slight PF

A
  • Tibia restrained from advancing over fixed foot→ 2nd rocker
    • GRF anterior to knee earlier in St==more knee EXT force
  • Length+stiffness of toe plate INCs==3rd rocker limtd → biases knee into EXT
40
Q

Anterior Floor Reaction + Ground Reaction Moments

41
Q

Anterior Floor Reaction AFO

Biomechanically, what does it do?

Indicated for based off of that?

A

Enables pt w/ little quad function to be stable t/o stance phase

  • Indications:
    • Weak quads→ remember quads have to counter knee flexion moment****
    • Crouched gait→ bc will lessen demand on quads by moving GRF anterior to knee sooner
42
Q

Anterior Floor Reaction AFO

Based off what you know biomechanically….

NOT indicated for:

A
  • Not indicated:
    • Uncontrolled genu recurvatum
      • bc already hyperEXTd
    • Structural knee instab. (ligs)
    • Knee flex contracture >10*
      • AFR AFO will still control DF and knee flex, but will not create true EXT moment
43
Q

Anterior Floor Reaction AFO stops/limits…

A

DF

*bc remember DF assoc’d w/ knee flex which could = buckling!!!

44
Q

AFR AFO depicted in picture form…

A

see pics read description!!!!

45
Q

The AFO w/ the “Knee pad” looking thing

A

Patella Tendon Bearing “PTB” AFO

46
Q

PTB AFO

Primary goal:

A
  • Reduce axial loading to the knee, foot, ankle
47
Q

PTB AFO

HOW does the PTB AFO reduce axial loading to knee, foot, ankle?

A
  • Set in slight knee flex (10*)
    • BW loaded onto anterior shell + patella tendon
      • ==> DECd loads on tib, fib and bones of foot***
48
Q

PTB AFO

EXCELLENT OPTION for…

A
  • anyone who reqs reduced WB thru foot:
    • CMT ankles
    • Neuropathic ulcers on plantar surface
    • slowly healing fx’s of foot
49
Q

PTB AFO pics

50
Q

Supramalleolar Orthotic (SMO)

Biomechanical function:

A
  • Incs control of STJ valGus and vaRus by lengthening proximal lever arm upward
    • Think “high-top sneaker”
51
Q

SMO

Based off biomechanic function….

Indications:

A
  • CP after corrective sx→ tendon lengthening
  • Chronic INV instab.→ STJ trauma
  • Periph neuropathy
  • MM disease
  • Pts w/ adequate knee strength/control
    • ***SMO won’t correct knee!!!!
52
Q

Static AFOs prevent DF/PF ankle mvmts necessary to perform functional activities efficiently

see pics and notice compensations

53
Q

Posterior Leaf Spring (PLS)→ Dynamic AFO

*2 things to remember:

A
  1. Narrow trimline
  2. MORE intrinsic mobility of foot
54
Q

Posterior Leaf Spring PLS→ Dynamic AFO

ALL Dynamic AFOs allow this:

A

Sagittal plane motions @ ankle***

55
Q

PLS Distinction from all dynamic AFOs

A
  • Trim lines well behind med/lat malleoli==> more flexibility
    • *Thickness of thermoplastic==> determines flexibility
56
Q

PLS and the Rocker Systems

1st→3rd

A
  • 1st Rocker
    • PLS provides controlled lowering of foot toward ground
  • 2nd Rocker
    • Flexibility of PLS allows enough DF for tibial advance. over foot in MSt
  • 3rd Rocker (PSw) and Sw
    • PLS hold ankle @ 90* (neutral)→ assists w/ clearance + pos’ing for next heel strike
57
Q

PLS trades _____ for _______

A

PLS trades stability for mobility

58
Q

Drawbacks of PLS

A
  • DECd mediolateral control
  • DECd knee control
    • not structured to control knee
  • NOT effective w/ mod-severe spasticity
    • they’ll burst right thru it

PLS trades stability for mobility

59
Q

Spiral AFOs

A

*Semirigid plastic

  • During stance→ Uncurls (widens) as limb accepts wt
  • MSt→ ankle comes to neutral→ returns to orig. shape
  • MSt-TSt→ sprial compresses (like coiled spring)→ aids in push-off as ankle DFs
  • Swing→ spiral returns to orig shape to hold foot in neutral
60
Q

Only difference bw Spiral AFO vs. HemiSpiral AFO

A

Hemi employs same mechanics w/ slightly greater control of Pes Varus (supination)***

61
Q

Hemi-Spiral AFOs

A
  • Same mechanics as spiral BUT→ slightly greater control of pes varus (supination)
  • No fasteners, light wt.
  • Intimate fit→ NOT for edetamous limbs
  • Mod control of foot and ankle
    • trimline ht and thickness thermoplastic
62
Q

Spiral and hemi-spiral AFOs

Ex’s

63
Q

Conventional AFO→ Dynamic AFO

aka

A

Metal uprights w/ leather

64
Q

Conventional AFO→ Dynamic AFO

Ankle control

A
  • Ankle control w/ stops and assists
  • Biochannel adjustable ankle lock (BiCAAL) vs single channel joint
  • Ankle stops named for motion they RESTRICT**
    • DF stop or PF stop
  • Most common→ 0* PF stop (stops unwanted PF)
    • useful to clear foot during Sw
65
Q

Conventional AFO

More on Ankle Stops

What stop would be useful for controlling knee buckling (excess. flexion) from LR→MSt?

A

DF Stop

*Bc excess DF assoc’d w/ excess Knee Flexion (buckling)

66
Q

Conventional AFO (double upright AFO) w/ Jt Controls

A

Bichannel (2 channels) adjustable ankle lock (BiCAAL)

67
Q

Conventional AFO

DF Assist

A
  • MOST Common→ Spring mech. incorp’d into mech. ankle jt to assist DF***
  • Mech. that produces force to aid in desired jt motion
  • Compressed during late stance and recoils during Swing
  • To ADD/DEC DF assist:
    • tighten/loosen screw adding tension to spring***
68
Q

Conventional AFO-DF Assist

A
  • Approp for→ gross DF strength defs
    • peroneal N. palsy, CMT
  • DF assist/PLS not ideal→ those w/ hypERtonicity and neuromotor equinovaRus
  • >>> option for fluctuating edema
  • Drawbacks→
    • incd wt.
    • dec surf area
    • min→none M/L stability
69
Q

Conventional AFO w/ Calcaneal VaRus/ValGus Control Strap

A
  • Named for where the wider, non-buckle side of strap is (see pics)
  • LATERAL strap→ CORRECTS calcaneal vaRus (subtalar INversion)
  • MEDIAL strap→ CORRECTS calcaneal vaLGus (subtalar EVersion)
70
Q

Conventional AFO w/ calcaneal varus/valgus control strap

*named for side where BIG lg surface area part of strap is!!! see pic for example slide 50

LATERAL STRAP

A
  • L→M force
  • Corrects calcaneal vaRus or subtalar INversion
71
Q

Conventional AFO w/ calcaneal varus/valgus control strap

*named for side where BIG lg surface area part of strap is!!! see pic for example

MEDIAL STRAP

A
  • M→L force
  • Corrects calcaneal valGus or subtalar EVersion
72
Q

Articulating (hinged) Thermoplastic AFO

*NOTE: person must have how much active DF to be able to use?

A

5* active DF

73
Q

Articulating (hinged) thermoplastic AFO

A
  • bw foot/calf
  • 5* active DF needed***
  • Effective how?→ adding PF stop mechanism (usually @ 90*)
74
Q

One of the Goals w/ Orthotics

A

Wear least amt of extrinsic stuff while controlling as much as we can****

75
Q

Articulating Thermoplastic AFO

Benefits of the hinge mech.

A
  • Easy progress thru 1st/2nd rockers
  • Controls knee hyperEXT in MSt
  • INC mobility
  • Energy efficient
76
Q

Articulated thermoplastic AFOs

Ex’s

A

A&B→ True single-axis joints

C→ Allows mvmt into DF/PF w/out an actual articulation

77
Q

Articulated (hinged) thermoplastic AFO

Can have a DF/PF stop T/F?

78
Q

Hybrid (Plastic→Metal) AFO

Defined:

A
  • Adjustable ankle-locking jt.
  • NOT METAL uprights→ thermoplastic instead
79
Q

Hybrid Plastic-Metal

If you WANT MOTION→

A
  • Coil spring placed in channel + screw tightened d
80
Q

Hybrid Plastic-Metal

If motion needs to be BLOCKED→

A
  • Solid steel pins inserted instead of spring to stop motion beyond particular point
  • NOTE: Can stop PF and allow PF as neuromotor control dictates***
81
Q

Hybrid Plastic-Metal

A
  • Versatile/adjustable→ easy to work with
  • Indications→
    • those who have rapid changes in functional status
82
Q

Static>>>>Dynamic AFOs

83
Q

AFO and shoes

AFO use and benefit interrelated w/ cond/type of shoe***

A
  • INC ½ to 1 shoe size
  • Heel hts→ dramatically alter biomechanics or orthotic
  • More stable, solid AFO==> SOFTER heel reqd
    • Ex. rocker bottom (bc rockers lost w/ these)
  • *PLS loses effectiveness in loafer/slippers
84
Q

Ex’s AFO

Conventional, MAFO, Articulating

85
Q

Take Home Messages

AFO’s

A
  1. Must be comfortable
  2. Must look good
  3. Thermoplastic==MOST COMMON
  4. AFO should provide support for stability in stance AND clearance in Swing WITHOUT COMPROMISING rocker systems

Prosthetics&Orthotics (19 decks)

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