L3 LE Orthotics Flashcards
Full length lifts
complete full length shoe lifts on one side accommodate for leg length discrepancies
can also compensate for the patient not obtaining adequate ankle/knee/hip flexion on the opposite limb
Heel lift
typically used to accommodate PF contractures
also used for achilles tendonitis
Heel Wedge
supports calcaneal inversion or eversion or valgus at the ankle
medial wedge = inhibits calcaneal eversion
lateral wedge = inhibits calcaneal inversion
Heel cushion
soft pad that is placed on the heel of the inner sole to cushion the heel. goal is to reduce heel pain. often used for patients with calcaneal spur or plantar fasciitis
Heel cup
rigid insert that covers the plantar surface of the calcaneus and extends upwards. helps to stabilize the calcaneus in a neutral position as well as provide shock absorption for the heel. commonly used for pts with calcaneal spur or plantar fasciitis
Metatarsal Bar
adds a rocker to the metatarsal area to take weight off the rays
Rocker Sole
allows for smooth transition from heel strike to toe off with limited ankle motion
Use of shoes with orthoses
most orthoses rely on shoe to kep foot in contact with foot plate
-non slip sole on shoe and laces to mid foot
-depth of shoes is important and width of toe box
-watch for slipping at the heel
Accommodative Foot Orthoses
we are accommodating a certain position/condition of the foot. foot is not correctable or has pain with correction
used for RA, healed fractures, CMT, diabetes
Functional Foot Orthoses
designed to realign the bones and joints in the foot in order to decrease stress within the knee, ankle, foot
reduce pronation, supination, support calcaneus. usually will include wedging or posting to prevent abnormal compensatory movement within joints
What is the difference between functional and accommodative orthotics?
a functional orthosis is normally made of a firmer material, such as plastic and designed to realign the foot and body in accordance with ROM and flexibility
an accommodative orthosis is supporting the foot in its current position
Materials of Foot Orthoses
Top cover
Mid layer
Base layer
Top cover
soft neoprene type material, shock absorbing foam or leather
Mid layer
shock absorbing layer
Base layer
rigid foam, cork, or thermoplastic
Reliefs
reliefs will be modified into positive model to unload areas of the foot
i.e metatarsal heads, base of 5th metatarsal, plantar fascia
Additions
met pads to relieve pressure on metatarsal heads
extrinsic wedging at heel or forefoot for support
Varus wedge
wedge is on the medial aspect of the orthosis
force applied is shifted laterally resulting in supination/inversion and improved pronation control
Valgus Wedge
wedge is on the lateral aspect of the orthosis
force applied is shifted medially resulting in pronation/eversion
UCBL
type of foot orthosis used to stabilize the subtalar and tarsal joints in stance
indicated for rearfoot valgus/varus and pes planus
contraindicated with rigid foot deformity
SMO
supramalleolar orthosis
only crosses ankle joint, does not have any joints
control mid foot and calcaneal misalignment
mainly used in peds, adult foot may not take the forces needed for correction
Off the shelf
-used when pt does not have the need for the custom shape
-lower cost
-main benefit for swing phase deficits
-good option for early gait training
-limited benefit for more complex abnormalities
Custom AFO
-molded from cast
-thermoplastic or carbon fiber
-used when patient has deformation or will need more support in single or multiple planes
-higher cost
-best choice for complexity
Prximal Shell
-controls forward or backward progression of the tibia during stance
-can either be anterior or posterior shell
Anterior shell
provides stance phase knee stability by limiting tibial forward progression when AFO is solid and very stiff
limits DF in stance
may lead to knee hyperextension
Posterior Shell
beneficial for more complex gait abnormalities impacting both knee flexion and extension in stance
may allow greater DF than an anterior shell during stance depending on AFO stiffness
Trimlines
contact position of the material that can be cut more anteriorly or more posteriorly
trimlines impact stiffness of AFO
can be posterior or anterior cut
Anterior Trimline
material extends more anteriorly providing increased control and less motion
the more anterior the trimline, the more the stiff the AFO
Posterior Trimline
material provides less contact, providing decreased control and allowing more motion
anterior trimlines can be cut to be more posterior as control, muscle strength, improves
posterior to malleoli decrease ML control
Ankle Strap
secures the ankle into the AFO and limits heel positioning
Posterior Strap
allows adjustments for amount of DF
T-strap
can assist in controlling ankle varus/valgus