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6 Prosthetics & Orthotics > L3 LE Orthotics > Flashcards

L3 LE Orthotics Flashcards

1
Q

Full length lifts

A

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

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2
Q

Heel lift

A

typically used to accommodate PF contractures
also used for achilles tendonitis

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3
Q

Heel Wedge

A

supports calcaneal inversion or eversion or valgus at the ankle

medial wedge = inhibits calcaneal eversion
lateral wedge = inhibits calcaneal inversion

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4
Q

Heel cushion

A

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

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5
Q

Heel cup

A

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

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6
Q

Metatarsal Bar

A

adds a rocker to the metatarsal area to take weight off the rays

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7
Q

Rocker Sole

A

allows for smooth transition from heel strike to toe off with limited ankle motion

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8
Q

Use of shoes with orthoses

A

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

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9
Q

Accommodative Foot Orthoses

A

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

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10
Q

Functional Foot Orthoses

A

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

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11
Q

What is the difference between functional and accommodative orthotics?

A

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

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12
Q

Materials of Foot Orthoses

A

Top cover
Mid layer
Base layer

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13
Q

Top cover

A

soft neoprene type material, shock absorbing foam or leather

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14
Q

Mid layer

A

shock absorbing layer

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15
Q

Base layer

A

rigid foam, cork, or thermoplastic

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16
Q

Reliefs

A

reliefs will be modified into positive model to unload areas of the foot

i.e metatarsal heads, base of 5th metatarsal, plantar fascia

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17
Q

Additions

A

met pads to relieve pressure on metatarsal heads
extrinsic wedging at heel or forefoot for support

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18
Q

Varus wedge

A

wedge is on the medial aspect of the orthosis

force applied is shifted laterally resulting in supination/inversion and improved pronation control

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19
Q

Valgus Wedge

A

wedge is on the lateral aspect of the orthosis
force applied is shifted medially resulting in pronation/eversion

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20
Q

UCBL

A

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

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21
Q

SMO

A

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

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22
Q

Off the shelf

A

-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

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23
Q

Custom AFO

A

-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

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24
Q

Prximal Shell

A

-controls forward or backward progression of the tibia during stance
-can either be anterior or posterior shell

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25
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
26
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
27
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
28
Anterior Trimline
material extends more anteriorly providing increased control and less motion the more anterior the trimline, the more the stiff the AFO
29
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
30
Ankle Strap
secures the ankle into the AFO and limits heel positioning
31
Posterior Strap
allows adjustments for amount of DF
32
T-strap
can assist in controlling ankle varus/valgus
33
Double Metal Upright AFO
-hinges allow motion -DF/PF stops set by adjusting screws in each channel -springs can be added for DF assist -excellent choice for edema -allows modifications as recovery progresses -attaches to the shoes
34
Benefits of double metal upright AFO
-can provide DF assist -adjustable as pts needs change -allows for volitional muscle activation -can control stance phase knee flexion/extension based on adjustment at ankle
35
Considerations of Double metal upright AFO
not appropriate for PF spasticity need adequate ankle PROM need stable M/L stability
36
Solid or Rigid AFO
provides rigid support of the ankle in the desired position anterior trimlines thicker material fixed at ankle, in slight PF, neutral or DF based on control needed
37
Benefits of solid AFO
-increase ankle DF during swing -stiffness adjustability by changing trimlines -increase stance phase knee flex or ext by restricting ankle motion -decrease clubfoot (inv/pf) during stance -possible ankle control with PF spasticity -improve static balance
38
Limitations of solid AFO
reduced ability to allow volitional muscle control bulk and weight of the AFO does not allow for ankle DF during functional movements such as sit to stand
39
Ground Reaction AFO
provides knee stability through a posteriorly directed force at proximal tibia fixed at ankle in slight PF GRF anterior to the knee which prevents knee instability and collapse anterior shell for added tibial control carbon or plastic options
40
Benefits of GRAFO
-increases DF during swing -strong stance phase knee flex control -anterior proximal contact of AFO leads to stance phase knee extension -increases static balance
41
GRAFO Considerations
not appropriate for someone with genu recurvatum, strong hypertension thrust in stance, quads spasticity bulk and weight of AFO may be limiting
42
Semi-rigid AFO
-provides varying degrees of rigidity based on design and materials used -more posterior trimlines compared to solid AFO -ankle in slight PF, neutral or DF based on control needed -some ankle motion allowed based on material thickness/flexibility -material property choices restrict or allow motion
43
Benefits of semi-rigid AFO
-increase DF during swing -adjustability of stiffness by changing trimlines -control stance phase knee flexion or extension by limiting ankle motion -increase gait speed if AFO has fewer restrictions to movement -may increase dynamic balance based on design
44
Semi-Rigid AFO Considerations
-may not be appropriate for patient with PF spasticity -does not provide as much support at the knee compared to a rigid AFO -limited use if pt has equinaovarus (club foot)
45
Posterior Leaf Spring AFO
-most posterior trimline -more ankle motion allowed due to material flexibility -minimal to no medial lateral ankle support -minimal to no effect at the knee
46
Benefits of posterior leaf spring AFO
increase DF in swing lightweight prefabricated options increase gait speed
47
Considerations for posterior leaf spring AFO
not appropriate with PF spasticity or knee instability
48
Articulating AFO
-ankle joint is incorporated into the AFO -provides varying degrees of motion at the ankle through hinges and optional stops -DF/PF stops -resist and assist options available -allows for control at the knee with restricting or helping motion -allows for volitional muscle activation
49
Considerations of Articulating AFOs
-bulk and weight of AFO -not indicated for someone with PF spasticity ≥ 3 -less medial/lateral stability compared to solid AFO
50
Stops
limit ROM to restrict movement when strength, ROM, or motor control are decreased stops can be set to accommodate limits of joint ROM
51
PF stop
created when posterior materials contact can decrease genu recurvatum and equinovarus
52
DF stop
created when anterior materials contact can increase stability by decreasing stance phase knee buckling
53
Springs
assist movement when strength and/or control are decreased can assist DF during swing b/c of recoil can also assist with eccentric control of PF during loading response to reduce foot slap
54
Dynamic AFOs
enhance or resist ankle motion while allowing some motion and/or energy storage
55
Carbon Fiber AFO
stores and releases energy to assist PF for push-off minimal medial/lateral ankle support minimal to no adjustability
56
Benefits of carbon fiber AFO
DF assist increases push off force allows for volitional muscle activation allows for increased gait speed
57
Considerations for Carbon Fiber AFO
not indicated for equinovarus, knee buckling, genu recurvatum, limited ankle ROM, PF spasticity
58
Equinovarus
Clubfoot, also known as talipes equinovarus (TEV), is a common foot abnormality, in which the foot points downward and inward. The condition is present at birth, and involves the foot and lower leg
59
Arizona AFO
-custom gauntlet style AFO -leather with thermoplastic reinforcement -used for failed fusions -dx of OA or post tibial tendon dysfunction -immobilizes ankle but allow for toe roll over
60
Mods for AFO
padding medial/lateral flange extrinsic wedging
61
Padding
bony prominences to protect skin
62
Medial/lateral Flange
restricts medial or lateral forces
63
Extrinsic wedging
additional control over lateral or medial forces
64
KO
custom or off the shelf based on anatomic challenges, knee deformation stabilize knee after ACL/PCL off load OA can be used for hyperextension
65
KAFO
-provided to compensate for weakness, paralysis or skeletal problems which cause lower limb instability -appropriate for pts with knee hyperextension and/or knee weakness -always custom fabricated
66
Free motion KAFO
no restriction or assistance
67
Posterior offset
provides stability at the knee when knee is in full extension
68
Drop lock
locked in extension when standing must manually unlock to sit
69
Stance lock knee joints
knee joint locks at extension and unlocks at toe load
70
HKAFO
indiciations include traumatic paraplegia, spina bifida, muscular dystrophy and rotational control
71
RGO
reciprocating gait orthosis BIL HKAFO that provides contralateral hip extension with ipsilateral hip flexion seen in rehab, peds, paralysis
72
FES
functional electrical stimulation alternative to traditional orthoses for pts with foot drop and intact peroneal nerve force sensor is worn to detect heel off and heel strike
73
CPG for FES w/AFO
strong evidence of benefit for individuals for LE lack of motor control post CHRONIC stroke both methods provide immediate orthotic effects at ankle FES --> more therapeutic effects, better for faster walkers AFO--> more compensatory effects, better early in treatment
74
What to use for insufficient knee flexion to clear floor during swing
small lift contralateral shoe no orthotic componentry available
75
What to use for insufficient DF during swing
FES orthosis single axis AFO with DF assist and PF stop posterior leaf spring dynamic AFO
76
What to use for mid to late stance knee hyperextension
heel lift AFO with PF stop solid ankle AFO in DF
77
What to use for knee instability/buckling
AFO with DF stop ground reaction AFO with DF stop KAFO with posterior offset knee, knee lock, or stance lock and free swing
78
What to use for Excessive supination
foot orthosis with forefoot valgus post lateral hindfoot wedge AFO with lateral flange
79
What to use for excessive pronation
foot orthosis and varus post UCBL SMO Arizona AFO AFO with medial flange
80
Functional Training needed for LE ORthosis
gait stairs navigating various surfaces ramps sit to stand
81
People with blocking DF will have difficulty with
STS, ascending ramps, squatting, descending stairs
82
People with blocking PF will have difficulty with
descending ramps, eliminates active push off

6 Prosthetics & Orthotics (11 decks)

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