LE orthoses Flashcards
Orthoses are used to (7)
- align/position limb segments to enhance movement and func
- Min influence of abnorm tone
- Provide comfortable and safe positions for pt to func
- Promote joint alignment and min. risk of contracture
- Protect limb following sx
- Enhance alignment following pharm intervention
- Provide alternative methods for mobility
Orthotic shoes
custom or prefabricated
-indicators: enhance shock absorption, reduce shear stress
-accomodate/support deformities
relieve pressure areas
Shoes- common mods
-inflare/outflare (toe in/out deforms)
-lifts (LLD >3/8in)
-wedges/posting (small LLD, varus/vagus deform)
-pressure relief (bony prom./pressure areas)
-rocker soles (decrease pressure on met heads, sub for PF/DF)
Inserts- goals (6)
- provide additional cushion/shock absorption
- Provide relief for pressure areas
- Reduce shearing forces at foot
- balance/support joint of foot in neutral position
- limit abnorm movements
- correct flexible deform or accomodate fixed deform
Rearfoot varus abnorm
Inversion of calc (limited pron)
gait: inc lateral heel contact, rapid and excess pronation
medial rearfoot wedge- increases inversion, reduce stress from excess pron, small degrees of change, flexible pronated foot type
Forefoot varus
inversion of forefoot on hindfoot, medial foot is higher than lateral side (compen: calc eversion+navic collapse leads to excess pron)
gait: excess pronation during stance, lack re-supin
medial forefoot wedge- eliminates need for compensation by supporting deformity, controls amount of pron, post under plantar met area prox to 1st MTP
Forefoot valgus
eversion of forefoot on hindfoot
comp: calc inversion leads to supin
gait: excess supin during LR and stance
lateral forefoot wedge -promotes pronation, limits supin, wedge prox to 5th met head
Inserts (pes cavus/planus) predicting success
anti-pron
-goal to help maintain arch height and support navicular
-pts with more mobile feet tend to have more success
CAM boot
CAM_ controlled ankle movement
max protection, postop or after extensive injury, WB ability, can combine with other mods (wedge-achilles rupture, rocker bottom)
Ankle orthoses
affect TC and subtalar joint but NOT midfoot/forefoot
common use: ankle sprain (stirrup, lace up, combo, sleeve)
Ankle braces- efficacy
-Early WB with support for ankle sprains (A)
-increased risk of ankle sprain in individuals that don’t use external support (B)
PKO (prophylactic)
Goal: prevent soft tissue/lig injury
contact vs non
lig protection concept
football/high impact sports
effects: increase muscle performance, increase LL stiffness, improve knee proprio, no change kinematics
Healthy population= BRACING NOT supported. High risk of ACL injury it is recommended
Rehab Knee orthoses
Goal: limit ROM to allow healing following injury or sx
use: joint protection, progressive mobility, activity police, contracture prevention for amputees
FKO (functional)
Goals: provide mechanical stabilization, protect joint following sx repair and RTS
some overlap with PKO
Commonly used with ACL injury (deficiency, ACLR, high risk)
ACL injury deficiency
Copers:
goal: protect joint from injury caused by excess tibial translation or rotation
bracing NOT able to replicate normal ACL func
can increase postural stability and proprio
