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
ACLR postop
rehab rxed to prevent re-rupture
FKO rxed when progressed to intense exercise/RTS
braces do NOT: decrease pain or effusion, improve weakness, prevent ROM loss, improve laxity
RTS: first 6-12mnths
Unloading braces
goal: decrease compressive load or decrease deformity from OA
medial OA: varus deformity
lateral OA: valgus deformity
PFPS braces
goal: correct faulty patellar tracking causing pain
should be used in conjunction with exercise and activity mods
Hip orthosess
indics: DDH, dislocation, postop
components: pelvic suspension, hip articulation, thigh support
short lever arm requires increased rigidity
Postop: controlled motion, restrict movement, adjustable. Common with labral repair, THA revision
DDH: brace to hold hips in flex and ABD. Pavlik harness or serial casting
