LE Orthoses/Prosthetics Flashcards
Are orthotics good as a solo treatment?
No, can be utilized with other interventions to help treat patients.
7 things orthoses are used for?
- ) Align or position limb segments to enhance voluntary movement and improve function
- ) Minimize the influence of abnormal tone on posture and movement
- ) Provide user with comfortable and safe positions in which they can function
- ) Promote joint alignment and minimize risk of contracture or other secondary disorders
- ) Protect a limb following surgery
- ) Enhance alignment following pharmacological intervention
- ) Provide alternative methods for mobility
What are the (4) indicators for orthotic shoes?
- Enhanced shock absorption
- Reduce shear stresses
- Accommodate and support foot deformities
- Accommodate or relieve pressure areas
Orthotic Shoes Common Modifications.
Inflare/outflare
-Toe in/out deformities
Lifts
-Leg length discrepancy
Wedges/posting
- Leg length discrepancy
- Varus/valgus deformity
Pressure relief
-Boney prominence/Pressure sensitive areas
Rocker soles
- ↓ pressure on met heads
- Sub for ankle PF/DF during stance phase
Lifts:
- Used when leg length discrepancy is >___.
- Typically a _____/_____ build up.
- Not used for functional leg length discrepancy, but rather _________.
- > 3/8in
- heel/sole
- structural
Wedges:
- Wedges with high posterior and low anterior can address what?
- Can also be _______/_________.
- Consider effects up the chain. For example, high posterior wedge creates what at the ankle and knee?
- small leg length discrepancy
- medial/lateral
- ankle PF creating knee extension
Pressure Relief:
- What are the (3) most common areas of high pressure?
- Useful for wounds or history/risk of skin breakdown.
- Calcaneal tubercle
- Met heads
- Navicular
Rocker Bottom:
- Decrease ________ pressure.
- Accommodate lack of ankle ____/____.
- Decrease met head pressure.
- Lack of ankle DF/PF.
What are the (6) therapeutic goals of orthotic inserts?
- ) Provide additional cushioning/shock absorption.
- ) Provide relief for pressure sensitive areas.
- ) Reduce shearing forces of the foot.
- ) Balance or support the joints of the foot in neutral position to protect from excessive stress.
- ) Limit abnormal movements.
- ) Correct flexible deformity or accommodate a fixed deformity.
Orthotic Inserts (Accommodative)
- Provide protection or relief to particular areas or structures of the foot
- Impaired sensation (neuropathies)
- Shock absorption, reduce shearing, or relief of painful structures
Orthotic Inserts (Functional)
- Control and support the subtalar joint, rearfoot, and/or forefoot
- Influences the biomechanics of the foot
- Shock absorption, support joints, change mechanics
- ________ orthotic is better for more subluxed, rigid, and deformed foot.
- ________ orthotic is better for more normal foot with some extra motion.
- Accommodative
- Functional
List some common structural abnormalities.
-Rearfoot Varus Rearfoot Valgus -Forefoot Varus -Forefoot Valgus -Pes planus/cavus
Rearfoot Varus:
-________ of the calcaneus with the subtalar joint in neutral.
Rearfoot Valgus:
-________ of the calcaneus with the subtalar joint in neutral.
- Inversion
- Eversion
Is rearfoot varus or valgus more common?
-Rearfoot Varus
Rearfoot Varus Orthotic Options:
-________ rearfoot wedge/posting.
-Medial
Forefoot Varus:
- __________ of the forefoot on the hindfoot with the subtalar joint in neutral.
- ________ foot higher.
- What is the compensation for medial foot higher?
- Inversion
- Medial
- calcaneal eversion + navicular collapse → excessive pronation
Forefoot Varus Orthotic Options:
-_______ forefoot wedge.
-Medial
- Does forefoot or rearfoot varus lack re-supination?
- Are we more likely to find hypomobility in forefoot or rearfoot varus?
- Does forefoot or rearfoot varus predispose to post tib dysfunction?
- Forefoot Varus
- Forefoot Varus
- Forefoot Varus
Forefoot Valgus:
- ________ of the forefoot on the hindfoot with the subtalar joint in neutral.
- What is the compensation for this?
- Eversion
- calcaneal inversion → supination
Forefoot Valgus Orthotic Options:
-________ forefoot wedge.
-Lateral forefoot wedge.
Difference between pes planus/cavus.
Pes Planus = flat foot
Pes Cavus = accentuated arches
Orthotic Inserts Considerations.
- Effects in other areas - Posture
- Joint mobility
- Gait/dynamic assessment
What can be done before prescribing custom orthotics to patients?
- Perform taping to determine if orthotics will be useful.
- Next, try OTC orthotics.
- If still needs more support, go to customs.
PART 2: POST-OP
PART 2: POST-OP
What orthoses provides maximal protection and is used post-op or after extensive injury?
-CAM Boot (Controlled Ankle Movement)
- Ankle orthoses affect the ________/________ joints but not the _______/______ joints.
- What is a common use for ankle orthoses?
- affects talocrural/subtalar, not midfoot/forefoot
- Common for ankle sprains.
What does the CPG say about ankle braces?
- Braces indicates with strong evidence in acute ankle sprains.
- Chronic ankle instability bracing indicated with other things such as dynamic warm-up, proprioceptive training.
(5) Types of Knee orthoses.
- Prophylactic
- Rehabilitation
- Functional
- Unloading
- Patellofemoral
- What is the goal of a Prophylactic (PKO)?
- What is this used in more often?
- Mitigate or altogether prevent soft tissue or ligamentous injury to the healthy knee.
- Contact sports to limit injury to high risk people.
Who is high-risk for knee ligament injury?
- Age 13-18
- Female
- Sport type involving pivoting, jumping, skiing
PKO Effects:
- May increase muscle ________.
- May increase lower limb _________.
- May improve knee ___________.
- Little, if any change in joint kinematics.
- performance
- lower limb stiffness
- proprioception
What is the goal of Rehabilitation Knee Orthoses?
-Limit ROM to allow for healing of the knee joint structures following an injury or surgery.
What are Rehabilitation Knee Orthoses useful for?
- Joint protection
- Progressive mobility
- Activity police
- Contracture prevention (amputees)
What is the goal for Functional Knee Orthoses (FKO)?
- Provide mechanical stabilization that is usually provided by anatomical structures.
- Protect the joint following surgical repair and return to sport.
- FKOs have some overlap with _____.
- FKOs are most commonly used for what?
- PKO
- ACL injury
FKOs in ACL Deficient “copers”:
Goal is to protect the joint from further injury caused by excessive tibial translation/rotation. Is bracing able to replicate normal ACL function?
-NO
FKOs in ACLR (post-op):
Traditional course:
-Rehab brace prescribed to prevent re-rupture from inhibited quads.
-FKOs prescribed when patient progresses to intense exercises or RTS.
-__________!
-Multiple studies support that braces _______ decrease pain/effusion, improve muscle weakness/inhibition, prevent ROM loss, improve laxity.
- Controversial!
- DO NOT
FKO ACLR (post-op) Recommendations:
- Increased surgical success and innovation.
- Lacking evidence to support routine use
- Controlled, comprehensive rehab
- Bracing generally not recommended, with what few exceptions?
-kinesiophobia, adolescents, high-risk athletes
What is the goal of Unloading Braces?
-Decrease compressive load in one or more knee joint compartments, or decrease deformity resultant from OA.
- Medial OA = ______ deformity
- Lateral OA = _______ deformity
- -Medial OA = varus deformity
- Lateral OA = valgus deformity
Unloading Braces (Valgus) Biomechanical Changes.
- Reduction in KAM
- Decreased medial compartment load
- Decreased muscle co-contraction
- Increase in medial compartment joint space
Unloading Braces (Valgus) Functional Changes.
-Decreased pain
-Improved gait biometrics (Gait Speed,
Get up and go)
-Improved QOL
Patellofemoral OA:
- Goal?
- Results?
Goal: Decrease contact stress across the patellofemoral joint by encouraging proper alignment or tracking, thereby reducing painful compression of the arthritic joint.
Results:
- No changes in quad function.
- Difficulty controlling dynamic patellar alignment, but can improve static alignment.
- No known negative side effects.
PFPS Braces:
- Goal?
- Evidence?
Goal: Correct faulty patellar tracking that is leading to pain.
- Poor consensus on who would benefit from PF bracing.
- Overall poor evidence to support long term use.
- Should not be used in isolation.
Hip Orthoses Indications.
- Developmental Hip Dysplasia (DDH)
- Dislocation
- Post-op
Hip Orthoses Components.
- Pelvic Suspension
- Hip Articulation
- Thigh Support
Hip Orthoses - DDH:
- Goal?
- Typical treatment?
- Goal: Brace use to hold hips in flexed and abducted position.
- Treatment: Pavlik Harness or serial casting
Main Takeaways.
- Bracing in the msk population serves to correct movements, protect joints, and restore function
- Not appropriate for all patients, should be considered in the context of greater patient care
- Custom orthotics for structural abnormalities of the foot are common, but the concept of STJ neutral is controversial. What other techniques could be tried first?
- Knee and ankle bracing has good support for use for injury prevention in certain populations
- Hip bracing is difficult!
