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S6- MSK 2 > LE Orthoses/Prosthetics > Flashcards

LE Orthoses/Prosthetics Flashcards

1
Q

Are orthotics good as a solo treatment?

A

No, can be utilized with other interventions to help treat patients.

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2
Q

7 things orthoses are used for?

A
  1. ) Align or position limb segments to enhance voluntary movement and improve function
  2. ) Minimize the influence of abnormal tone on posture and movement
  3. ) Provide user with comfortable and safe positions in which they can function
  4. ) Promote joint alignment and minimize risk of contracture or other secondary disorders
  5. ) Protect a limb following surgery
  6. ) Enhance alignment following pharmacological intervention
  7. ) Provide alternative methods for mobility
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3
Q

What are the (4) indicators for orthotic shoes?

A
  • Enhanced shock absorption
  • Reduce shear stresses
  • Accommodate and support foot deformities
  • Accommodate or relieve pressure areas
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4
Q

Orthotic Shoes Common Modifications.

A

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
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5
Q

Lifts:

  • Used when leg length discrepancy is >___.
  • Typically a _____/_____ build up.
  • Not used for functional leg length discrepancy, but rather _________.
A
  • > 3/8in
  • heel/sole
  • structural
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6
Q

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?
A
  • small leg length discrepancy
  • medial/lateral
  • ankle PF creating knee extension
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7
Q

Pressure Relief:

  • What are the (3) most common areas of high pressure?
  • Useful for wounds or history/risk of skin breakdown.
A
  • Calcaneal tubercle
  • Met heads
  • Navicular
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8
Q

Rocker Bottom:

  • Decrease ________ pressure.
  • Accommodate lack of ankle ____/____.
A
  • Decrease met head pressure.

- Lack of ankle DF/PF.

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9
Q

What are the (6) therapeutic goals of orthotic inserts?

A
  1. ) Provide additional cushioning/shock absorption.
  2. ) Provide relief for pressure sensitive areas.
  3. ) Reduce shearing forces of the foot.
  4. ) Balance or support the joints of the foot in neutral position to protect from excessive stress.
  5. ) Limit abnormal movements.
  6. ) Correct flexible deformity or accommodate a fixed deformity.
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10
Q

Orthotic Inserts (Accommodative)

A
  • Provide protection or relief to particular areas or structures of the foot
  • Impaired sensation (neuropathies)
  • Shock absorption, reduce shearing, or relief of painful structures
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11
Q

Orthotic Inserts (Functional)

A
  • Control and support the subtalar joint, rearfoot, and/or forefoot
  • Influences the biomechanics of the foot
  • Shock absorption, support joints, change mechanics
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12
Q
  • ________ orthotic is better for more subluxed, rigid, and deformed foot.
  • ________ orthotic is better for more normal foot with some extra motion.
A
  • Accommodative

- Functional

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13
Q

List some common structural abnormalities.

A 
-Rearfoot Varus
Rearfoot Valgus
-Forefoot Varus
-Forefoot Valgus
-Pes planus/cavus
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14
Q

Rearfoot Varus:
-________ of the calcaneus with the subtalar joint in neutral.

Rearfoot Valgus:
-________ of the calcaneus with the subtalar joint in neutral.

A
  • Inversion

- Eversion

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15
Q

Is rearfoot varus or valgus more common?

A

-Rearfoot Varus

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16
Q

Rearfoot Varus Orthotic Options:

-________ rearfoot wedge/posting.

A

-Medial

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17
Q

Forefoot Varus:

  • __________ of the forefoot on the hindfoot with the subtalar joint in neutral.
  • ________ foot higher.
  • What is the compensation for medial foot higher?
A
  • Inversion
  • Medial
  • calcaneal eversion + navicular collapse → excessive pronation
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18
Q

Forefoot Varus Orthotic Options:

-_______ forefoot wedge.

A

-Medial

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19
Q
  • 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?
A
  • Forefoot Varus
  • Forefoot Varus
  • Forefoot Varus
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20
Q

Forefoot Valgus:

  • ________ of the forefoot on the hindfoot with the subtalar joint in neutral.
  • What is the compensation for this?
A
  • Eversion

- calcaneal inversion → supination

21
Q

Forefoot Valgus Orthotic Options:

-________ forefoot wedge.

A

-Lateral forefoot wedge.

22
Q

Difference between pes planus/cavus.

A

Pes Planus = flat foot

Pes Cavus = accentuated arches

23
Q

Orthotic Inserts Considerations.

A
  • Effects in other areas - Posture
  • Joint mobility
  • Gait/dynamic assessment
24
Q

What can be done before prescribing custom orthotics to patients?

A
  • Perform taping to determine if orthotics will be useful.
  • Next, try OTC orthotics.
  • If still needs more support, go to customs.
25
Q

PART 2: POST-OP

A

PART 2: POST-OP

26
Q

What orthoses provides maximal protection and is used post-op or after extensive injury?

A

-CAM Boot (Controlled Ankle Movement)

27
Q
  • Ankle orthoses affect the ________/________ joints but not the _______/______ joints.
  • What is a common use for ankle orthoses?
A
  • affects talocrural/subtalar, not midfoot/forefoot

- Common for ankle sprains.

28
Q

What does the CPG say about ankle braces?

A
  • Braces indicates with strong evidence in acute ankle sprains.
  • Chronic ankle instability bracing indicated with other things such as dynamic warm-up, proprioceptive training.
29
Q

(5) Types of Knee orthoses.

A
  • Prophylactic
  • Rehabilitation
  • Functional
  • Unloading
  • Patellofemoral
30
Q
  • What is the goal of a Prophylactic (PKO)?

- What is this used in more often?

A
  • Mitigate or altogether prevent soft tissue or ligamentous injury to the healthy knee.
  • Contact sports to limit injury to high risk people.
31
Q

Who is high-risk for knee ligament injury?

A
  • Age 13-18
  • Female
  • Sport type involving pivoting, jumping, skiing
32
Q

PKO Effects:

  • May increase muscle ________.
  • May increase lower limb _________.
  • May improve knee ___________.
  • Little, if any change in joint kinematics.
A
  • performance
  • lower limb stiffness
  • proprioception
33
Q

What is the goal of Rehabilitation Knee Orthoses?

A

-Limit ROM to allow for healing of the knee joint structures following an injury or surgery.

34
Q

What are Rehabilitation Knee Orthoses useful for?

A
  • Joint protection
  • Progressive mobility
  • Activity police
  • Contracture prevention (amputees)
35
Q

What is the goal for Functional Knee Orthoses (FKO)?

A
  • Provide mechanical stabilization that is usually provided by anatomical structures.
  • Protect the joint following surgical repair and return to sport.
36
Q
  • FKOs have some overlap with _____.

- FKOs are most commonly used for what?

A
  • PKO

- ACL injury

37
Q

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?

A

-NO

38
Q

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.

A
  • Controversial!

- DO NOT

39
Q

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?
A

-kinesiophobia, adolescents, high-risk athletes

40
Q

What is the goal of Unloading Braces?

A

-Decrease compressive load in one or more knee joint compartments, or decrease deformity resultant from OA.

41
Q
  • Medial OA = ______ deformity

- Lateral OA = _______ deformity

A
  • -Medial OA = varus deformity

- Lateral OA = valgus deformity

42
Q

Unloading Braces (Valgus) Biomechanical Changes.

A
  • Reduction in KAM
  • Decreased medial compartment load
  • Decreased muscle co-contraction
  • Increase in medial compartment joint space
43
Q

Unloading Braces (Valgus) Functional Changes.

A

-Decreased pain
-Improved gait biometrics (Gait Speed,
Get up and go)
-Improved QOL

44
Q

Patellofemoral OA:

  • Goal?
  • Results?
A

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.
45
Q

PFPS Braces:

  • Goal?
  • Evidence?
A

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.
46
Q

Hip Orthoses Indications.

A
  • Developmental Hip Dysplasia (DDH)
  • Dislocation
  • Post-op
47
Q

Hip Orthoses Components.

A
  • Pelvic Suspension
  • Hip Articulation
  • Thigh Support
48
Q

Hip Orthoses - DDH:

  • Goal?
  • Typical treatment?
A
  • Goal: Brace use to hold hips in flexed and abducted position.
  • Treatment: Pavlik Harness or serial casting
49
Q

Main Takeaways.

A
  • 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!

S6- MSK 2 (21 decks)

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