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.

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

- 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

LE Orthoses/Prosthetics Flashcards by Chance Lee Cauble

Are orthotics good as a solo treatment?

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

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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

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What are the (4) indicators for orthotic shoes?

Enhanced shock absorption
Reduce shear stresses
Accommodate and support foot deformities
Accommodate or relieve pressure areas

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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

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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

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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

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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

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Rocker Bottom:

Decrease ________ pressure.
Accommodate lack of ankle ____/____.

Decrease met head pressure.

- Lack of ankle DF/PF.

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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.

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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

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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

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________ orthotic is better for more subluxed, rigid, and deformed foot.
________ orthotic is better for more normal foot with some extra motion.

Accommodative

- Functional

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List some common structural abnormalities.

-Rearfoot Varus
Rearfoot Valgus
-Forefoot Varus
-Forefoot Valgus
-Pes planus/cavus

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

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

Inversion

- Eversion

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Is rearfoot varus or valgus more common?

-Rearfoot Varus

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Rearfoot Varus Orthotic Options:

-________ rearfoot wedge/posting.

-Medial

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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

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Forefoot Varus Orthotic Options:

-_______ forefoot wedge.

-Medial

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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

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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

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!