LE Orthosis Flashcards
Principles of LE orthosis
Used only as indicated and as long as necessary
Allow joint movement
Must be functional
Where should an orthotic ankle joint be centered?
Tip of the medial mallelous
Where should an orthotic knee joint be centered
over the prominence of the medial femoral condyle
Positioning of an orthotic hip joint
Allows patient to sit upright @ 90 degrees
Foundation for most LE orthoses
Shoes
function of shoes
transfer weight to the ground
protection from terrain and weather
shoes have the greatest WB on what parts of the foot?
slightly lateral to the ball of the foot
posterolateral edge of the heel
parts of a shoe
upper
sole
heel
upper is divided into three parts which are:
vamp
quarter
tongue
anterior aspect of the upper part of a shoe
vamp
posterior aspect of the upper part of the shoe
quarter
open lace
blucher
closed lace
balmoral
recommended for individuals c limited manual dexterity
strap
recommended for a more precise adjustment
lace
distinguished by a separation between the anterior margins of the lace
blucher
lace stay is continuous with the vamp
balmoral
important feature of a blucher
permits substantial adjustability
in what conditions are blucher laces recommended
for edematous pts c paralyzed toes
advantages of blucher lace
ease of donning
greater foot entry space and adjustability
where are low quarter shoes terminated at
below the malleoli
advantages of low quarter shoes
does not restrict foot or ankle motion
advantages of high quarter shoes
covers both malleolus
provides foot stability
can accommodate pes equinus
advantages of a broad and low heel
provides the greatest stability
distributes the weight between the back and the front of the foot
indications of high heels
heel pain
achilles tendinitis
rigid pes equinus
disadvantages of high heels
puts stress on metatarsals and knees
what does high heels promote?
knee flexion and hip flexion
height of heel that aids transition through the stance phase
1 in (2.54 cm)
what does a higher heel do?
places ankle in greater plantarflexion and forces the tibia forward
protects the toes from stubbing and
vertical trauma
Toe boxing
condition for using toe boxing
should be high enough to
accommodate hammer toes or similar deformity
longitudinal plate that reinforces the sole
between the anterior border of the heel and the
widest part of the sole at the metatarsal heads
Shank
stiffens the quarter and generally
terminates at the anterior border of the heel
Counter
anterior border of the heel
breast
posterior border of the heel
pitch
widest area of the foot
ball
how much should be the allowance from the longest toe for a shoe to be well-fitted?
1/2 inch
requirements of a well-fitted shoe
1/2 inch allowance from the longest toe
Widest part of the shoe corresponds c the broadest part of the foot
Snug from heel to ball of the foot
Quarters don’t gap excessively
Reduce load on painful heel
Heel-spur insert orthosis
feature of a heel-spur insert orthosis
has a concave relief to minimize pressure on the tender area
prevent depression of the subtalar joint and flattening of the arch
Longitudinal arch support
what is flattening of the arch called?
pes planus
provides minimum support to the medial longitudinal arch
Scaphoid pad
where is the scaphoid pad positioned?
medial border of the insole with the apex between the sustentaculum tali and the navicular tuberosity
used to relieve pain and activity limitation associated c pes cavus
insert orthoses
Transfers weight from metatarsal head to
the metatarsal shaft
Metatarsal pad
Indications for using metatarsal pad
reduce plantar
pressure; particularly in pts c
diabetic neuropathy
where are metatarsal pads placed?
apex should be under the metatarsal shafts
Alters alignment of the rearfoot
Heel wedge/post
What are the two types of wedges?
medial and lateral
medial heel wedge corrects…
pronation
eversion
pes varus
pes planus
flat foot
lateral heel wedge corrects…
supination
inversion
pes varus
pes cavus
clubfoot
Anterior border of medial side is extended
forward
Thomas heel
Indication for using thomas heel
Pes valgus
Transfers stress from MTP joints to MTP shafts
Metatarsal bar
How is the metatarsal bar positioned?
posterior to the MTP heads
Indication of using MTP bar
metatarsalgia
Reduces the distance the wearer must travel during the stance phase
Rocker bar/bottom
What does the rocker bar do?
Shifts load from MTP joints to MTP shafts and improves late stance phase
Indication for using rocker bar/bottom
Pts c difficulty in push-off
Raises one foot in order to shift balance
Shoe lifts
Indication for using shoe lifts
LLD
Components of an AFO
foundation
ankle control
foot control
superstructure
provides good control of the foot and is removable and lightweight
insert foundation
a u-shaped traditional foundation for AFO
stirrup foundation
a type of stirrup that provides maximum stability of the orthosis on the shoe
solid stirrup
three segments of a split stirrup
central portion
medial angled side piece
lateral angled side piece
advantages of a split stirrup
simplifies donning as the wearer can detach uprights from the shoe
a dorsiflexion assist
posterior leaf spring
indication for using a posterior leaf spring
weak dorsiflexion, foot drop
when is posterior leaf spring not indicated?
when a pt has medio-lateral ankle instability
bulkier than the posterior leaf spring
Klenzak joint/Dorsiflexion spring assist
mechanism of a Klenzak joint
coiled spring compresses in stance and
rebounds during swing.
advantage of a Klenzak joint
the tightness of the coil can be adjusted
prevents toe dragging and controls knee buckling
Plantarflexion Resistance/Posterior Stop
indications for using for a Posterior Stop
weak dorsiflexors
what does a Posterior Stop promote?
dorsiflexion due to weak pre tibials
the triceps surae is made up of
Gastrocnemius (medial and lateral)
Soleus
Indication for using Dorsiflexion resistance/Anterior stop
pts c paralysis of the triceps surae
what does an Anterior Stop do?
controls genu recurvatum and buckling
promotes plantarflexion and knee extension
function of a posterior pin
limits plantarflexion
function of a posterior spring
assists dorsiflexion
function of an anterior pin
limits dorsiflexion
function of an anterior spring
assists plantarflexion
indication for using a posterior pin
plantar spasticity, toe dragging, pain c ankle motion
indication for using a posterior spring
flaccid PF, knee hyperextension
indications for using an anterior pin
weak PF, weak knee extensors, pain c ankle motion
Limits all foot and ankle motions
Plastic Solid AFO
Indications for using Plastic Solid AFO
hemiplegia
spastic diplegia
resists/assists both PF and DF
Bi-channel adjustable ankle locks
medial T-strap
valgus correction strap
posting for medial T-strap
lateral
lateral T-strap
varus correction strap
posting for lateral T-strap
medial
Able to offset/unload weight from knee area
Superstructure
components of a superstructure
two uprights
shell
band/brim
Reduce amount of weight transmitted through
the foot
Patellar tendon bearing-brim
Indication for patellar tendon bearing-brim
post-op pain
Imposes posteriorly directed force providing
extension moment in the stance without
preventing flexion during swing
Floor reaction orthosis
what does floor reaction orthosis promote?
places foot in slight PF
controls motion in all planes
spiral AFO
disadvantages of spiral AFO
cannot accommodate fluctuating leg volume
components of an orthosis with knee flexion instability
solid heel
AFO in fixed DF
Anterior trim line on AFO
components of an orthosis with knee extension stability
cushioned heel
AFO in fixed PF
posterior trim line
Posterior offset knee jt
Components of KAFO
Knee control
Knee cap
Genu Valgum/Varus correction
Superstructure
Stabilizes the knee in extension during the
early stance phase of gait.
Offset knee jt
How is a offset knee jt positioned?
posterior to the midline of the leg
contraindication for using an offset knee jt
knee flexion contracture
most common knee control and is manually and gravity manipulated
Drop ring lock
Drop ring lock knee control is challenging for pts who have
Limited hand function
What should be done to provide maximum stability when using drop ring lock?
lock medial and lateral joints
contraindication for using drop ring lock
knee flexion contracture
Provides simultaneous locking of both
uprights
Pawl lock c bail release
Pawl lock c bail release is used for pts who have
dexterity problems
how is the pawlock unlocked?
pulling up of bails
disadvantages of using pawlock
increases energy expenditure
Allows joint locking at different angles of knee
flexion
Serrated knee lock
Indication of serrated knee lock
Pts c knee extension contracture
Provides sagittal knee stability
knee cap
disadvantages of knee cap
may restrict sitting
