Lower Extremity Orthoses (FO and AFO) Flashcards
What are the purposes for orthotic prescription?
-improve performance of functional activities
-improve/enhance mobility (transfers/ambulation)
-deformity prevention
-correction of passivley modifiable deformity
-immobilization/control/prevention
-regulate or reduce muscle tone
-stabilizing weak or flaccid muscles
-improve quality of life
What are the purposes of foot orthoses (inserts)
-alignment correction
-deformity accommodation
-facilitate supination/pronation
-pain relif
-improve foot and/or proximal alignment
-relieve WB stresses
What are 2 types of deformities/contractures?
Fixed: cannot be passively corrected
Flexible/Dynamic:
-result from over activity of muscle tendon groups but when at rest are passively correctable
-can also develop adjacent joints in response to coupling effects of deformities above/below
What are 2 types of FO fabrication?
Pre-fabricated (off the shelf)
-generic fit, good for short term use (healing, function/training aid, contracture prevention)
-typically cheaper
Custom (definitive)
-permanent benefit is needed
-mechanically and physiologically stable
-individualized to patient
FO Length types?
Full length: extend to toes
Sulcus: proximal to toes
3/4: met heads
Types of FO flexibilities?
Soft
-provides cushion, shock absorption, redistribute plantar pressures
Semi-rigid
-provides some flexibility and shock absorption
-provides control of the foot
Rigid
-stabilizes deformities
-controls abnormal motion
-provides support
What needs to be documented for FOs?
-length
-flexibility
-fabrication method
When are FO’s indicated for use?
-abnormal medial longitudinal arch
-leg length discrepancy
-rearfoot amlaignment
-diabetic foot
Abnormal medial longitudinal arch
Pes planus
-if flexible, can be correct with FO
-posterior tibialis supports arch
Pes cavus
-support deformity
Leg length discrepancy
-caused by previous injury to leg, bone infection, congenital, idiopathic
-Normal: up to 3/5 inch
-1 2/3 inch difference will result in gait abnormalities
-use heel lift or shoe lift
Rearfoot malalignment
Rearfoot varus
-use medial wedge to accommodate (decrease hyperpronation)
Rearfoot valgus
-use lateral wedge to accommodate (decrease supination)
-medial wedge to correct
Diabetic Foot
-increased risk for skin breakdown
-FO provide pressure relief
Rocker shoes
-decrease forefoot pressure
-facilite forefoot rocker
What are the purposes for AFOs?
-provide ankle stability
-correct malalignment
-control drop foot
-enhance mobility
-deformity prevention
-regulate or reduce muscle tone
How to prescribe an orthotic device?
- Identify where in the gait cycle abnormal tone or muscle performance is impaired. Where is the gait deviation?
- Determine what factors can be compromising the particular abnormal phase of gait
- Identify what specific orthotic intervention would benefit the particular abnormal phase of gait cycle
*AFOs can be worn by many patients who can walk without them, however walking with them makes them safer and more efficient
What does AFOs provide during swing phase?
-external support during swing (position of ankle/foot) for foot clearance
-Optimize position of the limb for initial contact in preparation for stance stability
What does AFOs provide during stance phase?
-optimize position of ankle/foot
-influence proximal alignment
-provide external support for stance stability
-depending on the device, may also facilitate forward progression
What are 5 types of AFOs?
-Solid (fixed) AFO
-Hinged (articulating) AFO
-Anterior floor reaction
-Energy storage and return
-Tone inhibiting AFO
What impact on gait/function does solid/fixed AFO have?
-provides stance stability, medial-lateral support
-accelerated heel rocker
-loss of ankle and forefoot rocker
-assists with foot clearance
-positions foot for IC
-places foot in plantigrade
-places subtalar joint and ankle in neutral
What impact on gait/function does hinged/articulating AFO have?
-allows for limited ankle ROM
-provide medial-lateral stability
-can have DF/PF assist/stop
-aides in foot clearance
-some rockers preserved
What impact on gait/function does posterior leaf spring have?
-control PF from IC to LR
-allows DF during stance
-support foot during swing phase
What impact on gait/function does anterior floor reaction AFO have?
-maintains ankle in proper alignment
-compensates for weak or absent gastroc/soleus muscle
-facilitates Plantarflexion-knee extension couple
-anterior shell controls forward tibial progression
Anterior floor reaction AFO are not appropriate for?
-individuals with knee ligamentous instability or genu recurvatum
What impact on gait/function does energy storage and return AFO have?
-assist limb clearnace in swing
-positions heel for IC
-assists with forward propulsion
Energy storage and return AFO are not appropriate for?
-individuals with moderate to severe hypertonicity
What does tone inhibiting AFO used for?
-controls ankle posiiton
-provides stance stability
-inhibits reflexes induced by tactile stimulation
-controls muscles length (spasticity caused by stretch)
-indicated for patients with hypertonicity with significanty impaired motor control
How to document OBJECTIVE gait deviations?
-Magnitude (increased, decreased, excessive, inadequatte, lack of timing, related to ROM)
-Side: left/right
-Joint
-Direction/motion: flexion/extension
-phase of gait
How to document ASSESSMENT gait deviations?
-include etiology of gait deviation: impaired motor control, abnormal joint ROM, impaired sensation, pain
-impact/significance on functional tasks: weight acceptance, single limb support, swing limb advancement
