O&P Flashcards
Difference between accommodative vs corrective orthosis?
Accommodative: for fixed deformities to redistribute forces
Corrective: modify CKC and loading.
What type of shoe opening do you want for use with orthoses
Blucher - has vamps that open wide for ease of application
NOT bal that has stitched down vamps.
Post vs wedge with orthotics?
Post – placed inside shoe for modification
Wedge – placed outside of shoe for modification (external modification)
Medial wedge (varus post)
limits or controls excessive eversion (pronation) and IR of tibia at heelstrike.
Lateral wedge (valgus post)
controls calcaneal and subtalar joints that are excessively inverted (supinated) and supinated at heelstrike
Heel lift
accommodates for leg length discrepancy
Inside shoe - up to 3/8 inch
Outside shoe - anything greater than 3/8 of inch.
Rocker bar
located proximal to metatarsal heads and improves weight shifting onto the met heads
Rocker bottom
located proximal to metatarsal heads and improves weight shifting onto the met heads
Subtalar neutral norm
~1-4 deg of inversion
Noted tibiofibular varum in subtalar neutral requires what compensation
medial foot elevation requiring excessive compensatory foot pronation during gait
Reasons for genu recurvatum
equinus deformity at the ankle
poor control of quad/hamstring
LLD (slight) – larger LLE will cause excessive knee flexion contralateral
Navicular Drop
Greater than 10 mm drop is considered abnormal. Places pt in excessive pronation
What rotational components superiorly can cause abnormal foot pronation
internal tibial torsion leads to increased medial rotation forces
Femoral anteversion leads to increased medial rotational forces
What rotation components superiorly can cause abnormal foot supination
Excessive external tibial rotation leading to increased lateral rotation forces
Excessive femoral retroversion leading to increased lat. rotation forces
Metatarsalgia
Pain at met heads from compression of plantar digital nerve
Solution: Shoe with….
Wide width (reduce pressure on transverse met. arch)
Long shoe with high toe box so that MTP’s are not cramped
Cushioned sole for shock absorption
Low heel to minimize pressure on met heads
If severe: transverse metatarsal bar (moves pressure from met heads to met shafts) Rocker sole (reduces motion of painful joints)
Sesamoiditis
Inflammation of sesamoid bones under 1st met heads
Solution: Shoe with…
Transverse metatarsal bar → (pressure from met heads to met shafts)
Rocker sole → (reduces motion at hallux joint)
Morton’s Syndrome
Pain between 1st & 2nd met heads; 2nd toe as long or longer than 1st toe
Solutions: Shoe with…
Long medial counter for rearfoot support/stability
Morton’s extension: flexible platform under 1st met & toe (1/8 to ¼”)
High & wide toe box to reduce compression on transverse arch
Long shoe to accommodate long 2nd toe
Thomas heel or medial sole wedge to support medial longitudinal arch
Mortons interdigital Neuroma
Pain at proximal phalanx or intersitital space b/w met heads (especially b/w 3rd & 4th)
Solutions: Shoe with…
Wide shoe to relieve transverse arch compression
Long enough to ↓ PF of MTP joints
Long medial counter to ↓pronation
Cushioned sole for ↑ shock absorption
Low heel to take pressure off of met heads
Metatarsal bar or rocker bar
Hallux Valgus (Bunions)
Pain at medial aspect of 1st MTP
Solution: Shoe with…
High/wide toe box
Thermold/soft upper
Long enough so toes are not cramped
Soft cushioned outsole
Low heel
Metatarsal Bar or Rocker sole
Hammertoes
Presentation: Weight bearing on met heads & distal phalanx
MTP: hyperextension
PIP: flexion
DIP: extension
Solutions: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP’s & extension of PIP’s
Soft cushion outsole
Low heel
Metatarsal bar or Rocker sole
Claw toes
Presentation: Pressure on the tip of the distal phalanx
MTP: hyperextension or flexion
PIP: hyperflexion
DIP: hyperflexion
Solution: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP joint & ext. PIP’s
Soft cushion outsole
Low heel
Metatarsal bar, rocker sole
Mallet toes
Presentation: Weight bearing on tip of distal phalanx
MTP: hyperextension
PIP: neutral
DIP: flexion (buckles)
Solution: Shoe with…
High & wide toe box
Thermold/soft upper
Long enough to promote flexion of MTP’s & extension of PIP’s
Soft cushion outsole
Low heel
Metatarsal bar, rocker sole
Pes planus
Observable pronation of midfoot results of foot to supinate during midstance
Solutions: Shoe with
o Fixed:
Broad shank (extra wide mid-foot)
Straight Last
Long Medial Counter
Medial Wedge sole to ↓ pressure on met heads & stabilize foot
o Flexible:
Long medial counter
Thomas heel with medial flare
Straight Last
Pes Equinus
Plantarflexion deformity
Solution: Shoe with…
o Fixed:
Posterior platform to support rearfoot from heel strike to midstance & mimics DF at toe-off
Equalize LLD (when equinus is unilateral)
o Flexible:
Low heel
Rocker bottom to provide DF assist and reduce loads on met heads
Pes Cavus
Excessive longitudinal arch with pressure on met heads and heel
Solutions: Shoe with…
Lateral flare for stability
Firm heel counter for rearfoot stability
Cushioned sole for shock absorption
Curved last to accommodate foot deformity
Metatarsal bar to reduce stress on met heads
Plantar Fasciitis
Pain on plantar surface of foot at heel
Solutions:
Long medial counter to limit heel valgus
High heel to limit tension on plantar fascia and Achilles tendon in WB
Posterior Heel Elevation
Night splint (5º of DF, in NWB)
Gel Cups
Haglund’s Deformity, Achilles Tendinitis, and Bursitis orthotic choices
Heel pain
Cause:
Haglund’s deformity: Osseous formation at insertion of Achilles tendon at calcaneus
Achilles tendinitis: Repetitive or intense strain on Achilles tendon
Heel Bursitis: Overuse or direct trauma to joint
Solutions for Haglund’s deformity, Achilles Tendinitis, and Bursitis:
Higher heel (slight) to reduce DF
Long medial counter to limit subtalar motion
Long shoe to reduce compression
Possible backless shoe for Haglund’s deformity
Posterior heel elevation to reduce tension on Achilles tendon
Foam filled heel cup
Pt with peripheral neuropathey with decreased Tib ant. (3-/5) and foot slap. Had dec. sensation and has occasional falls due to tripping. Hip and knee grossly 4/5. ROM is WNL for LE. Which orthotic is most appropriate?
Custom posterior leaf spring orthosis
- Custom posterior leaf spring orthosis: would be the most appropriate orthosis for this patient. This orthosis resists plantar flexion at heel strike and during swing phase, thus preventing foot slapping and toe dragging. A custom orthotic would be necessary since the patient has decreased sensation and is prone to skin breakdown.
- Prefabricated orthotic: would not be appropriate due to the patient’s diminished sensation. Sensory deficits typically require a custom-made orthotic to reduce the risk of skin breakdown.
Distal interphalangeal splint
- Rigid splint that is placed on either the volar or dorsal aspect of the finger and spans from the tip of the finger to the proximal portion of the middle phalanx.
- Used to immobilize the DIP joint to allow injured structures to heal or to rest a painful or inflamed joint.
- Conditions include: mallet finger, a distal Phalanx fracture, and DIP joint arthritis.
- When treating mallet finger, the DIP joint should be placed in neutral or slight hyperextension to allow for healing of the damaged extensor tendon.
Ulnar gutter splint
- Rigid splint that covers the ulnar side of the forearm and hand as well as the fourth and fifth digits.
- Used to immobilize the metacarpals and phalanges and is commonly used following a fracture to these structures.
- When splinting, the metacarpophalangeal (MCP) joints are placed in 60-90 degrees of flexion with the interphalangeal (IP) joints in full extension and the wrist in slight extension.
Radial gutter splint
- Rigid splint that covers the radial side of the forearm and hand as well as the second and third digits.
- Includes a thenar hole to allow for free movement of the thumb.
- This type of splint is used to immobilize the metacarpals and phalanges and is commonly used following a fracture of these structures.
- When splinting, the MCP joints are placed in 60-90 degrees of flexion with the IP joints in full extension and the wrist in slight extension.
Thumb spica splint
- Rigid splint that covers the radial side of the forearm and hand as well as the thumb.
- May cover the entire thumb or may stop at the proximal phalanx of the thumb and thus allow for IP joint motion.
- Used to immobilize the wrist and MCP joint of the thumb
- Commonly used for treating gamekeeper’s thumb, scaphoid fractures, first metacarpal fractures, de Quervain’s syndrome, and other thumb injuries.
- When splinting, the wrist should be in 20 degrees of extension with the MCP joint in slight flexion.
Volar/dorsal forearm splint
- Rigid splint that extends from the proximal forearm to the metacarpal heads, allowing for full elbow and MCP joint motion.
- Includes a thenar hole to allow for free movement of the thumb as well.
- Used to immobilize the wrist joint and is commonly used for treating fractures of the carpals, fractures of the distal radius or ulna or soft tissue conditions (e.g., sprain, tendonitis).
- Positioning of the splint will vary based on the condition being treated. This type of splint can also place the wrist and hand in a functional position to allow for improved grasping for patients with significant weakness of the forearm and hand. By placing the wrist in 20 degrees of extension, the finger flexors are shortened and have an improved mechanical advantage for grasping.
Sugar tong splint
- Rigid splint that covers the wrist and elbow joints and allows for greater immobilization than a volar or dorsal forearm splint.
- Limits supination and pronation in addition to any wrist motion.
- The splint starts on the dorsum of the hand, extends along the dorsal forearm to wrap around the elbow, and continues along the volar forearm to end at the palmar aspect of the hand.
- When splinting, the elbow should be in 90 degrees of flexion with the wrist and forearm in neutral.
- Commonly used for treating carpal fractures and distal radius or ulna fractures.
Long arm splint
- Rigid splint that covers the elbow joint (typically on the posterior side), spanning from the wrist to the distal humerus.
- Immobilize the elbow joint to allow for healing following injury or surgery.
- Prevent elbow flexion and extension movements as well as supination and pronation.
- This may be done following an elbow or proximal forearm fracture or to treat a soft tissue injury (e.g., tendonitis, tendon repair).
- When splinting, the elbow is typically placed in 90 degrees of flexion with the forearm in neutral.
Corset
- Constructed of fabric and may have metal uprights within the material to provide abdominal compression and support.
- Utilized to provide pressure and relieve pain associated with mid and low back pathologies.
Halo Vest Orthosis
- Invasive cervical thoracic orthosis that provides full restriction of all cervical motion.
- A metal ring with four posts that attach to a vest is placed on a patient and secured by inserting four pins through the ring into the skull.
- This orthosis is commonly used with cervical spinal cord injuries to prevent further damage or dislocation during the recovery period.
- A patient will wear a halo vest until the spine becomes stable.
Milwaukee Orthosis
- Designed to promote realignment of the spine due to scoliotic curvature.
- Custom made and extends from the pelvis to the upper chest.
- Corrective padding is applied to the areas of severity of the curve.
Taylor Brace
- Thoracolumbosacral orthosis
- Limits trunk flexion and extension through a three-point control design.
Thoracolumbosacral Orthosis (TLSO)
- A custom molded TLSO is utilized to prevent all trunk motions and is commonly utilized as a means of post-surgical stabilization.
- The rigid shell is fabricated from plastics in a bivalve style using straps/ Velcro to secure the orthosis.
Parapodium
- A parapodium is a standing frame designed to allow a patient to sit when necessary.
- It is a prefabricated frame and ambulation is achieved by shifting weight and rocking the base across the floor.
- It is primarily used by the pediatric population.
Craig Scott Knee ankle foot orthosis
KAFO designed specifically for people with paraplegia.
This allows a person to stand with a posterior lean of the trunk
What is the primary purpose of wearing a shoe with a medial sole flare?
resist eversion
A medial sole flare increases stability of the ankle by resisting eversion. A lateral sole flare would be used to resist inversion.
Relationship between DF/PF and knee flexion/knee extension (in regards typically to the orthosis)
DF associated with knee flexion
PF associated with knee extension
If someone has too much knee flexion – typically they have too much DF and if restricting DF this will help with the issue
Gait with paraplegia (orthoses/energy expenditure/which level)
Use of B KAFOs
Requires 6x energy expenditure than normal walking
Typically not used about T11 due to decreased trunk support/control
Hemiplegia and gait (speed/energy expenditure)
2x energy expenditure
1/2 the prior level of walking speed
A floor-reaction ankle-foot orthosis would be most appropriate for a patient that:
- demonstrates difficulty with knee flexion during gait
- presents with a spinal cord injury at the level L1
- demonstrates difficulty with knee extension during gait
- presents with stroke and demonstrates poor balance
demonstrates difficulty with knee extension during gait
A floor-reaction ankle-foot orthosis promotes knee extension and can help reduce knee buckling with ambulation.
A floor-reaction ankle-foot orthosis would be most appropriate for a patient that:
- demonstrates difficulty with knee flexion during gait
- presents with a spinal cord injury at the level L1
- demonstrates difficulty with knee extension during gait
- presents with stroke and demonstrates poor balance
demonstrates difficulty with knee extension during gait
A floor-reaction ankle-foot orthosis promotes knee extension and can help reduce knee buckling with ambulation.
Which of the following is the most appropriate for daytime use by a 14-year-old female with a mid-thoracic curve of 25 degrees?
- Boston thoracolumbosacral orthosis
- Philadelphia collar
- Jewett brace
- halo-vest
Boston thoracolumbosacral orthosis
The Boston thoracolumbosacral orthosis is used for daytime bracing and is most effective for curves below 35 degrees. A spinal orthosis is often warranted for scoliotic curves ranging from 25-40 degrees. Surgical intervention may be necessary for curves over 40 degrees.
Scoliosis intervention
Bracing most effective for curves < 35 deg.
A spinal orthosis is often warranted for scoliotic curves ranging from 25-40 degrees.
Surgical intervention may be necessary for curves over 40 degrees.
A solid ankle cushion heel is most likely to be prescribed to which patient requiring a prosthesis?
- an athlete who wishes to return to running and other sports
- a child
- a senior citizen who wishes to return to household and community ambulation
- a female who wishes to return to hiking mountainous terrain
A senior citizen who wishes to return to household and community ambulation
A solid ankle cushion heel (SACH) is appropriate for both genders and all ages and is most useful for ambulation over even surfaces for household distances.
A Pavlik harness would result in the hip being positioned in:
hip flexion and abduction
A Pavlik harness is the primary method of treating developmental dysplasia of the hip (DDH). DDH is a subluxed or dislocated hip in infancy as a result of abnormal congruency of the femoral head and acetabulum. The Pavlik harness maintains the infant’s hips in flexion and abduction to enhance acetabular development.
Which cervical orthosis effectively limits motion in all planes and allows for early mobility and rehabilitation after a vertebral fracture?
- Jewett orthosis
- Milwaukee brace
- Boston brace
- Minerva orthosis
Minerva orthosis
The Minerva orthosis positions the head and applies stabilizing forces under and around the chin and occiput to restrict flexion and extension, lateral motion and rotation of the head and cervical spine. The remaining options would not limit mobility in the cervical spine.
Which variable would be the most compelling to warrant use of a scoliosis brace?
-10 degree scoliotic curve
- rapid progression of an existing curve
- significant pain impacting functional activities
- subjective report of instability
rapid progression of an existing curve
Bracing is typically used in patients with 20-40 degree scoliotic curves. Rapid progression of an existing curve often warrants utilization of a scoliosis brace even if the magnitude of the curve does not reach the typical 20 degree threshold.
