Orthodics

Question 1

biomechanical balance kinetic chain

Answer 1

subtalar neutral position
- allows the foot to be mobile in pronation and stiff in supination
- 0 degrees in ankle, subtalar neutral, balanced forefoot

Question 1

what is the rear foot and its joints

Answer 1

calcaneus
1) talocrural joint
2) subtalar joint

Question 2

what is the forefoot and its joints

Answer 2

the center of pressure through the first ray
1) 1st metatarsal phalangeal joint

Question 3

the mid foot at its joints

Answer 3

1) Tarsometarsal joint
2) calcaneocuboid joint
3) Talonavicular joint

Question 4

subtalars job at inital contact

Answer 4

shock absorber (pronation)

Question 5

subtalars job at midstance

Answer 5

still shock absorption. LR moves the foot into full pronation

Question 6

subtalars job at terminal stance

Answer 6

moves into full supination for rigidity

Question 7

kinetic problems with closed chain over pronation

Answer 7

• anterior pelvic tilt
• internal rotation of the femur
• valgus knee
• internal rotation of the tibia and fibula

Question 8

pronation in the subtalar joint

Answer 8

• medial rotation of the talus
• adduction and PF talus
• calcaneal eversion

Question 9

kinetic problems with closed chain supination

Answer 9

• posterior pelvic tilt
• femur external rotation
• knee varus
• external rotation of the tibia and fibula

Question 10

supintation of the subtalar joint

Answer 10

-abduction and DF talus
- calcaneal inversion

Question 11

KAM (knee adduction moment)

Answer 11

• moment of compressive forces across the medial knee
• most force at LR and terminal stance
• accepts 60-70 % of weight bearing forces throughout this compartment

Question 12

the relationship between knee varus and KAM

Answer 12

knee varus increases KAM. It is a direct relationship

Question 13

static stabilization

Answer 13

rigid device, permits body segment in fixed position (stability)

Question 14

dynamic stabilization

Answer 14

mobile device, permits the body segment motion

Question 15

principles of designing orthotic function

Answer 15

• patient related (easy to don on and off)
• soft tissue: not break down skin
• at risk diagnosis (diabetics, neuropathy)
• tolerant to compression and shear forces
• functional level of the pt

Question 16

Insoles purpose

Answer 16

• modify heel, midfoot or forefoot
• padding for pain (metatarsalgia, planterfasciitis)
• heel lift for leg length
• wedges for supination/pronation

Question 17

Instability orthotics purpose

Answer 17

• have heel cup for calcaneous
• longitudinal arch support
• UCBL

Question 18

what orthodic can be used to help reduce KAM

Answer 18

• valgus wedged insoles on the medial side of the foot

Question 19

UCBL purpose

Answer 19

• used for pronated foot
• holds the calcaneus in a neutral position
• used for significant issues such as arthritis, hypotonia
• helps prevent midfoot collapse into pronation

Question 20

the higher the trim lines the

Answer 20

better control of the calcaneus

Question 21

what can a leaf spring AFO be used for

Answer 21

people who are having foot drop during swing phase

Question 22

what would you prescribe for ankle instability in stance phase

Answer 22

solid or hinged AFO

Question 23

what would you prescribe for ankle planter flexion

Answer 23

solid AFO with strap

Question 24

what would you prescribe for knee hyperextension in stance phase

Answer 24

AFO setting ankle joint to neutral or a bit of DF

Question 25

AFO adaptations to trimlines

Answer 25

allow for more or less control of the ankle

Question 26

what are the different trimlines

Answer 26

- metatarsal trimline - foot trimline - ankle trimline - standard trimline - anterior trimline - proximal trimline

Question 27

what pathologies are AFOs typically prescribed for

Answer 27

- weakness - CP - head injury - peripheral neuropathy - alignment - SCI - progressive disease

Question 28

what do orthotics use to accomplish the goals of its design

Answer 28

force principles

Question 29

an orthotic is most comfortable and effective when

Answer 29

1) pressure = force/area 2) control direction of primary force and direction of counter forces

Question 30

off the shelf orthotics

Answer 30

- mass manufactured - the degree to which they can be modifies or adjusted to fit an individual varies (this can be problematic for people with foot deformity, wide or narrow feet, large calf muscles, sensory impairments or variable limb volume

Question 31

examples of off the shelf orthotics

Answer 31

- standard AFO - Leaf Spring AFO

Question 32

Leaf spring AFO design

Answer 32

- shallow trim lines for less support and more mobility - no other straps to control or brace the foot - foot plate

Question 33

purpose of leaf spring AFO

Answer 33

- support the weight of the foot during swing phase as means of enhancing swing limb clearance - assist with controlled lowering of the foot during loading response in stance as part of the first heel rocker

Question 34

what type of pt would you prescribe leaf spring too

Answer 34

peripheral nerve, multiple sclerosis, CVA, myositis pt with foot drop in swing

Question 35

what type of patient is leaf spring NOT good for

Answer 35

CP pts

Question 36

other AFOs for foot drop

Answer 36

- posterior shell - DF assist brace: stiffness with energy storage within shell enhances PF power

Question 37

Solid AFOs design

Answer 37

- larger trim lines allow for more control of the tibia - support for the calcaneus - wider control of the footplate: prevents excessive eversion and inversion

Question 38

purpose of solid AFO

Answer 38

- to resist PF during swing phase - fulcrum force applied to the anterior ankle by velcro strap - made form thick thermoplastic - hold the ankle in a biomechanically neutral position - might have medial and lateral corrugations incorporated within

Question 39

what type of pt are solid AFOs prescribed for

Answer 39

pt with spatisity - tone-inhibition bar if hypertincity is severe (metatarsal bar) - people who are not responding to therapy and have no LR

Question 40

static AFO (Solid AFO)

Answer 40

- aims to hold the foot in place. more stability less mobility

Question 41

what are the disadvantages of solid AFOs

Answer 41

- does not support the heel rocking phases - proximal anterior strap prevents tibia advancement and lack of eccentric control in LR

Question 42

how do pts with solid AFO with anterior staps compensate for losing tibial advancement

Answer 42

by flexing their knee in midstance