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PHTH 534: Gait > Orthotics > Flashcards

Orthotics Flashcards

1
Q

What is the purpose of orthotics?

A
  • control abn. compensatory movements (by bringing the foot to the floor)
  • to create a biomechanical balanced kinetic chain by controlling/reducing pathologic motion in the LE by keeping the foot in a subtalar neutral position
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2
Q

Why does the subtalar joint become rigid during toe off?

A

to propel an individual forward during gait

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3
Q

What is a foot orthotic and its purpose?

A
  • they are wedges for supination/pronation
  • to maintain biomechanical alignment
  • used to correct knee varus/valgus
  • prevents/helps with pain, pressure distribution, and skin protection
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4
Q

Describe what the center of pressure of the foot should look like for good biomechanics?

A

The center of pressure should start at the calcaneus during loading response, moving laterally towards the midfoot in midstance, and end medially towards the big toe during push off.

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5
Q

Which is most frequently encountered as an issue overpronation or excessive supination?

A

Overpronation; it leads to knee valgus and increased medial force through the patella

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6
Q

Why is subtalar joint flexibility and stability important during gait?

A

The subtalar joint requires flexibility for uneven surfaces, gait, and balance.

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7
Q

What occurs in the subtalar joint during initial contact?

A
  • the subtalar joint is in neutral
  • assists in shock absorption
  • pronation of the subtalar; rotation of the tibia to absorb
  • flexible
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8
Q

What occurs in the subtalar joint during midstance?

A
  • the foot moves into full pronation during loading response
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9
Q

What occurs in the subtalar joint during terminal stance?

A
  • the foot moves into supination and becomes rigid
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10
Q

How should the LE ideally look like when performing a standing assessment of alignment?

A
  • the ASIS, patella, and midpoint between the malleoli should be in alignment
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11
Q

What are the repercussion of overpronation in a closed chain position?

A
  • anterior pelvic tilt
  • internal rotation (femur, fibula, tibia)
  • valgus knee
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12
Q

In which directions does the talus and calcaneus shift when overpronation occurs?

A
  • the talus shift medially (add. and plantarflexion) while the calcaneus shifts laterally (everts)
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13
Q

What movement occurs at the pelvis during over pronation?

A
  • the pelvis experiences an anterior tilt
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14
Q

What are the repercussions of supination in a closed chain?

A
  • posterior pelvic tilt
  • external rotation (femur, tibia, and fibula)
  • knee varus
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15
Q

What occurs to the talus and calcaneus during supination?

A
  • the talus shift laterally (abd. and dorsiflex) while the calcaneus shift medially (inverts)
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16
Q

How would you measure for knee varum?

A
  • you would measure between the knees
17
Q

How would you measure for knee valgus?

A
  • measure between the ankles/malleoli
18
Q

What is KAM and its significance?

A
  • KAM: knee adduction movement
  • KAM increases GRF
  • during walking KAM places the knee into varus and causes an increase in medial compressive forces (60-70% of force passes in medially)
19
Q

What is the purpose of foot orthotics?

A
  • supportive apparel that provides soft tissue protection, bone/joint stability (static & dynamic) , and controls the body segment
20
Q

What do inside shoe orthotics (inserts) provide?

A
  • modify heel, midfoot, or forefoot
  • padding for pain
  • heel lift for pain
  • wedges for excessive sup/pron
21
Q

What are UCBL’s and their purpose?

A
  • UBL’s: University of California Berkely lab
  • characteristics: high trim lines
  • orthotics for arthritis, hypotonia
  • hold the calcaneus in neutral
  • mainly used for over pronation
22
Q

How do you perform a navicular drop test?

A
  • record subtalar neutral on a piece of paper (neutral found when navicular and cuboid bone are in parallel)
  • record subtalar position during weightbearing
  • positive test found at 10 mm difference
23
Q

What gait deviations do you look for in the swing phase?

A
  • drop foot
  • consider AFO or leaf spring
24
Q

What gait deviations do you look for in stance phase?

A
  • ankle instability (solid AFO or hinged AFO)
  • ankle plantarflexion (solid AFO w/support strap)
  • knee hyperextension (inserts that keep the joint at neutral)
25
Q

AFO’s are widely prescribed for..?

A
  • weakness, stroke, cerebral palsy, head injury, peripheral neuropathy, alignment, SCI, progressive disease
26
Q

When is an orthosis most comfortable and effective?

A
  1. Pressure= F/A
  2. Able to control direction of primary force and direction of counterforces
27
Q

When is a leaf spring AFO most useful?

A
  • when a pt is experiencing foot drop
  • most effective in swing phase (enhances swing limb clearance and assists with controlled heel contact)
28
Q

What are some reasons why a patient might be experiencing a foot drop?

A
  • peripheral neuropathy (fracture, diabetes, bed rest, etc)
  • MS
  • Stroke or CVA
  • myositis
29
Q

What are the characteristics of a step smart AFO and what is it used for?

A
  • Has a posterior shell
  • Used for foot drop
30
Q

What are the characteristics of a F3 carbon fiber AFO and what is it used for?

A
  • it is light weight; durable, w/ anterior shell
  • dorsiflexion assistance, enhances plantarflexion power
31
Q

What are the characteristics of a solid AFO (SAFO) and what is it used for?

A
  • to resist PF during swing
  • has 2 straps (one at the calf and one at the ankle)
  • has larger trim lines for more tibia control
  • wider control of foot plat to prevent excessive inversion and eversion
32
Q

What are the disadvantages of a SAFO?

A
  • interferes with all 3 ankle rockers
  • lose tibial advancement, 1st rocker
  • no knee flexion or toe off leading to decrease stride length
33
Q

What is a static AFO and its characteristics?

A
  • rigid
  • positioned for 0 degrees of dorsiflexion w/ a balanced forefoot

PHTH 534: Gait (10 decks)

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