- thermoplastic molded - better cosmesis (fits inside the shoe) - lightweight - cannot accommodate large fluctuations in size - inherently warmer

Orthotics and Prosthetics Flashcards by Armi B

goals of lower limb orthoses

maintenance or correction of body alignment
assistance or resistance to joint motion
axial loading of the orthosis and therefore relief of distal weight bearing forces
protection against physical insult

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what is the purpose of orthotics

resist motion
enhance motion
resist undesired motion
limit motion
stop motion

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ankle foot orthoses can be sub-classified into

static

- dynamic

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purpose of ankle foot orthosis

control arc of motion of tibia over the foot
control STJ motion
apply the controlling force through the calf area

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what are the different types of ankle-foot orthoses

single and double bar AFO’s
total contact AFOs
off-weight AFOs

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single and double bar AFOs

metal stirrup or stirrups attached to the shoe with a hinge at the level of the ankle joint
cosmetically less accepting

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sinlge bar AFOs are primarily for

pediatric patients

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double bar-primarily for

adult patients

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hybrid single and double bar AFOs

-designed using a molded plastic foot orthosis

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what is the advantage of using a hybrid single and double bar AFOs

-better cosmesis as compared to standard double uprights

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what do metal channels within the ankle articulation allow for in single and double bar AFOs

allow for the application of springs/pins
springs allow/resist motion (dorsiflexory assist)
pins limit motion (plantarflexory stop)

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dorsiflexor assist AFO

used when dorsiflexors are weak
allow controlled loading of the foot from heel strike to FF loading
assists swing phase toe clearance

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indications for a plantarflexory stop AFO

for spasticity of the deep/superficial posterior muscle group
spastic eqinus
pathology is associated with knee hyperextension

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what is the function of a plantarflexory stop AFO

creates knee flexion moment

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indications for a dorsiflexory stop AFO

weakness or paralysis of ankle plantarflexors

- weakness or paralysis of the quadriceps

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what is the function of a dorsiflexory stop AFO

causes a knee extension moment

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what is another name for a total contact AFO

solid ankle AFO

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Total contact AFOs

thermoplastic molded
better cosmesis (fits inside the shoe)
lightweight
cannot accommodate large fluctuations in size
inherently warmer

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function of solid ankle AFOs

provides maximum control in all 3 planes

- the anterior trim line is at the centre of the malleoli

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appearance of floor reaction AFOs

-appears very similar to the solid ankle AFO except that the foot plate extends further distally and the ankle is held in slight plantarflexion

function of a floor reaction AFOs

used to provide sagittal plane knee stability (particularly, prevention of knee flexion collapse pas the middle of midstance)

posterior leaf spring AFO

similar to the solid ankle AFO except that the posterior ankle is trimmed way back to provide some flexibility

which off-loading AFO is most common

the patellar tendon bearing (PTB) AFO is the most common

function of an off-loading AFO

designed to reduce axial loading of the distal limb by applying prosthetic principles at the knee

supramalleolar (ankle-foot) Orthoses (SMOs) evoled from

UCBL

what do SMOs address

- sagittal plane problems and facilitates clearance during swing - proximal timelines may be just above the malleoli to just below the muscle belly of the soleus

what are SMOs used for

- mimi the effect of high top shoes but with better control - may be used as a transitional orthosis - may be used for chronic inversion instability

what SMOs/SCAFOs/AFOs are most commonly prescribed by DPMs

- Arizona brace (custom gauntlet type of brace) | - Richie brace (functional orthosis footplate with stirrups)

when are tension reducing ankle foot orthoses used

- in cerebral palsy, status post CVA and other spastic problems - the AFOs can be modified to provide immobilization and prevent deformities as a result of the spastic condition

types of knee-ankle foot orthoses

Single and Double bar KAFOs Total contact KAFOs Unweighting KAFOs

general concept of knee ankle foot orthoses

- keep in mind the purpose | - consider the locking mechanisms

what are prosthetics

- a prosthesis is a replacement part | - an artificial device used to replace a missing part of the body

reasons for amputation

``` Disease Trauma Tumor Congenital deformity Pain ```

podiatric implications for prosthetics

- preserving the foot in order to prevent the need for a prosthesis - planning the level of amputation - shoe fillers can be used for amputations DISTAL to Lis-Franc's amputation

different prothesis require

- different levels of energy consumption, coordination and balance - studies have shown that patients who wear less prostheses have less depression

long term problems with prosthesis

``` Edema at the socket Pressure at the socket causing atrophy of muscle and subcutaneous tissue Osteoporosis secondary to reduced weight-bearing Bone spurs Allergic reactions to socket materials Cysts Infections Reduced blood flow Stump neuroma Complaints of tiredness ```

when are shoe fillers primarily used in foot prosthetics

for amputations DISTAL to the Lis-Franc's joint

when shoe fillers are used why type of sole is needed

rigid sole to prevent the shoe from "curling up"

for amputations including Lis-Franc's and Chopart's amputation, what type of shoe is needed

custom molded shoe should be made to fit the stump otherwise a prosthetic foot will be needed

when are prosthetics used

-for amputations proximal to Chopart's, the prosthetic choices are highly variable and dependent upon the level of amputation

when is a prosthetic foot required

for a Syme's amputation or any amputation proximal to that area

what is the most common prosthetic foot

- the SACH (solid ankle cushioned heel) foot is the most commonly used - a polyurethane heel is used which compresses at heel strike to mimic plantarflexion

purpose of a single axis foot

allows limited dorsiflexion and plantarflexion

energy storing foot

- various designs have been created to provide a greater mechanical advantage - and reduce the energy consumption required by amputee

patellar tendon bearing socket

- designed to eliminate weight bearing on bone | - uses a total contact conept, providing force over the entire area of the residual limb rather than at the distal tip

total surface bearing socket design

similar to the PTB but eliminates specific contact points

liner materials

Silicone Viscoelastic Urethane

Suspension Methods (How the prosthesis is attached)

Cuffs Wedges Sleeves