Orthotics and Prosthetics Flashcards
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
what is the purpose of orthotics
- resist motion
- enhance motion
- resist undesired motion
- limit motion
- stop motion
ankle foot orthoses can be sub-classified into
- static
- dynamic
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
what are the different types of ankle-foot orthoses
- single and double bar AFO’s
- total contact AFOs
- off-weight AFOs
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
sinlge bar AFOs are primarily for
pediatric patients
double bar-primarily for
adult patients
hybrid single and double bar AFOs
-designed using a molded plastic foot orthosis
what is the advantage of using a hybrid single and double bar AFOs
-better cosmesis as compared to standard double uprights
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)
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
indications for a plantarflexory stop AFO
- for spasticity of the deep/superficial posterior muscle group
- spastic eqinus
- pathology is associated with knee hyperextension
what is the function of a plantarflexory stop AFO
creates knee flexion moment
indications for a dorsiflexory stop AFO
- weakness or paralysis of ankle plantarflexors
- weakness or paralysis of the quadriceps
what is the function of a dorsiflexory stop AFO
causes a knee extension moment
what is another name for a total contact AFO
solid ankle AFO
Total contact AFOs
- thermoplastic molded
- better cosmesis (fits inside the shoe)
- lightweight
- cannot accommodate large fluctuations in size
- inherently warmer
function of solid ankle AFOs
- provides maximum control in all 3 planes
- the anterior trim line is at the centre of the malleoli
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
