Orthotics from Orthotists Perspective Flashcards
Goal of ANY Orthotic Treatment
- Limit or assist motion
- Limit deformity or pain
- Protect fragile structures –> prevent further progression, reduce stress on a joint
Choosing Appropriate Orthotic Intervention
- Previous Orthotic History
- Cognition
- Attitude
- Outside Support
- Condition of Extremity
- Muscle Tone
- Gait Evaluation
Determinants of Gait
- Pelvic Rotation
- Pelvic Tilt
- Knee Flexion at Midstance
- Foot and Ankle Motion
- Knee Motion
- Lateral Pelvic Displacement
-All influence energy expenditure and the mechanical efficiency of walking
Pelvic Tilt
- At midstance, COG reaches it’s highest point
- Pelvis tilts down on the swing side 5 degrees
- Depresses COG 3/16”
4 Questions for an orthotic prescription
-What control is needed?
-What are the deficits?
-What assistance is needed?
-What function should remain?
Basic Principles of Orthoses
- Balanced parallel force systems used to control motion
- 3 points of force application required to control motion in one plane (1 corrective, 2 stabilizing)
- The larger the corrective force, the larger the surface area required for the force application to stay within soft tissue tolerances for pressure
Metal and Leather Benefits
- Little contact on limb
- Traps little heat
- Accommodates fluctuating edema
- Structurally Sturdy
Metal and Leather Drawbacks
- Heavy
- High force with less control due to lack of contact areas
- Limited to one pair of shoes
- Bulky
- Requires more maintenance
Plastic Benefits
- Vacuum formed
- Intimate contact can be customized for more weight bearing with bony prominence relief
- Allows most biomechanical control
- Better shoe fit
- Easily Adjusted
- Colored/patterned plastics
Plastic Drawbacks
- Can be hot
- Difficult with fluctuating edema
Benefits of Carbon
- laminated to mold
- intimate contact can be customized for more weight bearing with bony prominence relief
- Allows most biomechanical
- Best shoe fit
- Lightest weight
drawbacks of carbon
not easily adjusted
5 functions of AFOs
- Block plantarflexion
- Block dorsiflexion
- Assist dorsiflexion
- Control supination (3 point pressure system)
- Control pronation (3 point pressure system)
*** can correct some deviations but might create others
Classes of Orthoses- Off the shelf
- prefabricated
- requires minimal self-adjustment (can be completed by patient or beneficiary or supplier of device)
- patient or therapist can obtain without orthotist assistance
- Generally paid for OOP or billed through hospital/therapy
classification of orthoses - custom fit
- prefabricated
- requires more than minimal self-adjustment (trimmed, bent, molded)
- requires expertise of certified orthotist to fit item on the patient
- orthotist submits to insurance fro coverage/reimbursement, more cost effective than custom fabricated
** typically seen spinal
classification of orthoses - custom fabricated
- custom (based on measurements, cast and/or digital model)
- Provides total contact
0 more control over final design since fabrication is done via orthotist - orthotists submits to insurance for coverage/reimbursement
OTS plastic AFO - Design
- One size fits most
- Plastic calf band with posterior strut to footplate
- little contact on skin, decrease risk of skin breakdown
- stops most PF
- very flexible, can be too flimsy on larger patients
OTS plastic AFO - Indications
- Neurological injuries (return of function is anticipated)
- Short term use: acute foot drop, inpatient rehab, while waiting for another device
(good when coming out of TKA or THA when nerve might have been nicked)
OTS (custom fit) carbon AFO - Design
- carbon fiber calf cuff wit posterior strut and attached foot plate (more dynamic/springiness motion through late stance into swing phase)
- Stops PF
- very lightweight and strong
OTS (Custom Fit) Carbon AFO - Indications
- foot drop (isolated)
- mild coronal ankle instability
- mild spasticity
- patient with adequate ROM to load the strut
- Mild/moderate knee buckling
OTS (Custom Fit) Carbon AFO - Contraindications
PF contractures/knee hyperextension
OTS (Custom Fit) Carbon AFO with Anterior Panel - Design
- Carbon fiber anterior panel (‘shin guard’) with strut and attached foot plate
- Provides more knee control to prevent excessive/unwanted knee flexion through stance
phase - Still provides springiness at late stance into swing phase
- Stops plantarflexion and some
dorsiflexion - Lightweight and stron
OTS (Custom Fit) Carbon AFO with Anterior Panel - Indications
- foot drop
- mild coronal ankle instability
- mild spasticity
- patient with adequate ROM to load the panel/strut
- moderate knee buckling instability
- contraindicated: PF contractures/knee hyperextension
Supramalleolar AFOs (SMOs) - Design
- Intimately fitting, low profile wrap around AFO –> Wraps around dorsum of ankle and forefoot
- Pediatric populations –> Thicker plastic needed to accommodate an adult for weight bearing (less ideal)
- Several 3 point pressure systems –> Total contact, multiplane control
- Ends 2-3” proximal to malleoli
- Can be used as an inner portion of an AF