Orthotics PT Perspective

Question 1

Shoe - what is important to consider

Answer 1

Need a deep toe box

Lacing - need to be able to open shoe enough to get orthotic in

Question 2

Advantages of plastic vs. metal

Answer 2

lighter weight
can be more flexible
cosmesis

Question 3

Disadvantages to plastic vs. metal

Answer 3

May not last as long
Fits closer to skin so need to be careful with breakdown
Weight gain or edema - need to be careful
Children and growth

Question 4

Advantages of metal vs. plastic

Answer 4

Sturdy, more durable

More accomodative to edema

Question 5

Disadvantages to metal vs. plastic

Answer 5

bulky

heavier

Question 6

Posterior leaf spring AFO - need to be careful with

Answer 6

trim lines - thin so break easily

Usually don’t give someone an over the counter for permanent use

Question 7

Klenzak does what

Answer 7

DF assist/PF stop

Question 8

Pawl and bail lock vs. drop ring lock

Answer 8

Pawl or Bail - you don’t have to do it manually

Drop ring - need to manually do it, at least for the keeper

Question 9

Craig Scott KAFO - set in

Answer 9

DF, anterior tibial band and no knee cap

Question 10

Craig Scott KAFO - allows for

Answer 10

increased stability in ambulatory patients with SCI

Pts will use swing to or swing through gait pattern

Question 11

THKAFO - parpodium often used for

Answer 11

kids with spina bifida to allow them to ambulate in classroom or home setting
Also allows them to stand at an earlier age

Question 12

THKAFO - Reciprocal Gait Orthotic (RGO)

Answer 12

When you shift weight to one side, the cable will flex the hip to bring it forward and then keep reciprocating

Question 13

Cant do what with RGO

Answer 13

stairs or curbs!

very bulky under clothes

Question 14

HKAFO - typically put who in this one

Answer 14

paraplegics
maybe with crutches
this allows them control at the hip

Question 15

THKAFO - who is typically put in this

Answer 15

cervical lesions - not very functional though

Also seen with spina bifida

Question 16

Moved to doing what for paraplegics

Answer 16

AFOs with walkers - so that they can have reciprocal gait pattern

Question 17

Orthotic checkout - what do you want to do first

Answer 17

just look at the orthotic itself - check the straps, check the inside, run hands along trim lines, check the joints for the motion or lack of that you wanted

Question 18

Orthotic checkout - step after inspecting the orthotic itself

Answer 18

look at the patient and at their skin

Question 19

Orthotic checkout - put the orthotic on and then what

what position are you in

Answer 19

In sitting, recheck the fit - go along the trim lines again, check fibular head space, run fingers along it and feel for space, look at joints

Question 20

Orthotic checkout - after looking at orthotic on foot in sitting, do what?

Answer 20

Put the shoe on and make sure that it fits appropriately in there
Have them stand up and put weight through it
Check the toes and squeeze around the foot

Question 21

What do we do for an orthotic checkout after checking the orthotic on the foot in the shoe

Answer 21

Have them ambulate with it and see how it functions

Question 22

Amount of wear

Answer 22

depends on patient

inpatient maybe try 2 or 3 times of walking about 75 ft or whatever their comfortable distance is

Question 23

If redness persists ___ ___ then you are calling the orthotist for adaptations to be made

Answer 23

20 minutes

Question 24

Role of PT

Answer 24

Calcaneal alignment
Navicular control
Wearing time
Skin condition
OTC orthotics 
Medications
Donning/Doffing
NDT orthotics
Fabrication of foot plates

Question 25

PT role in prescribing orthotic

Answer 25

Deciding if we think we need an orthotic or not and what type of orthotic you want
MD will write the Rx for it PT gets in touch with the orthotist and then they will come cast, fit, and deliver it