Pediatric Orthotics Flashcards
Clubfoot presentation
Forefoot adduction and supination
Hindfoot equines and varus
twice as often in boys than girls.
bilateral in 1/2 cases. idiopathic
Ponseti method of treatment of clubfoot
4-6 weeks of serial casts
Achiles lengthening
Dennis Browne Bar and straight last shoes
Treatment protocol for dennis brown bar/Ponseti AFOs
full time 3 months
3x/day stretching
Nigth time shoes/bar until age 2-4
Orientation of Dennis brown bar
70 ER on effected side
45 on non effected side
DF bend 15 in bar to reduce stress on knee
Heel width- shoulder width
Plastizote heel counter
Arthrogryposis
Lack of fetal movement leading to contractures.
Can present with several musculoskeletal deformations.
Cerebral Palsy
Damage to the cerebrum around the time of birth
Non progressive
Persistent disorder of movement and posture
Scoliosis, contratures, dislocations
Different presentation of CP
Spastic CP- 80percent
Usually spastic at gastric and hamstring, and iliopsoas.
Athetoid- 10 percent
Uncontrollable movements. Orthotics ttyplically used less.
Ataxic- 7 percent
Poor balance. Orthotics used for proprioception and bettered balance.
Myelomeningocele/Spina Bifida
Neural tube defece
Occulta- usually little or no neurological impairment
Menigocele- extrusion of meninges. Cord stays in canal
Myelomeningocele- Associated with neurological impairments. Nerve roots lead to flaccid paralysis. Spinal cord damage leads to spastic paralysis.
Levels and common orthotics
T12-L2-wheelchair, standing podium, RGO.
L3-L4- HKAFO, KAFO
L4-L5: AFO,
Sacral Agenesis- supramalleolar or UCBL
Precuts Carinatum
Congenital condition causing asymmetry of sternum and ribs.
Flexible deformity, usually increases with growth spurt.
More common in boys than girls
Can be painful and have respiratory symptoms. Exercise intolerance
Treatment of pectus carinatum
Surgical treatment
Precuts carinatum band- 16-18 hours a day for 1 year. Wean out for 6 months to a year.
Blount’s disease
Growth disorder of medial aspect of tibial physics.
Varus angulation of tibia and IR
Girls> males
obesity and genetics play factor
Blount’s disease tx
observe for first 2 years of life.
KAFO designed to provide rotation and 3 point correction (corrective force on lateral fibula). Usually ineffective in adolescents
Tibial osteotomy in severe cases
DDH- developmental hip dysplasia
“clunking” hip popping out of socket
Shallow acetabulum congenitally
Girls> boys
Galleazi sign- in supine. Patient appears to have a shortened femur with feet not flat on table
Orthotic treatment of DDH
Pavlik Harness
- birth to 6 months
- Anterior strap follows axially line
- 90 degrees of hip flexion
- hip abduction
- Ful time for six weeks
