Quiz 3 - Orthotics COPY Flashcards
What do shoes do?
Distribute weight bearing for comfort
What are 2 additional functions that orthopedic shoes provide?
- Reduce pressure on sensitive/deformed areas to pain free areas - Provide a foundation for AFO’s and extensive bracing
What are the major portions of a shoe?
- Upper - Sole - Heel Reinforcements
What does the upper portion of a shoe consist of? What variations are within these?
- The Vamp (Blucher/Balmoral) - The Quarter (High/Low)
What should a shoes sole consist of? What should they be made of?
- Outter: external and Inner: internal sole (leather) - Metal Reinforcement in between with rivets
If shock absorption is needed, what type of additions should be added?
Resilient (strong but flexible)
What does a 1 inch heel in adults that shifts the COG anteriorly aid in? What does it not significantly disturb?
- Aids in Transition through stance phase - Normal hip and knee alignment
What reasons or conditions would we want to build up a persons heel for (up to 3 inches)?
- Achilles Repair/Accommodate short Achilles - Balance issues (to shift cog anteriorly)
What type of issues does a toe box reinforcement in the vamp provide for (internal/external)?
- Vertical trauma (internal) - Stubbing toes (internal) - Hammer Toes (internal) - Diabetes (external) - Neuropathy (external) - Arterial/Wounds (external)
A longitudinal piece that reinforces the shoe is called ______.
- the Shank
A _____ stiffens the quarter. A person with severe ____ should have a ___________ that prevents the foot from ________.
Counter; pes valgus (collapsed medial longitudinal arch) ; long medial counter; rolling inwards
What type of foot can be accommodated or corrected?
A flexible mid/forefoot
What is a Last considered to be in Orthotics and Prosthetics?
The mold over which a shoe is made (shape of soul)
What is the first thing we should consider when selecting a style of shoe?
Last
What type of shoe opening is easier to put on? What type of patient conditions would this accommodate?
Blucher - CVA (vascular issues) - Diabetic ( neuropathy issues) - Paralyzed Leg (prevents sheering) - Edema (swelling issues)
Why would we need to add an internal correction to the heel or foot?
- Calcaneus correction (medial/lateral; pronation/supination - Support of longitudinal arch - Posture correction - Heel Spurs (give back fat pad) - Pressure Relief (weight shift)
Why would we need to add a pad to an internal correction?
- Heel Spurs - Pain relief - Shift or relieve high pressure areas (1st/2nd metatarsal weight bearing)
How does the shape of a heel spur insert reduce pain?
Slopes anteriorly
What are internal corrective inserts made of?
- Soft material - Hard Plastics
What type of condition would need metatarsal pads glued into an inner sole to transfer stress from metatarsal heads to the metatarsal shafts to reduce plantar pressure?
- Diabetic Neuropathy - Pes Cavus (pain relief) - Mortons Neuroma
What is the minimum support used for pes planus? What does it support?
Scaphoid Pad - Longitudinal Arch
The alignment of the calcaneus can be corrected Internally or Externally. T/F
True
Where are external corrections typically built in?
- Heel - Inbetween Inner/Outter soles
Why would we choose an external correction over an internal correction? What is the disadvantage of an external correction?
- Does not reduce shoe volume - Will erode as the patient ambulates
What are the disadvantages of an internal correction? What type of patient conditions would be at a disadvantage?
Can reduce shoe volume (make shoe tighter) - Edema - Abrasions/Sheering * all reasons for using a Blutcher over Balmoral
What is a frequently prescribed external modification that alters the alignment of the calcaneus?
Heel wedge
What type of wedge is incorporated into a Thomas heel? What this combination help support?
Medial Wedge - Longitudinal arch
The ____ border of a _____ heel extends _____ on the _____ side to augment the effect of the _____ wedge in supporting the _____.
Medial; Thomas; Foward; Medial; Medial; Longitudinal Arch
What type of external correction is intended for pes valgus?
Thomas Heel with a medial wedge
What type of support would you want to give to a patient that needs more external support of the entire midfoot and ankle? What type of patients are these?
Thomas Heel and Medial Wedge - Obese - Arthritic - Plantar Fasciitis * Any that need more support
What other joints can correcting a pes valgus help with up the kinetic chain?
- Knees (valgus) - Hips
What is the purpose of a sole wedge?
- Alter Metatarsal Alignment (encourages lateral to medial foot alignment)
A ________ _______ is flat strip of _______, placed ________ to the ________ _________. At ________ _______, the bar transfers stress from the ________ heads to the shafts.
Metatarsal bar; Leather; Posteriorly; Metatarsal Heads; Late Stance; Metatarsal
What is the convex strip attached proximal to the metatarsal heads? What does it improve?
Rocker bar - Late Stance
What does the curve in the rocker bar do?
Encourages lateral to medial as foot goes from heel strike to late stance
How much of a leg length discrepancy is indicated for an external and internal modification?
External: Over 3/8 inch Internal : Under 3/8 inch
What is used for a leg length discrepancy with an internal modification?
Heel lift
Why would someone choose a steel stirrup over a plastic or insert AFO?
- doesnt want plastic in their shoe - doesn’t break as easy
What are the advantages and disadvantages of a solid stirrup?
Advantages: - Maximum Stability - Lighter/Less Bulky than Spilt Stirrup - Less likely to detach with activity Disadvantages: - Complex donning - Can’t detach upright at shoe level - Isn’t interchangeable with shoes
What are the advantages and disadvantages of a split stirrup?
Advantages: - Can be modified - Simplified Donning - Can detach upright at shoe level - Interchangeable with shoes (if central piece riveted) Disadvantages: - Heavier/Bulkier than Solid Stirrup - More likely to detach with heavy activity
What type of shoe is best for an internal AFO?
Balmoral
What are most AFO’s prescribed to control? How do they achieve this?
Ankle Motion ( ankle control) - By limiting plantar flexion and/or dorsiflexion
What type of dorsiflexion does a posterior leaf AFO provide?
Passive Dorsiflexion
What does a posterior leaf spring AFO assist AND allow?
Dorsiflexion
Why does the spring assist in AFO yield slight plantarflexion at heel contact?
To protect against inadvertent knee flexion (buckling)
During gait dorsiflexion likes to translate into knee ______ and plantarflexion likes to transition into knee ______.
Flexion; Extension
What assistance is provided by a posterior leaf spring that arises from a plastic inset AFO?
Dorsiflexion
If you can’t plantarflex, how will it affect a persons swing phase?
It will shorten it (can’t toe off, less extension)
What is added to a Plastic Solid AFO?
Trim lines (Anterior Malleoli)
What type of patient condition would benefit from a plastic posterior spring leaf AFO? Why
- Foot drop (CVA) - Back patient * doesn’t provide medial/lateral stability which these 2 patient conditions can still have.
What is the best plastic AFO type for a person who needs medial/lateral ankle stability?
Solid AFO
What two are conditions that an AFO plantarflexion stop prevent?
- Toe drag - Genuine Recurvatum
Why would we want an AFO dorsiflexion stop/limit?
Prevent Buckling
What will you have to check with a Solid Plastic AFO?
- Lateral and medial malleolus
What is the term BiCAAL stand for?
Bi Channel Adjustable Ankle Locks
What is the difference between a BiCAAL Metal AFO and a Plastic Hinged AFO?
BiCAAL: - Can block or assist through springs/pegs (posterior/anterior) Hinged AFO: - Can block only (posterior)
What does a hinged AFO allow? How can you increase this?
Dorsiflexion - Build up posterior portion (blocks plantar flexion)
What is a Toe Off AFO good for? What is it contraindicated for?
Mild to Severe Foot Drop ( assist dorsiflexion) Mild to Moderate Ankle Instability - Moderate to severe spasticity or edema (contraindicated)
What is a Carbon Fiber Ypsilon AFO good for? What is it contraindicated for?
Mild to Severe Foot Drop (assist dorsiflexion) Ankle Freedom - Unstable ankle joint (contraindicated) - Moderate to severe spasticity or edema (contraindicated)
What are the benefits of carbon AFO’s?
- Lightweight - Newest type
What type of AFO consists of one or two uprights, and a shell, band, or brim called a T-strap that controls inversion of the foot?
Superstructure
Which single upright AFO moderately controls but doesn’t eliminate motions in all planes?
Spiral (Superstructure)
Which AFO provides variety of control, but are not cosmetic?
Metal AFO’s
What is one drawback to Metal AFO’s?
Heavy (but there are pt that love them)
______ orthoses are ______ AFOs designed for children with ______ ______ ______ and adults with ______ ______. These are good for ______ deformities.
Tone reducing; Plastic; Spastic Cerebral Palsy; Spastic Hemaplegia; Flexible
What type of KAFO joints are at the knee? What does the 2nd achieve?
Hinge Joint Offset Hinge Joint - stabilizes the knee in extension
What type of locking mechanisms can be at the knee hinge joint? How do they work?
Drop Ring - ring drops down in extension Pawl lock with bail release - posterior lock that releases both hinges when pulling up on bail Computer Assistance - like the prosthetic C leg (processor controlled. lithium battery)
HKAFO drop ring locks at the _____ and _____, and has a _____.
Hip; Knee; Pelvic Band
What type of patient would need a THKAFO? What is the drawback?
Spina Bifida Spinal Cord Injury (What level???)
What device consists of a broad base, posterior nonarticulated uprights extending from a flat base to a midtorso chest band, and a posterior thoracolumbar band with anterior leg bands contribute to stability?
Standing Frame Walker
What similar orthosis to a standing walker which is made in both child and adult sizes? What is the major difference?
Swivel Walker - It has two distal plates that rock slightly to enable a swiveling gait.
What are 3 options that can place a paraplegic in standing? Which one allows sitting?
- Standing Walker - Swivel Walker - Parapodium (allows sitting)
What type of AFO is designed for adults with paraplegia, molded to conform to the patient’s legs and feet with a foot plate angled at approximately 15° plantarflexion to shift the wearer’s center of gravity anterior to the ankles?
Stabilizing Boots
What type of KAFO is prescribed for patients with paraplegia with shoe reinforced transverse and longitudinal plates, BiCAAL joints, solid ankle section, and a pretibial band? What type of gait does this allow and why?
Craig Scott Orthosis - swing-to or swing-thru gait pattern (pt still has control of hip)
Which orthoses has hip joints that are connected by one or two metal cables or rods, the knees stabilized with knee locks, and the feet encased in a solid ankle orthoses?
Reciprocating Gait Orthoses (THKAFO)
_____ orthoses such as a _____ increase _____ pressure. They are made for people with _____.
Trunk; Corset; Abdominal; LBP
What are rigid orthosis good for?
Controlling motion ( especially after surgery)
A _______ is a rigid orthoses includes a pelvic band, which should provide firm anchorage over the midsection of the buttocks, and a thoracic band, intended to lie horizontally over the lower thorax without impinging on the scapulae. (Lateral flexion resisted). What is it known as?
Lumbosacral Flexion Extension Lateral Control Orthoses - Knight Spinal Orthoses
What type of Orthoses is a Taylor Brace for kyphosis?
Thoracolumbar flexion extension lateral control orthoses (similar to Knight)
What collar has a mandibular and occipital extensions and a rigid anterior? What is it sometimes used for?
Philadelphia Collar - upper cervical injuries
Which collar usually has two anterior adjustable posts joining a sternal plate to a mandibular plate and two posterior uprights connecting a thoracic plate to an occipital plate (moderate control). What is the draw back?
Four Post Cervical Orthosis - if not fitted properly, motion restriction is compromised
Provides maximum stabilization of the head and Cervical spine and is invasive?
Halo Orthosis
A nonsurgical and oldest scoliosis orthotic management is a ______ _______ and it is most effective for curves less than __ degrees.
Milwaukee Brace; 35
What does a rod or a spring do in the posterior channel of a biCAAL joint?
Rod - Block Plantarflexion Spring - Assist in Dorsiflexion
What does a rod/spring do in the anterior channel of a biCAAL joint?
Rod: - Block Dorsiflexion Spring: - Spring Assist Plantarflexion
Which BiCAAL setting is best for a patient with foot drop?
- Posterior Block
Can an AFO control the knee? What will prevent genu recurvatum?
Yes - Posterior Stop/ Increased Dorsiflexion
Which of the AFOs available in lab will prevent knee buckling? Support your answer.
- Anterior Block (Prevents Dorsiflexion)
Should a person with kidney disease use a plastic AFO?
No (due to edema) Internal
Should a person with congestive heart disease use a carbon fiber AFO?
No (due to edema) Internal
What type of patient conditions are contraindicated for carbon AFO’s?
- Unstable ankle - Moderate/Severe Spasticity - Edema
Can you name seven attributes of a Craig Scott orthosis?
- BiCAAL - Dorsiflexion Assist - T-Strap - Pre-Tibial Band - Pawl Lock/Bail Release - Transverse/Longitudinal Plates - Thigh Band
What level of patient with SCI may be able to ambulate with a craig scott orthosis in home?
T10-T12
- What level of patient with SCI may be able to ambulate with a craig scott orthosis in the community?
L1-L3
What is the difference between a knight, Taylor and Milwakee brace?
*All control flexion/extension/lateral flexion/extension Taylor: Thoracolumbar Sacral Support (Kyphosis) Knight: Lumbosacral Support Milwaukee Brace: (Scoliosis)
What motion will a posterior leaf spring orthosis prevent? What condition(s) is it prescribed for?
Plantarflexion - Dropfoot
Would a posterior leaf spring be good for a person with medial/lateral instability?
No (No trimlines - go with Solid AFO)
What does a T strap do? Be able to identify it.
Controls Foot Inversion (Suprastructure)
What is a Spiral AFO and who is it contraindicated for?
- Controls but doesn’t eliminate motion in all planes (light stability)
What does a hinged AFO with a posterior stop do? Be able to identify it.
Block Plantarflexion
A patient with paralysis to the triceps surae benefits from what characteristics in a brace?
Anterior Block
What is the angle that is most indicated for a Milwaukee Brace?
Less than 35 degrees
