week 12 Flashcards
1
Q
explain evidence for use of foot orthotics to control foot motion and pressure relief
A
- orthotics support longitudinal and transverse arch of foot
- control magnitude and rate of foot pronation during walking
- material density orthoses should be based on patient preference/comfort
2
Q
total rearfoot eversion was (biggest or smallest) for soft vs hard inserts
A
- total rearfoot eversion was smallest for soft inserts and twice as large for hard inserts
- so sensory feedback was key to controlling foot motion, not just “posting”
3
Q
what pathologies benefit from orthotics
A
- plantar fasciitis
- posterior tibialis tendonitis
- anterior knee pain
- why? orthotics limit only 2 degrees, but 2 degrees is 20% of total ROM (8-10 degrees)
4
Q
pros and cons of custom vs pre-fab orthotics
A
5
Q
orthotics of EBP
A
- foot orthosis should not be stand-alone treatment - use other exercise/ortho treatment
- foot orthoses with total plantar contact can decrease strain on plantar fascia and reduce collapse of medial arch
- foot orthoses can provide short-term (3 months) pain and function improvement - not long term
- type of orthotic (custom vs pre-fab) makes no difference in degree of pain or function improvement - patient comfort is most important
6
Q
indications for orthotic devices
A
- goal of any orthosis is to address pathological symptoms
- an orthosis will do one or all of these: control pain, motion, deformity
7
Q
an orthosis with do one or all three of these:
A
- motion: by stopping, limiting, or assisting it at a specific joint or position
- pain: by limiting or stopping motion, or by reducing stress to a joint through support or through shock-reducing cushion
- deformity: by supporting an existing deformity and preventing it from progressing, by using to alter tha deformity or change the position to what is considered natural
8
Q
goals/considerations of orthotics
A
- meets individual’s mobility needs and goals
- maximizes stance phase stability
- minimizes abnormal alignment
- minimally compromises swing phase
- effectively pre-positions the limb for initial contact
- ensuring the device will work with the patient’s preferred AD
- comfort: can be worn for long periods without damaging skin or causing pain, can be easily donned and doffed
9
Q
basic principles of orthoses
A
- balanced parallel force system used to control joint motion
- three points of force application required to control motion in one plane: one corrective force and two stabilizing forces
- the larger the corrective force, the larger the surface area required for the force application (with the goal of staying with soft tissue tolerance for pressure)
10
Q
6 orthoses
A
- FO: foot orthosis
- AFO: ankle foot orthosis
- KAFO: knee ankle foot orthosis
- HKAFO: hip knee ankle foot orthosis
- KO: knee orthosis
- HO: hip orthosis
name for the joints they cross (mostly)
11
Q
6 orthoses
A
- FO: foot orthosis
- AFO: ankle foot orthosis
- KAFO: knee ankle foot orthosis
- HKAFO: hip knee ankle foot orthosis
- KO: knee orthosis
- HO: hip orthosis
name for the joints they cross (mostly)
12
Q
FO: foot orthosis
A
- rigid, semi-rigid, or flexible
- custom fabrication and off the shelf
- subtalar joint support: frontal plane
- fits into shows – low profile
- options: full length/partial length, soft vs firm material, reinforcement, off-loading
13
Q
FO indications
A
- pes planus/pronation
- pes cavus/supination
- plantar fasciitis
- heel spurs
- metatarsalgia
- mild-moderate calcaneal varus/valgus
- mold-moderate midfoot deformity
- laxity
- diabetic neuropathy
14
Q
UCBL: university of cal berkley laboratory
A
- more corrective
- thermoplastic
- custom fabrication
- controls calcaneus and midfoot: transverse plane, frontal plane
- most corrective foot orthotic
- indications: flexible moderate pronation/calcaneal deformity (Down syndrome), moderate deformity, plastic materails (range of rigid support), require larger/wider shoe size
15
Q
SMO: supra malleolar orthosis
A
- cross ankle
- plastic materials
- custom fabrication
- controls calcaneus, midfoot: tranverse plane, frontal plane
- ankle support: frontal plant
- allows free dorsiflexion and plantarflexion
- softer materials
16
Q
SMO indications
A
- ankle instability: frontal plane (M/L)
- flexible calcaneal and midfoot deformity: frontal plan, transverse plane
- moderate-severe deformity
- visible above shoe line
17
Q
ankle foot orthoses
A
18
Q
universal AFO fitting goals
A
- increase ankle stability
- improve cadence
- increase balance/step length
- limit “foot drop”
- increase knee stability at mid stance
- limit genu recurvatum
- create heel-to-toe gait pattern efficiency
- desire for guided control in 3 planes
19
Q
metal AFO
A
- old school
- aluminum sidebars attached to a shoe, leater/metal calf band
- custom fabrication
- articulation at ankle: free motion, limited motion, assisted DF/PF
- controls ankle motion: sagittal plane
20
Q
metal AFO indications
A
- ankle motion management: sagittal plane only
- edema: constant fluctuating volume
- patient preference
- contraindications: increased weight, more time for fabrication, increased maintenance
21
Q
PLS-AFO: posterior leaf spring
A
- thermoplastic materials
- custom and off the shelf options
- material flexibility at the posterior plastic strut (3/4 inch to 1.5 inch wide): sagittal plane(df and pf)
- footplate support:transverse plane (midfoot)
- light weight
22
Q
PLS-AFO indications
A
- drop foot
- tibialis anterior weakness
- dorsiflexion paralysis
- lightweight
- low profile
- off the shelf options
- minimal foot deformity
23
Q
dynamic carbon fiber AFO
A
- carbon fiber materials
- off the shelf, some custom options
- energy storing properties: sagittal plane
- indications: thin lightweight material, low profile, drop foot, df/pf weakness, CVA/MS/neuropathy
24
Q
SA-AFO: solid ankle foot orthosis
A
- thermoplastic or carbon materials
- custom fabrication
- trimlines anterior to malleoli
- fixed ankle position for all phases of gait
- 3 planes of control: saggital plane stability, frontal plane support, transverse plane support
25
SA-AFO indications
* potential or somplete paralysis: gastroc and soleus
* mild instability of the knee: quad weakness
* deformities of ankle: varus/valgus
* contracture/spasticity management
* traumatic LL injury with pain
26
GRAFO: ground reaction AFO
* thermoplastic materials
* custom fabrication
* padded anterior tibial section
* knee extensoin moment in stance: **sagittal plane** (limits tibial progression)
* ankle support: **frontal plane**, **transverse plane** (if stiff enough)
27
GRAFO indications
* crouch gait
* quad weakness: 3-/5
* knee instability
* weak plantarflexors
* not indicated for: genu recurvatum, > 20 degrees knee flexion contraction
28
articulated ankle foot orthosis
* thermoplastic and carbon material
* custom fabrication
* motion allowed at ankle: **sagittal plane**
* options: dorsiflexion assist, pf/df stops
* three planes of control: **sagittal plane** (controlled motion), **frontal plane** (support), **transverse plane** (support)
29
articulated AFO indications
* drop foot
* need for natural ankle motion
* desired motion at ankle at sagittal plane
* control of ankle: frontal plane, transverse plan, medial/lateral ankle instability, varus/valgus deformity
* plantarflexion contraction
* drawbacks: allowing motion is reducing control, ankle joint add bulk and weight, poor cosmesis
30
arizona AFO: leather ankle gauntlet
* leater gauntlet reinforced with plastic, lace up custom molded
* frontal plane support
* adjustability for edema management
* low profile, increased comfort solid ankle and articulating styles
* mostly immobilizes ankle
* indications: posterior tibia tendon dysfunction (PTTD), tendonitis ankle arthritis, degenerative joint disease (DJD), chronic sports injuries, ankle trauma/failed fusions
31
CROW: charcot restrain orthotic walker
* complete contact - more pressure distribution
* thermoplastic with custom soft foam liner and insert, rocker bottom
* custom fabrication
* three planes of support: frontal, sagittal, transverse
* indications: charcot joint, chronic diabetic ulcers, ischemic necrosis, fracture managemtn
32
richie brace
* indications: PTTD, lateral ankle instability, peroneal tendinopathy, cavo-varus deformity
* features: semi-rigid support, control of 1st ray, midtarsal, and subtalar joint, control of ankle inversion/eversion, unrestricted sagittal ankle motion
* full or 3/4 length foot plate
33
PRAFO: pressure relief ankle foot orthosis
* soft padded fabric/lambs wool, plastic reinforcement PLS
* off the shelf
* saggital plane support of ankle
* transverse plane support of hip position
* no posterior heel contact
* easy adjustability
* indications: prolonged supine bedrest, prevention of pf contractures, maintain neutral hip rotation in supine, not intended for ambulation
34
KO: knee orthosis, ACL, or unloader
* composite/metal/carbon graphite options, titanium knee hinges
* custom fabricated, off the shelf options
* support in three planes: sagittal (flexion/extension stops), frontal, transverse (limited)
* lightweight
* indications: ACL/PCL/MCL/LCL instabilities, high intensity athletic activities, OA, offloading support
35
post operative knee braces
* fabric reinforced with metal uprights
* off the shelf
* limited ROM: sagittal plane, frontal plane
* immobilizer
* short term use
36
KAFO: knee ankle foot orthosis
* thermoplastic with metal, carbon fiber, leather
* three planes of control for knee, ankle, foot: sagittal, frontal, transverse
* variety of knee/ankle joint types and function: torsion/contracture management, stance control, C-brace (microprocessor)
* used when stability during stance cannot be provided by AFO option -- or hyperextension of knee jeopardizes joint integry, when excessive varus/valgum is present
37
KAFO indications and contraindications
* knee instability/laxity: deformity
* HS/quad qeakness of paralysis
* spastic/flaccid paralysis of lower limb - post polio syndrome
* part time use
* increased weight and bulk: decreases compliance
38
hip orthoses
* usually more peds
* thermoplstic pelvis and thigh cuff with metal hip joints, fabric/foam lined
* custom fabrication or off the shelf
* unilateral or bilateral control
* variable abd/add control (frontal plane)
* variable hip flexio nstops (sagittal plane)
* indications: legg-calve-perthes, developmental dysplasia of the hip, post-surgical, hip dislocation
* low compliance
39
SWASH: sitting walking and standing hip orthosis
* thermoplastic hip and thigh cuffs, metal uprights that allow motion through a specific range
* off the shelf
* pediatric
* maintains hip abd: frontal plane, limits add while sitting/standing/walking
* free flexion/extension ROM: sagittal plane
40
SWASH indications
* spastic hemi/di/quadriplegia
* hip add tone
* post botox
* risk of hip displacement
* gait scissoring
* allows motion, ambulation
41
HKAFO: hip knee ankle foot orthosis
RGO: reciprocating gait orthosis
* thermoplastic with metal joints and uprights
* custom fabrication
* 3 planes of control at hip, knee, ankle: sagittal, frontal, transverse
* variety of joint type and function
* RGO: reciprocating pelvic attachment allows a reciprocal gait pattern -- requires trunk rotation/strength
42
HKAFO and RGO indications
* part time use - therapy: stance, ambulation
* myelomeningocele
* spina bifida
* paraplegia
* SCI C8-T12
* increased bulk, weight, expense
43
when to consult an orthotist
* redness pressure
* signs of poor fit: volume change, atrophy of muscles
* wear and tear/structural failure
* goals not met
* compliance issues
* custom vs off the shelf
* collaboration for design
| cory has talked about this like 6 times, so probably important
43
when to consult an orthotist
* redness pressure
* signs of poor fit: volume change, atrophy of muscles
* wear and tear/structural failure
* goals not met
* compliance issues
* custom vs off the shelf
* collaboration for design
| cory has talked about this like 6 times, so probably important
