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6 Prosthetics & Orthotics > L3 LE Orthotics > Flashcards

L3 LE Orthotics Flashcards

1
Q

Full length lifts

A

complete full length shoe lifts on one side accommodate for leg length discrepancies

can also compensate for the patient not obtaining adequate ankle/knee/hip flexion on the opposite limb

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2
Q

Heel lift

A

typically used to accommodate PF contractures
also used for achilles tendonitis

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3
Q

Heel Wedge

A

supports calcaneal inversion or eversion or valgus at the ankle

medial wedge = inhibits calcaneal eversion
lateral wedge = inhibits calcaneal inversion

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4
Q

Heel cushion

A

soft pad that is placed on the heel of the inner sole to cushion the heel. goal is to reduce heel pain. often used for patients with calcaneal spur or plantar fasciitis

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5
Q

Heel cup

A

rigid insert that covers the plantar surface of the calcaneus and extends upwards. helps to stabilize the calcaneus in a neutral position as well as provide shock absorption for the heel. commonly used for pts with calcaneal spur or plantar fasciitis

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6
Q

Metatarsal Bar

A

adds a rocker to the metatarsal area to take weight off the rays

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7
Q

Rocker Sole

A

allows for smooth transition from heel strike to toe off with limited ankle motion

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8
Q

Use of shoes with orthoses

A

most orthoses rely on shoe to kep foot in contact with foot plate

-non slip sole on shoe and laces to mid foot
-depth of shoes is important and width of toe box
-watch for slipping at the heel

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9
Q

Accommodative Foot Orthoses

A

we are accommodating a certain position/condition of the foot. foot is not correctable or has pain with correction

used for RA, healed fractures, CMT, diabetes

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10
Q

Functional Foot Orthoses

A

designed to realign the bones and joints in the foot in order to decrease stress within the knee, ankle, foot

reduce pronation, supination, support calcaneus. usually will include wedging or posting to prevent abnormal compensatory movement within joints

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11
Q

What is the difference between functional and accommodative orthotics?

A

a functional orthosis is normally made of a firmer material, such as plastic and designed to realign the foot and body in accordance with ROM and flexibility

an accommodative orthosis is supporting the foot in its current position

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12
Q

Materials of Foot Orthoses

A

Top cover
Mid layer
Base layer

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13
Q

Top cover

A

soft neoprene type material, shock absorbing foam or leather

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14
Q

Mid layer

A

shock absorbing layer

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15
Q

Base layer

A

rigid foam, cork, or thermoplastic

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16
Q

Reliefs

A

reliefs will be modified into positive model to unload areas of the foot

i.e metatarsal heads, base of 5th metatarsal, plantar fascia

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17
Q

Additions

A

met pads to relieve pressure on metatarsal heads
extrinsic wedging at heel or forefoot for support

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18
Q

Varus wedge

A

wedge is on the medial aspect of the orthosis

force applied is shifted laterally resulting in supination/inversion and improved pronation control

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19
Q

Valgus Wedge

A

wedge is on the lateral aspect of the orthosis
force applied is shifted medially resulting in pronation/eversion

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20
Q

UCBL

A

type of foot orthosis used to stabilize the subtalar and tarsal joints in stance

indicated for rearfoot valgus/varus and pes planus

contraindicated with rigid foot deformity

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21
Q

SMO

A

supramalleolar orthosis

only crosses ankle joint, does not have any joints

control mid foot and calcaneal misalignment

mainly used in peds, adult foot may not take the forces needed for correction

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22
Q

Off the shelf

A

-used when pt does not have the need for the custom shape
-lower cost
-main benefit for swing phase deficits
-good option for early gait training
-limited benefit for more complex abnormalities

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23
Q

Custom AFO

A

-molded from cast
-thermoplastic or carbon fiber
-used when patient has deformation or will need more support in single or multiple planes
-higher cost
-best choice for complexity

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24
Q

Prximal Shell

A

-controls forward or backward progression of the tibia during stance
-can either be anterior or posterior shell

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25
Q

Anterior shell

A

provides stance phase knee stability by limiting tibial forward progression when AFO is solid and very stiff

limits DF in stance
may lead to knee hyperextension

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26
Q

Posterior Shell

A

beneficial for more complex gait abnormalities impacting both knee flexion and extension in stance

may allow greater DF than an anterior shell during stance depending on AFO stiffness

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27
Q

Trimlines

A

contact position of the material that can be cut more anteriorly or more posteriorly

trimlines impact stiffness of AFO

can be posterior or anterior cut

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28
Q

Anterior Trimline

A

material extends more anteriorly providing increased control and less motion

the more anterior the trimline, the more the stiff the AFO

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29
Q

Posterior Trimline

A

material provides less contact, providing decreased control and allowing more motion

anterior trimlines can be cut to be more posterior as control, muscle strength, improves

posterior to malleoli decrease ML control

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30
Q

Ankle Strap

A

secures the ankle into the AFO and limits heel positioning

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31
Q

Posterior Strap

A

allows adjustments for amount of DF

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32
Q

T-strap

A

can assist in controlling ankle varus/valgus

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33
Q

Double Metal Upright AFO

A

-hinges allow motion
-DF/PF stops set by adjusting screws in each channel
-springs can be added for DF assist
-excellent choice for edema
-allows modifications as recovery progresses
-attaches to the shoes

34
Q

Benefits of double metal upright AFO

A

-can provide DF assist
-adjustable as pts needs change
-allows for volitional muscle activation
-can control stance phase knee flexion/extension based on adjustment at ankle

35
Q

Considerations of Double metal upright AFO

A

not appropriate for PF spasticity
need adequate ankle PROM
need stable M/L stability

36
Q

Solid or Rigid AFO

A

provides rigid support of the ankle in the desired position

anterior trimlines
thicker material

fixed at ankle, in slight PF, neutral or DF based on control needed

37
Q

Benefits of solid AFO

A

-increase ankle DF during swing
-stiffness adjustability by changing trimlines
-increase stance phase knee flex or ext by restricting ankle motion
-decrease clubfoot (inv/pf) during stance
-possible ankle control with PF spasticity
-improve static balance

38
Q

Limitations of solid AFO

A

reduced ability to allow volitional muscle control

bulk and weight of the AFO

does not allow for ankle DF during functional movements such as sit to stand

39
Q

Ground Reaction AFO

A

provides knee stability through a posteriorly directed force at proximal tibia

fixed at ankle in slight PF

GRF anterior to the knee which prevents knee instability and collapse

anterior shell for added tibial control

carbon or plastic options

40
Q

Benefits of GRAFO

A

-increases DF during swing
-strong stance phase knee flex control
-anterior proximal contact of AFO leads to stance phase knee extension
-increases static balance

41
Q

GRAFO Considerations

A

not appropriate for someone with genu recurvatum, strong hypertension thrust in stance, quads spasticity

bulk and weight of AFO may be limiting

42
Q

Semi-rigid AFO

A

-provides varying degrees of rigidity based on design and materials used
-more posterior trimlines compared to solid AFO
-ankle in slight PF, neutral or DF based on control needed
-some ankle motion allowed based on material thickness/flexibility
-material property choices restrict or allow motion

43
Q

Benefits of semi-rigid AFO

A

-increase DF during swing
-adjustability of stiffness by changing trimlines
-control stance phase knee flexion or extension by limiting ankle motion
-increase gait speed if AFO has fewer restrictions to movement
-may increase dynamic balance based on design

44
Q

Semi-Rigid AFO Considerations

A

-may not be appropriate for patient with PF spasticity
-does not provide as much support at the knee compared to a rigid AFO
-limited use if pt has equinaovarus (club foot)

45
Q

Posterior Leaf Spring AFO

A

-most posterior trimline
-more ankle motion allowed due to material flexibility
-minimal to no medial lateral ankle support
-minimal to no effect at the knee

46
Q

Benefits of posterior leaf spring AFO

A

increase DF in swing
lightweight
prefabricated options
increase gait speed

47
Q

Considerations for posterior leaf spring AFO

A

not appropriate with PF spasticity or knee instability

48
Q

Articulating AFO

A

-ankle joint is incorporated into the AFO
-provides varying degrees of
motion at the ankle through hinges and optional stops
-DF/PF stops
-resist and assist options available
-allows for control at the knee with restricting or helping motion
-allows for volitional muscle activation

49
Q

Considerations of Articulating AFOs

A

-bulk and weight of AFO
-not indicated for someone with PF spasticity ≥ 3
-less medial/lateral stability compared to solid AFO

50
Q

Stops

A

limit ROM to restrict movement when strength, ROM, or motor control are decreased

stops can be set to accommodate limits of joint ROM

51
Q

PF stop

A

created when posterior materials contact
can decrease genu recurvatum and equinovarus

52
Q

DF stop

A

created when anterior materials contact

can increase stability by decreasing stance phase knee buckling

53
Q

Springs

A

assist movement when strength and/or control are decreased

can assist DF during swing b/c of recoil

can also assist with eccentric control of PF during loading response to reduce foot slap

54
Q

Dynamic AFOs

A

enhance or resist ankle motion while allowing some motion and/or energy storage

55
Q

Carbon Fiber AFO

A

stores and releases energy to assist PF for push-off
minimal medial/lateral ankle support
minimal to no adjustability

56
Q

Benefits of carbon fiber AFO

A

DF assist
increases push off force
allows for volitional muscle activation
allows for increased gait speed

57
Q

Considerations for Carbon Fiber AFO

A

not indicated for equinovarus, knee buckling, genu recurvatum, limited ankle ROM, PF spasticity

58
Q

Equinovarus

A

Clubfoot, also known as talipes equinovarus (TEV), is a common foot abnormality, in which the foot points downward and inward. The condition is present at birth, and involves the foot and lower leg

59
Q

Arizona AFO

A

-custom gauntlet style AFO
-leather with thermoplastic reinforcement
-used for failed fusions
-dx of OA or post tibial tendon dysfunction
-immobilizes ankle but allow for toe roll over

60
Q

Mods for AFO

A

padding
medial/lateral flange
extrinsic wedging

61
Q

Padding

A

bony prominences to protect skin

62
Q

Medial/lateral Flange

A

restricts medial or lateral forces

63
Q

Extrinsic wedging

A

additional control over lateral or medial forces

64
Q

KO

A

custom or off the shelf
based on anatomic challenges, knee deformation
stabilize knee after ACL/PCL
off load OA
can be used for hyperextension

65
Q

KAFO

A

-provided to compensate for weakness, paralysis or skeletal problems which cause lower limb instability
-appropriate for pts with knee hyperextension and/or knee weakness
-always custom fabricated

66
Q

Free motion KAFO

A

no restriction or assistance

67
Q

Posterior offset

A

provides stability at the knee when knee is in full extension

68
Q

Drop lock

A

locked in extension when standing
must manually unlock to sit

69
Q

Stance lock knee joints

A

knee joint locks at extension and unlocks at toe load

70
Q

HKAFO

A

indiciations include traumatic paraplegia, spina bifida, muscular dystrophy and rotational control

71
Q

RGO

A

reciprocating gait orthosis

BIL HKAFO that provides contralateral hip extension with ipsilateral hip flexion

seen in rehab, peds, paralysis

72
Q

FES

A

functional electrical stimulation

alternative to traditional orthoses for pts with foot drop and intact peroneal nerve

force sensor is worn to detect heel off and heel strike

73
Q

CPG for FES w/AFO

A

strong evidence of benefit for individuals for LE lack of motor control post CHRONIC stroke

both methods provide immediate orthotic effects at ankle

FES –> more therapeutic effects, better for faster walkers
AFO–> more compensatory effects, better early in treatment

74
Q

What to use for insufficient knee flexion to clear floor during swing

A

small lift contralateral shoe
no orthotic componentry available

75
Q

What to use for insufficient DF during swing

A

FES orthosis
single axis AFO with DF assist and PF stop
posterior leaf spring
dynamic AFO

76
Q

What to use for mid to late stance knee hyperextension

A

heel lift
AFO with PF stop
solid ankle AFO in DF

77
Q

What to use for knee instability/buckling

A

AFO with DF stop
ground reaction AFO with DF stop
KAFO with posterior offset knee, knee lock, or stance lock and free swing

78
Q

What to use for Excessive supination

A

foot orthosis with forefoot valgus post
lateral hindfoot wedge
AFO with lateral flange

79
Q

What to use for excessive pronation

A

foot orthosis and varus post
UCBL
SMO
Arizona AFO
AFO with medial flange

80
Q

Functional Training needed for LE ORthosis

A

gait
stairs
navigating various surfaces
ramps
sit to stand

81
Q

People with blocking DF will have difficulty with

A

STS, ascending ramps, squatting, descending stairs

82
Q

People with blocking PF will have difficulty with

A

descending ramps, eliminates active push off

6 Prosthetics & Orthotics (11 decks)

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