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Prosthetics/Orthotics > Orthotics Lab - Shoes, Internal & External Shoe Modifications, AFO, SMOs & IMOs > Flashcards

Orthotics Lab - Shoes, Internal & External Shoe Modifications, AFO, SMOs & IMOs Flashcards

1
Q

What is a lift primarily used to accommodate for?

A
  • Leg length discrepancy
  • Promote greater ease in skin on the contralateral side
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2
Q

Where can lifts be added?

A
  • Permanently: Added to sole of the shoe
  • Temporarily: strapped to the shoe
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3
Q

How much of a lift can be accommodated within a shoe?

A
  • Lift of about 1/2 inch
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4
Q

What is the function of a cushioned heel?

A

Serves to absorb shock during loading at heel strike

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5
Q

When is a cushioned heel indicated?

A
  • When there is heel pain
  • May be prescribed when the individual is using a solid AFO to assist with forward weight shift
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6
Q

What is the function of a rocker sole, metatarsal bar and rocker bar?

A

To decrease weight bearing through metatarsal heads allowing for an easier or more comfortable transition from heel strike to toe off

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7
Q

What is the difference between a rocker sole, metatarsal bar and rocker bar?

A
  • Rocker sole: Extends the length of the sole of the shoe
  • Metatarsal Bar: strip of leather or rubber placed just posterior to the metatarsal heads
  • Rocker bar: similar to metatarsal bar but is more beveled at the ends & resembles the rocker base of a rocking chair
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8
Q

What do all the rocker bottoms styles do?

A

Reduce stress at metatarsal heads during push off phase of gait

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9
Q

When are rocker bottoms style indicated?

A

Whenever there is pain in the metatarsal heads

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10
Q

What is a flare?

A

Increases the M-L surface area of the bottom of the shoe & may be placed medially or laterally

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11
Q

What is a wedge?

A
  • Thicker on one side than another and when placed on the bottom of the shoe or between the inner and outer soles, tips the shoe in a desired direction
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12
Q

What do heel wedges directly influence?

A
  • Calcaneal/subtalar position, correcting a flexible deformity or supporting a rigid deformity
  • Greater influence up/down the chain with flexible deformities
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13
Q

Where does a sole wedge span?

A
  • Originates distal to the heel
  • Bisects the midline of the sole
  • Extends to the anterior midline of the footwear
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14
Q

What will a medial sole wedge create?

A

Inversion effect on the forefoot

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15
Q

What will a lateral sole wedge create?

A

Eversion effect on the forefoot

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16
Q

What is the function of a flare?

A
  • Increases individual BOS when they are wearing shoes
  • May bias & may prevent inversion/eversion injuries
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17
Q

What is the function a wedge?

A

Help correct flexible deformities or support rigid deformities

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18
Q

How would you manage a patient with flexible pronation deformity with the use flares/ or wedges?

A
  • Medial heel (hind foot) wedge pushes calcaneous superiorly and redistributes weight to the hind foot laterally
  • Lateral flare may encourage weight shift to the lateral side of the foot
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19
Q

How would you manage a patient with rigid pronation deformity with the use flares/ or wedges?

A
  • Lateral hind foot wedge supports everted hind foot and redistributes weight, reducing pressure on the medial side
  • Medial flare may help to improve balance by broadening BOS where foot is loaded
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20
Q

How would you manage a patient with flexible supination deformity with the use flares/ or wedges?

A
  • Lateral heel (hindfoot) wedge pushes calcaneous inferiority and redistributes weight in the hindfoot medially
  • Medial flare may encourage weight shift to medial side of the foot
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21
Q

How would you manage a patient with rigid supination deformity with the use flares/ or wedges?

A
  • Medial (hind foot) wedge supports inverted hind foot and redistributed weight reducing pressure on the lateral side
  • Lateral flare may help to improve balance by broadening BOS where foot is loaded
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22
Q

What is a Thomas heel and what is it most used for?

A
  • Extension of the front/distal edge of heel anteriorly on medial side
  • Used to increase stability of the sole of the shoe when there is pronation
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23
Q

What is a reverse Thomas heel?

A

Breast of the heel is extended anteriorly on the lateral side

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24
Q

What is the scaphoid pad and when is it indicated?

A

Convex pad used within the shoe to support the longitudinal arch

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25
Q

What is the proper positioning of the scaphoid pad within the shoe?

A
  • Placed under the longitudinal arch
  • Specifically at the apex of the pad should be positioned between the sustentaculum tali and the navicular tuberosity
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26
Q

What is a metatarsal pad and when is it indicated?

A
  • Soft domed shaped pad that supports the metatarsal arch and relieves pressure from the metatarsal meds by shifting pressure to the metatarsal shafts
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27
Q

Where should a metatarsal pad be placed?

A

Positioned just posterior (proximal) to the metatarsal heads and just anterior (distal) to cuneiform

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28
Q

What is the function and position of a heel spur insert?

A
  • Used to relieve pressure on the heel
  • Anteriorly sloped redistributing weightbearing forces toward the ball of the foot
  • Concave relief which helps to minimize pressure in tender area
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29
Q

Which motions are controlled by a solid ankle foot orthosis (SAFO)?

A

PF, DF, pronation & supination

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30
Q

When the SAFO is set in slight DF. how does this influence LE alignment?

A

Flexion moment is created at the knee and hip (ground reaction force passes anterior to the hip and posterior to the knee)

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31
Q

When is it indicated to have a SAFO set in slight DF?

A

Excessive hyperextension at the knee

32
Q

When the SAFO is set in slight PF. how does this influence LE alignment?

A

Ground reaction force passes anterior to the knee causing an extension moment

33
Q

When is it indicated to have a SAFO set in slight PF?

A

Individual demonstrates a crouch gait

34
Q

How will the incorporation of an elastic anterior/calf leg strap influence function and control of motion?

A
  • Elastic calf will allow some degree of forward translation of the tibia over the talus
  • Orthosis will effectively allow forward weight shift (DF) for functional transitions
35
Q

What is the purpose of a medial flange?

A
  • Assists in distributing primary force utilized to control pronation by attempting to prevent internal rotation of the tibia on the talus
  • Distributes the force across a larger surface therefore decreasing the amount of force necessary to be applied to the talks medially in attempt to control pronation
36
Q

What is the purpose of lateral flange?

A
  • Attempts to disperse the primary force necessary to control supination
  • Attempts to prevent external rotation of the tibia on the talus
37
Q

Where are partial footplates trimmed?

A

Posterior/ proximal to or right at the metatarsal heads

38
Q

Where do full footplates extend?

A

Extend out past the toes

39
Q

Why would you select a partial footplate for a patient?

A
  • Partial footplate might be indicated if the patient has active toe extension and is able to activate this motion though swing for adequate toe clearance
40
Q

Why would you select a full footplate for a patient?

A
  • if the patient will be ambulating and lacks active toe extension necessary for adequate clearance though swing
  • It may be indicated if there is excessive toe clawing and you wish to support the toes and/or attempt to provide some inhibition though the brace.
  • pediatric population: a full footplate may be an economical choice as it allows for length changes
41
Q

What is the indication for choosing a semi-rigid/flexible foot plate?

A
  • indicated when the individual will be ambulating (In order for forward progression to continue anteriorly there must be a natural break across the metatarsal heads)
  • A semirigid footplate will allow a metatarsal break.
  • If the foot plate is too rigid, the individual wearing the brace will have no choice but to externally rotate at the hip.
42
Q

When is a rigid footplate indicated?

A
  • indicated on a less frequent basis
  • If the braces are being worn just for positioning or for standing
  • may also be indicated when there is a partial foot amputation and the orthosis is designed to also hold a shoe filler (modification would be necessary to the shoe extrinsically)
43
Q

Are PLSO normally custom or stick orthosis?

A

Typically, a PLSO is a stock item because trimlines are narrow medial and laterally minimizing need for custom fit

44
Q

Does a PLSO control motion? If so how?

A
  • This orthosis may limit PF through swing.
  • PF: A force directed posterior/inferior originating from the top of the shoe or a calcaneal strap is balanced by an anteriorly directed force originating from the posterior superior portion of the plastic shell and a superiorly directed force from the bottom of the orthotic in the area of the metatarsal heads.
45
Q

Why does a PLSO only minimally prohibit DF?

A

DF is prohibited only minimally by this brace because the posterior portion of the brace is not strong enough to restrict forward movement

46
Q

Why does a PLSO not control pronation & supination?

A

Pronation and supination are not adequately controlled because there is no medial or lateral support to complete the three point pressure system.

47
Q

What is the purpose of a PLSO?

A
  • To assist motion
  • Primarily DF
48
Q

How does the PLSO assist DF?

A
  • As the patient PF at pushoff, the posterior portion of the plastic shell is compressed.
  • Once the brace is unloaded at the initiation of swing phase, the original position is restored
49
Q

Is PLSO designed to correct a flexible deformity or support a rigid deformity?

A

It typically does not correct or support a rigid deformity as there is very little brace contact with the foot and ankle

50
Q

What type of patient would a PLSO be indicated for?

A
  • patient who is demonstrating inadequate foot clearance through swing
  • peroneal neuropathy, Guillian Barre Syndrome, Polio or Post-PolioSyndrome etc
51
Q

What type of patient would a PLSO be contraindicated for?

A

If there is spasticity in the involved LE

52
Q

Single metal HAFO are almost never used but when may they be indicated?

A

If individual is of slight build and there is little to no spasticity (as in the case of drop foot secondary to peroneal neuropathy)

53
Q

When is a double upright HAFO indicated?

A

double metal upright AFO would provide greater stabilityand control and is indicated when a fair amount of force is necessary to control motion

54
Q

Where should a calf band and strap be positioned on an HAFO for optimal fit?

A
  • The higher the calf band the greater the leverage
  • the calf band should not extend over the fibular head to avoid undue pressure on the peroneal nerve
  • Superior lateral trimline should be located 1-1.5” below fibular head
55
Q

Why must a steel shank be incorporated into the shoe design with a HAFO?

A

Steel shank is necessary to add reinforcement to the bottom of the shoe and serves as the anchor for the metal uprights

56
Q

Why may a split stirrup be preferred over a solid stir up on a HAFO?

A
  • A split stirrup may be preferred as it allows each side to be detached from the shoe portion.
  • This may allow increased ease in donning and doffing and can be interchanged with different shoes.
57
Q

What are the cons of a split stirrup over a solid one on a HAFO?

A

the split stirrup is less durable and somewhat heavier than the solid stirrup

58
Q

What is the function of a medial T-strap?

A

Used to in attempt to correct pronation

59
Q

What is the function of a lateral T-strap?

A

Used to correct supination

60
Q

How is a T-strap named?

A

By the location it originates

61
Q

How does a medial T-strap attempt to correct pronation?

A

A laterally directed force originating medially at the medial T-strap is balanced by medially directed forces originating laterally at the lateral portion of the calf band and lateral portion of the shoe in the area of the 5th metatarsal head

62
Q

How does a lateral T- Strap attempt to correct supination?

A

A medially directed force originating laterally at the lateral T-strap is balanced by laterally directed forces originating medially at the medial portion of the calf band and medial portion of the shoe in the area of the 1st metatarsal head

63
Q

When may a a free ankle joint be used?

A
  • Free ankle joints are rarely used in an AFO design
  • free ankle joint may be a part of a KAFO or HKAFO
  • used for a patient with polio who has intact ankle musculature but compromised knee and/or hip control
64
Q

Ankle joints with a posterior stop limit what motion?

A

PF

65
Q

Ankle joints with an anterior stop will limit what motion?

A

DF

66
Q

When a posterior stop commonly used?

A

when the individual drags their foot through swing phase

67
Q

When is an anterior stop commonly used?

A

when individual demonstrated a crouched or very flexed gait

68
Q

When is a spring loaded DF assist indicated?

A

when DF facilitation is desired at initial swing

69
Q

When is use of a spring loaded DF assist & Spring loaded DF-PF assist contraindicated?

A

when there is spasticity

70
Q

When is a spring loaded DF-PF assist indicated?

A

When DF & PF facilitation is indicated

71
Q

How can range be adjusted in ankle joints with channel designs?

A

Use of various length of pins

72
Q

If a HAFO controls PF, what is the 3 point pressure system?

A

force directed posterior/inferior originating from the top of the shoe (laces/tongue) is balanced by an anteriorly directed force originating from the posterior portion of the calf band and a superiorly directed force from the bottom of the shoe in the area of the metatarsal heads

73
Q

If a HAFO control DF, what is the 3 point pressure system?

A

A force directed anterior/superior originating from the heel of the shoe is balanced by a posteriorly directed force originating from the anterior portion of the calf band and an inferiorly directed force from the top of the shoe in the area of the toe box

74
Q

Why might a molded shoe insert AFO with bilateral upright be an advantage over a conventional metal design?

A

Molded shoe insert may provide better correction of foot alignment as modification is internal & closer to bony structure of the foot

75
Q

What are some advantages of metal AFO designs compared to plastic designs?

A
  • Metal AFO can easily accommodate to changes in girth & length
  • May be cooler than plastic
76
Q

When are metal AFO indicated?

A
  • When changes of girth are anticipated
  • Prescribed for patients who have become accustomed to them & do not want to switch to plastic
  • Remote areas where supplies are not readily available
  • Not usually prescribed for children

Prosthetics/Orthotics (12 decks)

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