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Orthotic Study > Ankle Orthoses 2 > Flashcards

Ankle Orthoses 2 Flashcards

1
Q

Types of AFO designs

A

Conventional

Thermoplastic

Floor Reaction

Anterior Shell & PTB

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2
Q

Rigidity of thermoplastic AFO is influenced by a variety of factors

A

Type of plastic

Thickness of plastic

Trimlines

  • Anterior to malleoli results in increased A-P and M-L rigidity
  • Posterior to malleoli - Posterior leaf spring design, flexible at the ankle with somewhat of a dorsiflexion spring assist, does not maintain stability of hte ankle

Corrugations vacuum formed in place- carbon fiber inserts or rope modifications

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3
Q

Advantages of Conventional AFO

A

Dorsi/plantarflexion ROM easily adjusted

Limited skin contact

Edema accomodated

Permanent shoe attachment = compliance when wearing shoe

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4
Q

Disadvantages of Conventional AFO

A

Heavy

Shoes not easily changed

Cosmetics

Mediolateral control of ankle/foot not as good as in thermoplastic

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5
Q

Advantages of thermoplastic AFO

A

Lightweight

Shoe easily changeable

Cosmetically acceptable

Total contact increases control

Knee stability readily influenced by minor changes in orthosis or sole of shoes

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6
Q

Disadvantages of thermoplastic AFO

A

Limited Adjustability

Rigidity can not be increased

Fixed heel height

Intimate fit does not accommodate edema or changes in volume

Localized pressure and callus formations may occur over time

Insensitive skin must be closely monitored for breakdown

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7
Q

Indications for Articulated Plastic AFO

A

Weakness in one of dorsi or plantarflexion

Medial lateral instability of ankle

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8
Q

Contraindications for articulated thermoplastic AFO

A

Uncontrolled spasticity- motion at ankle increases spasticity

Severe pronation in midstance from uncontrolled tibial internal rotation

Genu valgus or varus deformities

Over lengthening of the Achilles tendon

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9
Q

Indication for floor reaction AFO

A

MInimum Grade 3 quads
with Over lengthening of the achilles

Crouch Gait

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10
Q

Contraindications for floor reaction AFO

A

Flixed flexion contracture of the knee and hip

Tight achilles tendon

Athetoid CP or balance defecit

Primitive reflex synergy patterns

Poor hip extension and poor quads

Adductor Spasticity

Flexible Genu valgum/varum

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11
Q

Floor reaction AFO Advantages

A

Greater energy efficiency than KAFO

Cosmetically acceptable

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12
Q

Floor reaction AFO Disadvantages

A

Dislocation of the tibia posteriorly on the femur

Difficulty in donning and doffing with spastic CP children

Ankle angle and pretibial shell not adjustable once fabricated

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13
Q

Anterior shell/PTB Indications

A

Provides rigid ankle support

Charcot joint, severely painful

External support for tibial fractures (dsital 2/3 only)

Additional support of ORIF (open rediuction internal fixation) of tibia, distal to tibial tubercle

Post operative fusions of the ankle

Avascular necrosis of the talar body

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14
Q

PTB AFO contraindications

A

Unreliable patient

Unstable fracture pattern

Total unloading ankle/foot inadvisable

Severe pitting or fluctuating edema

Arthritic condition of knee/unable to accept weight-bearing

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15
Q

PTB AFO Advantages

A

Removable for dressing/wound care

Light weight

Cosmetic

Circumferential adjustment

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16
Q

PTB AFO Disadvantages

A

Dependent on patient reliability

Shoe requires a soft heel and rocker bottom sole

More difficult to fit in shoe

Can be hot and cause discomfort

More frequent visit for adjustments, due to decreases in volume, to maintain suspension

17
Q

Types of Conventional AFO stirrups

A

Solid - does not allow for shoes changes, length dependent on m-l stability

Split - allows detachment of uprights, shoe exchange possible, can be incorporated into a plastic foot section so that patient no required to modify shoes to accommodate stirrups/uprights

Round - attached directly to uprights without ankle joints
- results in axis distal to anatomical axis

18
Q

Conventional Solid Ankle

A

No motion allowed

Indicated when motion creates pain, immobilization following fracture or fusion

Generally not recommended for paralytic conditions

19
Q

Conventional Limited Motion

A

Permits limited plantar/dorsiflexion as desired

Indicated to limite painful ROm for weak muscle control

Degree of motion determined prior to fabrication

20
Q

Conventional Free Motion

A

Does not limit motion in sagittal plane

Motion limited only in the frontal plane provided

21
Q

Dorsiflexion Assist (Klenzak)

A

Spring dorsiflexion with plantarflexion limited to 105 degrees

Used with weak or absent dorsiflexors

Not used in conjunction with spastic muscles

22
Q

Plantarflexion stop

A

Unlimited dorsiflexion

Plantar flexion limited to 90 degrees

Used with absent dorsiflexors when spring action may trigger spastic gastroc soleus

23
Q

Dorsiflexsion stop

A

Free palntar flexion

Dorsiflexion limited to 90 degrees or neutral

Active dorsiflexion, absent plantarflexors

Stabilize against undesirable dorsiflexion in the later half of stance phase

Prevents early knee flexion and subsequent limp

24
Q

Double Action

A

Designed as spring loaded device to offer dorsi/plantar flexion assist

Plantar flexion assist is ineffective due to the GRF at push off

Springs replaced with pins to act as dorsi/plantar stops, resulting in similar function to a limited motion joint

Easier to adjust and readjust

Long tongue stirrup indicated with limited motion joint

25
Q

Counteracting COntractures

A

Most effective method of treating contracture with an orthosis is a double adjustable ankle

Mechanical ankle joints are adjustable to accommodate changes made in plantar/dorsiflexion

As contractures are reduced or stretched out, mechanical ankle joint can be set to hold these corrections

Fixed deformities or contractures may be effectively treated with surgery

26
Q

Counteracting Spasticity

A

AFOs not intended to counteract significant spasticity

Mild spasticity or hypertonus may be controlled with orthosis

Generally, spasticity cannot be overpowered manually, AFO may not effectively control extremity

TONE REDUCING AFO or inhibitive casting technique

SMO

Incorporate modifications that inhibit tonic reflexes of the foot (Duncan, 1960)

Tonic reflexes involved in posturing reflexes and automatic movements to changes of COM and position of body when ambulating

Modifying foot plate to inhibit reflexes, assumed patient with upper motor neuron lesion will inhibit primitive reflex and synergistic patterns and obtain voluntary motor control and more normal gait patter

Dorsiflexion reflex- 1st MTP
Toe Grasp reflex - 3rd MTP
Eversion Reflex - 5th MTP
Inversion Reflex- Center of

Heel

27
Q

Charcot Ankle

A

Solid ankle orthosis

Either conventional or plastic with anterior trimlines, polyethylene anterior shell is indicated

28
Q

Tibial Torsion

A

Cannot be effectively controlled with an orthosis

Orthotic Study (45 decks)

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