AFOs Flashcards

1
Q

Stance phase - heel rocker

A
  • begins at initial contact and ends at foot flat

- occurs during loading response when ankle PF and knee extensors are working eccentrically

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2
Q

Stance phase - ankle rocker

A
  • tibia advances over ankle-foot complex during midstance

- ankle PF are working eccentrically to control tibial progression

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3
Q

Lack of ankle DF leads to

A

-either a shorter step or turning the foot out so we don’t have to step over it

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4
Q

Stance phase - forefoot (toe) rocker

A

-begins as the heel rises off the ground until push-off

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5
Q

AFOs and “rockers”

A

-AFOs change the rockers altering gait

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6
Q

6 purposes of an AFO

A
  1. prevent foot drop
  2. provide pre-positioning in swing phase
  3. provide M/L control in stance
  4. prevent excessive pronation/supination
  5. decrease knee flexion in stance
  6. prevent knee hyperextension in stance
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7
Q

DF stop

A
  • rod in anterior chamber
  • assists weak ankle PF (limits tibial progression during midstance and may help control knee in sagittal plane when there are weak quads)
  • restraint of tibial progression places vertical ground reaction force anterior to the knee - produces external knee extension moment
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8
Q

DF assist

A
  • spring in posterior chamber
  • serves to bring ankle joint through DF during swing phase
  • allows PF range of motion at loading response, which decreases knee flexion moment, which may de-stabilize the knee
  • the spring loads during plantarflexion and then releases energy to assist with DF
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9
Q

PF stop

A
  • rod in posterior chamber
  • assists with clearing toes during swing phase due to inadequate ankle DF strength
  • limits ankle PF range
  • may affect heel rocker because you need PF to complete
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10
Q

Tibia-to-floor angle - tibia placed into DF

A
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11
Q

Tibia-to-floor angle- PF

A

-tibia placed into slight PF will create a knee extensor moment during loading response and provide stability to the knee joint by placing the ground reaction force anterior to the knee

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12
Q

3 point force systems

A
  • control 2 articulating skeletal segments
  • corrective force is located on the convex side of the joint of interest
  • 2 counteractive forces are positioned on the opposite side above and below the joint
  • increases the distance of the counteractive forces increases their lever arm making them more effective
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13
Q

Review…

A

diagrams with arrows from the orthotics design and prescription handout

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14
Q

Overview of posterior leaf spring AFO

A
  • designed for foot drop without medial/lateral instability OR excessive tone
  • allows some weight bearing DF which “loads” the “spring”
  • allows for PF because of the tapering
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15
Q

Pros of posterior leaf spring AFO

A
  • flexible
  • doesn’t affect heel rocker (let’s you PF)
  • provides an ankle rocker (allows push-off)
  • holds in neutral when off ground
  • very minimal bracing
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16
Q

Cons of posterior leaf spring AFO

A
  • need ankle stability to use
  • not for severe tone
  • doesn’t control or grade PF at heel strike
17
Q

To use posterior leaf spring with tone

A

-have a metatarsal bar or inhibiting footplate added (aggravated in midstance - ankle rocker)

18
Q

Solid ankle AFO overview

A
  • trim line prevents all motions at the ankle

- increased stability prevents knee collapse (either hyperflexion or hyperextension)

19
Q

Pros of solid ankle AFO

A
  • lightweight
  • customized fit
  • good support
  • adjustable
  • even skin contact
  • helps knee instability
  • decreases tone - maintains stretch
  • blocks PF
  • prevents foot drop
  • provides M/L stability
20
Q

Cons of solid ankle AFO

A
  • not going to help ROM
  • so much stability
  • muscles not taxed
  • fixed volume
  • requires roomy shoe
  • must be monitored for changes in patient limb size
21
Q

Modifications that can be made to a solid ankle AFO

A
  • added heel rocker
  • put in more or less PF/DF depending on pt
  • shave or add padding when increased pressure
22
Q

Dual channel ankle joint (articulating AFO) - posterior chamber with spring

A
  • allows for controlled DF during loading response (compression of spring)
  • recoil of spring when foot is unloaded assists DF during initial swing
23
Q

Articulating AFO - posterior chamber with pin

A

-limits PF ROM - PF stop

24
Q

Articulating AFO - anterior chamber with spring

A
  • allows for control DF during midstance (ankle rocker)

- assists ankle PF during push off

25
Q

Articulating AFO - anterior chamber with pin

A

-limits ankle DF - DF stop

26
Q

Overview of dual channel ankle joint with PF stop

A
  • allows for free DF
  • prevents PF beyond ROM allowed by stop
  • provides a more normal gait pattern than SAFO
  • provides some medial-lateral control
27
Q

Overview of dual channel ankle joint with DF stop

A
  • provides a lift of the foot during swing phase
  • can be combined with PF stop or used without to free PF
  • provides some medial/lateral support
28
Q

Charcot restraint orthotic (CRO) Walker

A
  • management of charcot foot deformity
  • diabetic ulcer management
  • bi-valve
  • total contact
29
Q

Overview of ground reaction AFO

A
  • provides extra support to assist with knee extension in stance
  • solid ankle limits both DF and PF
  • can be hinged to allow for PF
  • for people with crouched gait
  • gives support to anterior shin to support tibia
  • not good when there are knee flexion contractures
30
Q

Pros of ground reaction AFO

A
  • gets control of knees without crossing knee joint
  • contoured to leg/foot
  • don’t need a KAFO
31
Q

Cons of ground reaction AFO

A
  • requires padding for tibial tuberosity (watch skin breakdown)
  • not good for knee flexion contracture bc patient will override it
32
Q

Noodle AFO

A
  • alternative to posterior leaf spring
  • better if patient needs orthotic long term vs. PLS
  • allows for pretty good Rom during gait
33
Q

Dynamic reaction AFO

A
  • total contact distributes force
  • flexible material for increased proprioceptive feedback with controlled mobility
  • excellent for high tone patients
  • allows graded PF at initial contact, graded DF for sit/stand, late stance
34
Q

Supramalleolar orthotic

A
  • terminates just superior to ankle joint
  • provides pre-positioning of foot in swing
  • alignment of foot in stance
  • does not provide assistance for foot drop
  • focuses on subtalar joint (correcting varus/valgus)
  • no control at the ankle
35
Q

UCB

A
  • heel cups
  • good for over pronators that need more than an arch support
  • will not be enough if excessive eversion is present at heel strike
36
Q

LE contracture mechanical splint

A
  • dynamic low load prolonged stretch for management of contractures
  • custom molded
  • adjustable resistance levels
37
Q

Other foot drop devices

A
  • ODFS foot switch
  • peromax
  • toe off family of produces
  • dynamic walk orthosis
  • bioness
  • walkaide