Basic Goals
- Maintenance/correction of body segment alignment
- Assistance/Resistance to joint motion
- Relief of distal weight bearing forces
- Protection against physical insult
FO
Foot Orthosis
AFO
Ankle Foot Orthosis
KO
Knee Orthosis
KAFO
Knee Ankle Foot Orthosis
HKAFO
Hip Knee Ankle Foot Orthosis
HO
Hip Orthosis
“Ideal Orthosis”
Function
Comfort
Cosmetic
Accomodative FO
Foot cannot attain neutral, FO may shim the gap to the fixed position
Corrective FO
May help the foot attain neutral position
SACH Heel
Heels that allow you to roll into PF position
Mimics First Rocker
Knee stability and achieve extended position earlier
Metatarsal Bars
For people with difficulties at the toe
Mimics the third rocker, stimulate metatarsal
DAFO (abb.)
Dynamic Ankle Foot Orthosis
Dynamic Ankle Foot Orthosis
Pediactric foot orthosis - CP, high tone
Most aggressive way to control just the foot
Limits movement of midfoot and forefoot - holding foot in functional position
Restricts Mobility, controls tone/spasticity
UCBL
Rigid plastic total contact design - insert into shoes
Hind foot/mid foot correction
Seen a lot in pediactrics population
Supra Maleolar Orthosis (SMO)
Needs to worn tightly with strap, unlike UCBL that is loosely placed
less invasive than standard AFO
Ankle stability that allows for some toe movement
Superwrap
Neuromuscular facilitator similar to an ACE wrap
Combo of kinesiotape and ACE wrap
Allow for control in flexible format, also lighter
Most common AFO
Metal Bars Total Contact Floor reaction Unweighting Immobilizing
Solid Ankle Foot Orthosis (SAFO)
Rigid AFO made of thermoplastic
Resist PF during swing phase
Locked ankle in AFO generates EXTENSOR moment at the knee during stance
Principles with PF control system with SAFO
Large primary force is applied in a posterior-inferior direction over anterior surface of ankle
Bilateral Metal Upright (bars)
Used for specific scenarios such as: post-polio, neuropathic feet
Foot added to it as well
Different AFO styles
Carbon Fiber
Spiral AFO
Posterior Leaf Spring
Dynamic
Carbon Fiber AFO
energy returning
Spiral AFO
limited control in all planes
Posterior Leaf Spring AFO
most common, narrow posterior shell, no M/L support
Dynamic
allows the most ankle motion
Aggressive spring assist/tilts forward
Total Contact AFO
Provides better contact of PF, DF, AND inversion/eversion
Floor Reaction AFO (FRO)
prevents forward tibial progression and subsequent knee collapse
Anterior orthosis - better for crouched, spastic knee flexion gaits
FRO not appropriate for who?
gen recurvatum or ACL deficient knees
Double Action Ankle
“Bi-channel adjustable ankle lock (BiCAAL)”
Can have a spring in one or 2 directions
Articulated vs Non-Articulated
Non-articulated: does not have the capacity for more movement so they need more control
Articulated: allows for more natural movement
Limited Motion Ankle Control
Bichannel adjustable ankle lock (BiCAAL)
Anterior Stop
Posterior Stop
Bichannel Adjustable Ankle Lock (BiCAAL)
anterior and posterior channels that can be fit with pins to reduce motion or springs to assist motion
Gives spring in both directions
Anterior Stop/Dorsiflexion Stop
Determines the limits of ankle dorsiflexion
Slight DF (5 degrees) = knee flexion
Controls knee hyperextension
Posterior Stop/Plantarflexion Stop
Limits of ankle plantarflexion
Slight PF (5 degrees) = knee extension
Control unstable knee that buckles
Spring Assist (Klenzak Housing)
Single anterior channel for spring assists to aid dorsiflexion
Posterior Leaf Spring (PLS)
plastic AFO inserted into shoe
Prevents foot drop
T Straps
Varus or Valgus correction straps
Medial strap = Valgus
Lateral strap = Varus
Unweighting AFO
Patellar Tendon Bearing
Specific Weight Bearing
Total Surface Bearing
Immobilizing AFO
Used for LE deficincy when ankle immobilization is desired:
Distal tibia/fibula fraction
Foot bone fracures
Tendoncalcaneous Rupture
Diabetic Foot (Charcot Foot)
Functional Neuromuscular Electrical Stimulation
Bioness
Electrical stimulation to return muscle activation
Knee Orthosis
Malalignment - genu varum, valgum, reucurvatum
Protect knee from undue loading/stress
Athletic KO
Preventative
Decreases lever arm which may not be sufficient
Non-Articulated KO
Short term use
Difficulty with mobility
Swedish knee cage for Genu Recurvatum
Pawl locks with Bail Release
Bail release on back so when it is pushed up onto it will allow the knee to flex
Will lock in extension for walking
