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gait final exam > Orthodics > Flashcards

Orthodics Flashcards

1
Q

biomechanical balance kinetic chain

A

subtalar neutral position
- allows the foot to be mobile in pronation and stiff in supination
- 0 degrees in ankle, subtalar neutral, balanced forefoot

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1
Q

what is the rear foot and its joints

A

calcaneus
1) talocrural joint
2) subtalar joint

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2
Q

what is the forefoot and its joints

A

the center of pressure through the first ray
1) 1st metatarsal phalangeal joint

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3
Q

the mid foot at its joints

A

1) Tarsometarsal joint
2) calcaneocuboid joint
3) Talonavicular joint

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4
Q

subtalars job at inital contact

A

shock absorber (pronation)

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5
Q

subtalars job at midstance

A

still shock absorption. LR moves the foot into full pronation

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6
Q

subtalars job at terminal stance

A

moves into full supination for rigidity

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7
Q

kinetic problems with closed chain over pronation

A
  • anterior pelvic tilt
  • internal rotation of the femur
  • valgus knee
  • internal rotation of the tibia and fibula
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8
Q

pronation in the subtalar joint

A
  • medial rotation of the talus
  • adduction and PF talus
  • calcaneal eversion
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9
Q

kinetic problems with closed chain supination

A
  • posterior pelvic tilt
  • femur external rotation
  • knee varus
  • external rotation of the tibia and fibula
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10
Q

supintation of the subtalar joint

A

-abduction and DF talus
- calcaneal inversion

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11
Q

KAM (knee adduction moment)

A
  • moment of compressive forces across the medial knee
  • most force at LR and terminal stance
  • accepts 60-70 % of weight bearing forces throughout this compartment
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12
Q

the relationship between knee varus and KAM

A

knee varus increases KAM. It is a direct relationship

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13
Q

static stabilization

A

rigid device, permits body segment in fixed position (stability)

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14
Q

dynamic stabilization

A

mobile device, permits the body segment motion

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15
Q

principles of designing orthotic function

A
  • patient related (easy to don on and off)
  • soft tissue: not break down skin
  • at risk diagnosis (diabetics, neuropathy)
  • tolerant to compression and shear forces
  • functional level of the pt
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16
Q

Insoles purpose

A
  • modify heel, midfoot or forefoot
  • padding for pain (metatarsalgia, planterfasciitis)
  • heel lift for leg length
  • wedges for supination/pronation
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17
Q

Instability orthotics purpose

A
  • have heel cup for calcaneous
  • longitudinal arch support
  • UCBL
18
Q

what orthodic can be used to help reduce KAM

A
  • valgus wedged insoles on the medial side of the foot
19
Q

UCBL purpose

A
  • used for pronated foot
  • holds the calcaneus in a neutral position
  • used for significant issues such as arthritis, hypotonia
  • helps prevent midfoot collapse into pronation
20
Q

the higher the trim lines the

A

better control of the calcaneus

21
Q

what can a leaf spring AFO be used for

A

people who are having foot drop during swing phase

22
Q

what would you prescribe for ankle instability in stance phase

A

solid or hinged AFO

23
Q

what would you prescribe for ankle planter flexion

A

solid AFO with strap

24
Q

what would you prescribe for knee hyperextension in stance phase

A

AFO setting ankle joint to neutral or a bit of DF

25
Q

AFO adaptations to trimlines

A

allow for more or less control of the ankle

26
Q

what are the different trimlines

A
  • metatarsal trimline
  • foot trimline
  • ankle trimline
  • standard trimline
  • anterior trimline
  • proximal trimline
27
Q

what pathologies are AFOs typically prescribed for

A
  • weakness
  • CP
  • head injury
  • peripheral neuropathy
  • alignment
  • SCI
  • progressive disease
28
Q

what do orthotics use to accomplish the goals of its design

A

force principles

29
Q

an orthotic is most comfortable and effective when

A

1) pressure = force/area
2) control direction of primary force and direction of counter forces

30
Q

off the shelf orthotics

A
  • mass manufactured
  • the degree to which they can be modifies or adjusted to fit an individual varies (this can be problematic for people with foot deformity, wide or narrow feet, large calf muscles, sensory impairments or variable limb volume
31
Q

examples of off the shelf orthotics

A
  • standard AFO
  • Leaf Spring AFO
32
Q

Leaf spring AFO design

A
  • shallow trim lines for less support and more mobility
  • no other straps to control or brace the foot
  • foot plate
33
Q

purpose of leaf spring AFO

A
  • support the weight of the foot during swing phase as means of enhancing swing limb clearance
  • assist with controlled lowering of the foot during loading response in stance as part of the first heel rocker
34
Q

what type of pt would you prescribe leaf spring too

A

peripheral nerve, multiple sclerosis, CVA, myositis pt with foot drop in swing

35
Q

what type of patient is leaf spring NOT good for

A

CP pts

36
Q

other AFOs for foot drop

A
  • posterior shell
  • DF assist brace: stiffness with energy storage within shell enhances PF power
37
Q

Solid AFOs design

A
  • larger trim lines allow for more control of the tibia
  • support for the calcaneus
  • wider control of the footplate: prevents excessive eversion and inversion
38
Q

purpose of solid AFO

A
  • to resist PF during swing phase
  • fulcrum force applied to the anterior ankle by velcro strap
  • made form thick thermoplastic
  • hold the ankle in a biomechanically neutral position
  • might have medial and lateral corrugations incorporated within
39
Q

what type of pt are solid AFOs prescribed for

A

pt with spatisity
- tone-inhibition bar if hypertincity is severe (metatarsal bar)
- people who are not responding to therapy and have no LR

40
Q

static AFO (Solid AFO)

A
  • aims to hold the foot in place. more stability less mobility
41
Q

what are the disadvantages of solid AFOs

A
  • does not support the heel rocking phases
  • proximal anterior strap prevents tibia advancement and lack of eccentric control in LR
42
Q

how do pts with solid AFO with anterior staps compensate for losing tibial advancement

A

by flexing their knee in midstance

gait final exam (6 decks)

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