Week 2 FO + AFO Flashcards by Alexis Ross

Purpose for orthotic prescription

Improve performance of functional activities
Improve/enhance mobility
Transfers
Ambulation
Deformity prevention : primary and secondary
Correction of passively modifiable deformity
Immobilization/Control/Prevention
Regulating or reduction muscle tone
Stabilizing weak or flaccid muscles
Improve quality of life

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foot orthosis

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AFO

ankle-foot orthosis

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KAFO

knee-ankle-foot orthosis

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HKAFO

hip-knee-ankle-foot othosis

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THKAFO

trunk-hip-knee-ankle foot orthosis

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knee orthosis

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hip orthosis

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Foot orthoses is also referred to as

insert

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Foot orthoses purposes

Alignment correction
Deformity accommodation
Facilitate supination/pronation
Pain relief
Improve foot and/or proximal alignment
Relieve weight-bearing stresses

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Foot orthosis patient education

recommend progressive increase in wear time

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Fixed contracture

can not be passively corrected

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Flexible/dynamic contracture

Also referred to as flexible
Result from over activity of muscle tendon groups but when at rest are passively correctable
Can also develop in adjacent joints in response to coupling effects of deformities above or below

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Prefabricated foot orthoses

“Off-the-shelf”
Generic fit
Good for short term use – healing, function/training aid, contracture prevention
Typically cheaper

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Custom foot orthoses

“Definitive”
When permanent benefit is
needed
When mechanically and physiologically stable
Individualized to patient

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Different length of foot orthoses

extends to toes
proximal to toes
met heads

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Soft foot orthoses

Provides cushioning
Absorbs shock
May redistribute plantar pressures

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Semi-rigid orthoses

Provides some flexibility and shock absorption
Provides control of the foot

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Rigid foot orthoses

Stabilizes deformities
Controls abnormal motion
Provides support

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Foot orthoses documentation

length
fabrication method
flexibility

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pes planus

If flexible, can correct with FO
Posterior tibialis supports arch
eversion

Pes cavus

to support deformity
IV to lat wedge

Leg length discrepancy

Caused by previous injury to leg, bone infection, congenital, idiopathic
“Normal” = Up to 3/5 inch
12/3 inch difference will result in gait abnormalities
Use heel lift or shoe lift

Rearfoot varus

Use medial wedge to accommodate
Decreases hyerpronation

Rearfoot valgus

Use lateral wedge to accommodate Decreases supination Use medial wedge to correct

Diabetic foot

Increased risk for skin breakdown – FO provide pressure relief

Rocker shoes

decrease forefoot pressure facilitate forefoot rocker

AFO

Pre-fabricated or custom Plastic (polypropylene), carbon fiber, or metal

AFO use

Provide ankle stability Correct malalignment Control drop foot Enhance mobility Deformity prevention Regulate or reduce muscle tone

Prescribing orthotic stage 1

Identify where in the gait cycle abnormal tone or muscle performance is impaired. Where is the gait deviation?

Prescribing orthotic stage 2

Determine what factors could be compromising the particular abnormal phase(s) of the gait cycle. (muscle, range of motion, spasticity)

Prescribing orthotic stage 3

Identify what specific orthotic interventions would benefit the particular abnormal phase(s) of the gait cycle.

Provide external support during swing (positioning of ankle/foot) for

foot clearance

Optimize position of the limb for initial contact in preparation for

stance stability

AFOs during stance

Optimize position of the ankle/foot May also influence proximal alignment Provide external support for stance stability Depending on the device, may also facilitate forward progression

Type of AFOs

Solid (fixed) AFO Hinged (articulating) AFO Anterior Floor reaction AFO Energy Storage and Return AFO Tone Inhibiting AFO

Solid or fixed AFO impact on gait/function

Provides stance stability Provides medial-lateral support Accelerated heel rocker Loss of ankle and forefoot rocker Assists with foot clearance Positions foot for initial contact Places the foot in plantigrade Places the subtalar joint and ankle in neutral

AFO in 5 deg PF

produces knee ext

AFO in 5 deg

produces knee flexion

Hinged/Articulating AFO impact on gait/function

Allows for limited ankle ROM Provide medial- lateral stability Can have DF/PF assist/stop Aids in foot clearance Some rockers preserved

Posterior Leaf spring impact on gait/function

Control PF from initial contact to loading response Allows for DF during stance Support foot during swing phase

Anterior floor reaction AFOS impact on gait/function

Maintains proper ankle alignment Compensates for weak or absent gastro-soleus muscles Facilitate plantarflexion-knee extension couple Anterior shell controls forward tibial progression

Anterior floor reaction AFO is not appropriate for

individual with knee ligamentous instability of genu recurvatum

Energy return or dynamic response AFOs impact on gait/function

Assist limb clearance in swing Positions heel for initial contact Assists with forward propulsion

Energy return or dynamic response AFO not appropriate for

inappropriate for individuals with moderate to severe hypertonicity

Toe inhibiting AFO

Controls ankle position Provides stance stability Inhibits reflexes induced by tactile stimulation Controls muscles length (i.e. spasticity caused by stretch) Indicated for patients with hypertonicity with significantly impaired motor control

Functional Electrical stimulation

Rely on stimulating the common peroneal nerve (anterior tibialis)

Use of ace wrap

DF assist

Document gait deviations

Magnitude- i.e. increased, decreased, excessive, inadequate, lack of Timing – i.e. early, late Related to ROM – i.e. decrease/increased excursion side joint direction/motion