8STANDARD METAL DOUBLE UPRIGHT SHOESSTIRRUPUPRIGHTSANKLE JOINTSKNEE JOINTSHIP JOINTSCALF BANDTHIGH BANDPELVIC BAND
9SHOES Function Characters - Protect foot - Warm foot - Modified to transfer body weight during walking from sensitive area to pain free areaCharactersComfortableFit : correspond shape of footproper room for foot expanding during wt bearinglonger 1cm than longest toe
15modifications A- medial longitudinal arch support - Deformity: Pes planus , pes cavus ,pes valgus- Modification:InternalSteel shank(0.5 inch back to planter apex of calcaneus to 0.25 inch post to break of shoes)Cookie insert or insole ( rigid leather 1.25 inch behind heel breast line to 0.5 inch behind 1st metatarsal head)Navicular pad (scaphoid pad) as cookie insert but made of sponge material used when patient cannot tolerate rigid cookie insertLongitudinal arch support ( for broader area of support to shift body weight laterally) ( plastic ,metal, leather)Long counter (leather sandwiched between shoes layers form rigid wall medially to 0.5 inch forward to heel breast line
16ExternalThomas heel ( orthopedic heel , key stone heel or s-shaped heel) anterior projection of medial breast line 0.5 inchThomas heel wedge ,wedge sandwiched between base of Thomas heel &outsoleMedial wedging (for medial arch support & shift body weight laterally) (height of wedging is height need to place calcaneus in near vertical position)Midway between medial breast line &break of shoesTo front end of soleTarsal & metatarsalSole wedgingHeel layerTalocalcaneal & talonavicular jointHeel wedgingSevere valgus deformitySole& heel wedgingmedial heel wedging& lateral sole wedgingFlat feetWeak footCross wedging
17Medial shank filler: from medial breast line to head of 1st metatarsal Valgus strap: in spasticity & valgus contracture applied medially to prevent foot & ankle from assuming a valgus attitudeB-Lateral longitudinal arch supportDeformity:Pes varus, pes planusModification:InternalLong counter laterallyLateral heel wedge insertExternalReverse Thomas heel: anterior projection of lateral breast line 0.5 inchLateral wedging: (heel, sole, sole &heel wedging)Medial shank filler: from Lateral breast line to head of 5th metatarsal
18Lateral flaring of shoes : to discourage varus deformity Heel flaring, sole flaring (1.5 inch post to 5th metatarsal base to end of out sole), Heel &sole flaring .Varus strap : applied laterallyC- Metatarsal arch supportIndication:Bursitis,metatarsalgia ,fracture of metatarsal bone, planter warts, hallux valgus & hallux rigidus, Morton's toe (short 1st MT& phalanges or amputated ).Modification:InternalMetatarsal pad:( elevate inner sole just behind Metatarsal head)Dancer pad:( feathered edge under surface of Metatarsal head) Metatarsal corset:( removable arch support, above types with elastic strap over dorsum of foot)Levy inlay: wedge shaped pad made of foam or rubber placed between hallux & 2nd toe to realign 1st MTP jointMorton's toe extension: extend from heel to tip of toe supporting medial longitudinal arch to restore 3point wt distribution.
20ExternalMetatarsal bar: behind & parallel to line from 1st to 5th MT head, in out sole so after heel strike wt borne to behind Metatarsal head.Rocker bar: as Metatarsal bar but extend to toe end.Denver bar: directly beneath transverse arch of foot at tarsometatarsal jointsNB: all above as same height of heelD-Heel modificationHeel elevation: to compensate for fixed equinus deformity or any leg discrepancy of 1.5 to 3 cm (if > 3cm so elevate heel & sole)Heel cushion relief: soft pad may filled with compressible material placed under painful part of heel.
27FO (foot orthosis)When foot cannot attain neutral, FO may shim the gap to that fixed position-Accommodative FOMay help the foot attain a neutral position-Corrective FOEither may unload compromised tissue; or may provide total contactMay be full custom or Off The Shelf (OTS)
28HEEL CUP: rigid plastic insert, cover planter surface of heel ,extend post, med, lat up the side of heel, to prevent lateral calcaneal shift in flexible flat foot.SESAMOID INSERT:0.75 inch length insert ,under hallux to transfer pressure off the short 1st MT head onto its shaft.LONGITUDINAL ARCH SUPPORT: applied med or lat.
30UCBL University of California at Berkeley Laboratory (UCBL) Rigid plastic total contact design formed over cast of foot held in maximal manual correction.Hind foot / mid foot correctionHeel cup extends proximal to inframalleolar area and distally to the metatarsal heads
32UPRIGHTS site:1 to t.5 cm from skin in short leg brace end at level of calf band in long leg brace med1.5 inch below pubic tubercle& lat at lower end of GTMETALS OR PLASTICROUNDED OR FLATSingle (post or lat) ORdouble (med &lat)Fixed or telescopingDISTALLY WITH ANKLEAND PROXIMALLY TO CUFF BAND
33ANKLE JOINTS site: opposite to malleoli upwards from medial to lateral(just below med malleolus & 0.5 inch above tip of lat malleolus)1- FREE MOTION2-PLANTER FLEXION ANKLE STOP3- DORSIFLEXION ANKLE STOP4-LIMITED MOTION ANKLE STOP5-DORSIFLEXION ASSISTSPRING JOINT(klenzak)6-Fixed ankle joint
35CALF AND THIGH BAND LEATHER LEVEL calf 1-2 inch below fibular head Lower thigh band 4inch from calf bandupper thigh band 1.5 inch below ischiumWIDE TO DISTRIBUTE FORCECALF BAND WITH PLANTER FLEXION STOP INCREASE KNEE FLEXION MOMENT SO USED IN GENU RECURVATUM
36KNEE JOINTS SINGLE OR POLYCENTRIC LEVEL at anatomical knee joint 0.5 inch above tibial plateauSINGLE AXIS1-FREE MOTION2-OFFSET KNEE JOINT3-DROP RING4-SWISS LOCK5-ADJUSTABLE KNEE LOCK (DIAL LOCK)
38HIP JOINTS AND LOCKS opposite to GT 1- MOVING HIP JOINT2- SINGLE AXIS3- TWO POSITION LOCK4- DOUBLE AXIS
39PELVIC BAND site midway between iliac crest > CONTROL ROTATION AND ADDUCTION1-BILATERAL PELVIC BANDAnt: ASIS, Post: middle of sacrumIn unilateral: from ASIS to PSIS2-PELVIC GIRDLE3-SILESIAN BELT
40AFO (ankle foot orthosis) Most common orthosisMetal barsTotal ContactFloor reactionUnweightingImmobilizingMost AFO’s can be articulating or non-articulating
41SMO Supra Maleolar Orthosis Low profile design that crosses the ankleLess invasive trim lines than a standard AFO
42Total Contact AFO’sprovide intimate fit with total contact to provide better controllight weight ( gms);more common today
43Floor Reaction AFO-Uses floor reaction force through toe aspect of foot plate to prevent forward tibial progression & subsequent knee collapse;May be articulated
44Unweighting AFOMay be patella tendon bearing (PTB), specific weight bearing or total surface bearing, TSB (inverted cone with lace closure) to unweight the ankle foot using prosthetic principles
45Immobilizing AFOCommonly used with a lower extremity deficiency when ankle immobilization is desireddistal tibia/ fibula fracturefoot bone fracturestendocalcaneus ruptureDiabetic Foot (Charcot Foot)
46Non-Articulating (Solid Ankle) Articulated or Non-articulatedMay be designed for progressive increases or decreases in sagittal plane ROM and controlAn articulating option may be available in many designs of AFO’sNon-Articulating (Solid Ankle)Articulating
50KO (knee orthosis) Useful for malalignment genu varum,valgum,recurvatum,to protect knee structures from undue loading/stressmay be preventative or correctivemay be permanent treatment for repaired/compromised knee structures
51Several Types of KO’s: Athletic KO- Non-articulated KO- Custom or OTS KO-
52Athletic KO- Preventative. Controversial as short lever arms may not be sufficient to diminish realistic damaging forces.Proprioception thought to play a role.
53non-articulated KO- usually for short term use difficult to transfer with
54Off-the-Shelf KO- Offers limited control of the knee. Restricts gross motion
55KAFO Knee Ankle Foot Orthosis Indicated when lesser devices are biomechanical insufficient;Combines KO & AFO
56Subtypes: Single/Double bar (upright) KAFO- Total contact KAFO- Ischial Weight Bearing (unweighting) KAFO-
57Single/Double Bar KAFO- Accommodates volume fluctuation,Cooler than total contact,Highest material strength.Several lock options.Lock for ambulation, unlock for sitting.May incorporate hyperextension stops.Various knee joints are availablee.g. Weight activated stance control, locking,
59Ischial Weight Bearing (unweighting) KAFO- Ischial containment or Quadrilateral style brims with high trimlines.Generally used with paralytic limbs.Not as effective with larger or obese individuals.
60HKAFO Hip Knee Ankle Foot Orthosis Very restrictive and laborious to swing-to or through in gaitcausing high rejection ratesIncludes Reciprocating Gait Orthoses (RGO), total contact, leather and metal upright
61Specific HKAFO: Reciprocating Gait Orthosis (RGO) Used in spinal cord injury.Combines flexion of one hip with extension of the opposite hip.The flexion power of one hip is utilized to extend the opposite hip.
62Hip Abduction Orthosis Commonly used post-operatively to position the femoral head optimally within the acetabulumHip Abduction orthoses can be an HO only or can have a KAFO extension.
63Specific Case Hip Orthosis (HO): S.W.A.S.H Orthosis Standing Walking And Sitting Hip OrthosisMaintains femoral abduction in standing, walking and sitting