Lower limb orthotics
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Transcript of Lower limb orthotics
Lower Limb Orthotics
An orthosis is any device added to the body to stabilize or
immobilize a body part, prevent deformity, protect against
injury, or assist with function.
The purpose of using an orthosis is to enhance normal
movement and to decrease abnormal posture and tone. Lower
extremity orthoses can be used to correct abnormal gait
patterns and to increase the efficiency of walking.
Some Basic Goals of Orthoses
a. Maintenance or correction of body segment alignment
b. Assistance or resistance to joint motion
c. Axial loading of the orthosis & therefore relief of distal weight bearing forces
d. Protection against physical insult
An orthosis is classified as a static or dynamic device
- A static orthosis is rigid and is used to support the weakened or paralyzed body parts in a particular position.
- A dynamic orthosis is used to facilitate body motion to allow optimal function. In all orthotic devices, 3 points of pressure are needed for proper control of a joint.
Principles A lower limb orthosis should be used only for specific management of a
selected disorder. The orthotic joints should be aligned at the approximate
anatomic joints.
The orthosis selected should be simple, lightweight, strong, durable, and
cosmetically acceptable. Considerations for orthotic prescription should
include the 3-point pressure control system, static or dynamic stabilization,
flexible material, and tissue tolerance to compression and shear force.
Lower Limb Orthoses:
FO ( foot orthoses)
AFO (ankle foot orthoses)
KO (knee orthoses)
KAFO (knee ankle foot orthoses)
HKAFO (hip knee ankle foot orthoses)
HO (hip orthoses)
FO (foot orthoses)
FOs affect the ground reactive forces acting
on the joints of the lower limb
In case of pes planus or flat foot which occurs due to ligamentous laxity and may be treated with a medial longitudinal arch support for alleviating pain
In case of pes cavus or claw foot there is excess pressure along the heel and metatarsal head areas, which can lead to pain.
This can be prevented by making the height of the longitudinal support just high enough to fill in the space of the shoe and the arch of the foot to distribute weight more effectively.
University of California Biomechanics Laboratory (UCBL)
A custom made foot orthoses deigned to prevent hyperpronation
Rigid plastic total contact design
Hind foot / mid foot correction
Heel cup extends proximal to inframalleolar area and distally to the
metatarsal heads
AFO (ankle foot orthosis)
Most common orthosis Types:
1. Metal bars
2. Total Contact
3. Floor reaction
4. Unweighting
5. Immobilizing
Most AFO’s can be articulating or non-articulating
Metal bars: It is a U shaped metal piece permanently attached to the
shoe. Its 2 ends are bent upwards to articulate
with the medial and lateral ankle joints. The proximal
stirrup attachment sites are shaped to enforce the desired
movements at the ankle joint. Commonly used in specific scenarios
i.e. Post-Polio, Neuropathic feet
Total Contact AFO’s: Provide sleek, intimate fit with total
contact to provide better control Subtypes are thermoplastic and thermosetting types Higher patient acceptance possibly due to light weight More commonly used today
Metal bars
Total Contact AFO
Floor reaction AFO
Uses floor reaction force through toe aspect of foot plate to prevent forward
tibial progression & subsequent knee collapse
May be articulated
Unweighting AFO
May be patella tendon bearing (PTB), specific weight bearing or
total surface bearing.
TSB (inverted cone with lace closure) which is used to
unweight the ankle foot using prosthetic principles.
Immobilizing AFO Commonly used with a lower extremity deficiency when
ankle immobilization is desired
Such as: distal tibia/ fibula fracture
foot bone fractures
tendocalcaneus rupture
Diabetic Foot (Charcot Foot)
KO (knee orthoses) Useful in cases of misalignment
Genu varum
Valgum
Recurvatum
To protect knee structures from undue loading/stress
May be preventative or corrective
May be permanent treatment for repaired/compromised knee
structures
Types of KO’s:
Athletic KO
Non-articulated KO
Custom or OTS KO (Off-the-Shelf KO)
Athletic KO Preventative.
Controversial as short lever arms may not be sufficient
to diminish the damaging forces.
Non-articulated KO
• Usually for short term use
• In order to stabilize the knee
Off-the-Shelf KO
• Offers limited control of the knee.
• Restricts gross motion
KAFO Knee Ankle Foot Orthoses
Indicated when lesser devices are biomechanically insufficient
Combines Knee Orthoses & Ankle Foot Orthoses
Subtypes: Single/Double bar (upright) KAFO Total contact KAFO Ischial Weight Bearing (unweighting) KAFO
Single/Double Bar KAFO: Accommodates volume fluctuation,
Highest material strength.
Several lock options.
Lock for ambulation and unlock for sitting.
Various knee joints are available
e.g. Weight activated stance control,
locking, polycentric, single axis, extension.
Total Contact KAFO: More customizable.
Better load distribution.
Double bar KAFO
Single bar KAFO
Total Contact KAFO
Ischial Weight Bearing (unweighting) KAFO:
Ischial containment or Quadrilateral style brim with high trim lines.
Generally used with paralytic limbs.
Not as effective with larger or obese individuals.
Hip Knee Ankle Foot Orthoses (HKAFO)
Very restrictive and laborious to swing-to or through in gait
causing high rejection rates
Includes Reciprocating Gait Orthoses (RGO), total contact, leather and metal upright, postural and others
Specific HKAFO: Reciprocating Gait Orthoses (RGO)
Commonly used in cases of spina bifida and 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.
Hip Orthoses (HO)
Hip Abduction Orthoses
Standing Walking AND Sitting Orthosis (SWASH)
Some Orthoses can intervene at the hip without crossing the hip.
S.W.A.S.H Orthosis: Standing Walking And Sitting Hip Orthosis
Maintains femoral abduction in standing,
walking and sitting
Hip Abduction Orthosis
Commonly used post-operatively to position the femoral
head optimally within the acetabulum
Orthopedic Shoes The healing shoe and surgical cast shoe/boot supports
the foot and surrounding muscles, joints and tendons to
help stabilize fractures, ulcers and for postoperative management.
Accommodative Foot Orthosis helps treat those with
vascular diseases and diabetic patients who has lost
sensitivity in their feet. The proper foot wear can help to
prevent sores and blisters that may lead
to a more serious condition.
Functional foot orthoses
Treats biomechanical issues such as plantar fasciitis,
hyper-pronation, types of tendonitis and other conditions
of the foot that cause pain or overuse of certain planes
of the foot or muscles and tendons.
Functional foot orthoses is used both as a preventative treatment and post injury treatment.
CTEV Shoes Modified shoes used once child starts walking with club foot
Consists of straight inner border to prevent forefoot adduction
Outer shoe raise to prevent foot inversion
No heel to prevent equinus
Congenital hip dislocation orthoses
Pavlik harness, Ilfeld splint and von Rosen splint are used
to maintain the hip in flexion and abduction position to
hold the femoral head within the acetabulum
Sequential Compression Therapy: These devices are placed around the limb that operative with intermittent compression to aid in controlling lymphedema and venous return. These are often used in hospitals following surgery to help prevent blood clots and aid in lower extremity circulation.
Compression Stockings: Compression stockings are
gradient stockings that help control edema/lymphedema
and aid in venous return.
Thank You