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Orthotic review
| Question | Answer |
|---|---|
| orthotic is device used | correct malalignment and prevent deformity, restrict or assist motion, transfer load to improve function, reduce pain |
| Splint | a temporary device that may serve the same functions; materials generally not as durable, able to withstand prolonged use. |
| Three-point pressure principle | forms the mechanical basis for orthotic correction; a single force is placed at the area of deformity or angulation; two additional counterforces act in the opposing direction. |
| Alignment | correct alignment permits effective function. |
| Alignment does two things | a. Minimizes movement between limb and orthoses, b. Minimizes compression on pressure sensitive tissues. |
| Shoes | the foundation for an orthosis; can reduce areas of concentrated pressure on pressure sensitive feet. |
| Blucher opening | has vamps (the flaps contain the lace stays) that open wide apart from the anterior margin of the shoe for ease of application. |
| Balmoral opening | has stitched down vamps, not suitable for orthotic wear. |
| Foot orthoses (FO) | may be attached to the interior of the shoe (an inserted pad) or exterior to the shoe (Thomas heel) |
| Metatarsal pad | takes pressure off the metatarsal heads and onto the metatarsal shafts; allows more push off in weak or inflexible feet. |
| Cushion heel | used to relieve strain on plantar fascia in plantar fasciitis. |
| Longitudinal arch supports | UCBL, scaphoid pad, Thomas heel. Corrects for pes planus. |
| Varus post (rear foot) | medial wedge- limits or controls eversion of the calcaneus and internal rotation of the tibia after heelstrike. |
| Valgus post (rear foot) | lateral wedge- controls the calcaneus and subtalar joint that are excessively inverted and supinated at heelstrike. |
| Forefoot medial wedge | for forefoot varus |
| Forefoot lateral wedge | for forefoot valgus |
| Postings are contraindicated in | the insensitive foot |
| Rocker bar | improves weight shift unto the metatarsal heads; improves weight shift onto metatarsals. |
| Rocker bottom | builds up the sole over the metatarsal heads and improves push off in weak or inflexible feet. May also be used with insensitive feet. |
| Posterior leaf spring (AFO) | has a flexible narrow posterior shell; functions as dorsiflexion assist; holds foot at 90-degree angle during swing; displaced during stance; provides no medial-lateral stability. |
| Modified AFO | has a wider posterior shell with trimlines just posterior to malleoli; foot plate includes more of medial and lateral borders of foot; provides more medial-lateral stability (control of calcaneal and forefoot inversion and eversion). |
| Solid ankle AFO | has widest posterior shell with trimlines extending forwards to malleoli; controls(prevents)dorsiflexion, plantarflexion, inversion and eversion. |
| Spiral AFO | a molded plastic AFO that winds(spiral) around the calf; provides limited control of motion in all planes. |
| Patellar-tendon-bearing brim AFO | allows for weight distribution on the patellar shelf similar to patellar-tendon-bearing prosthetic socket; reduces weight-bearing forces through the foot. |
| Tone-reducing orthosis | molded plastic AFO that applies constant pressure to spastic or hypertonic muscles (plantarflexors and inverotrs); snug fit is essential to achieve the benefits of reciprocal inhibition. |
| Hinge joint knee control KAFO | provides mediolateral and hyperextension control while allowing for flexion and extension. |
| Offset: the hinge is placed | posterior to the weight bearing line (trochanter-knee-ankle (TKA) line); assists extension, stabilizes knee during early stance; patients may have difficulty on ramps where knee may flex inadvertently. |
| Drop ring lock | ring drops over joint when knee is in full extension to provide maximum stability; a retention button may be added to hold the ring lock up, permit gait training with the knee unlocked. |
| Pawl lock with bail release | the pawl is a spring-loaded posterior projection (lever or ring) that allows the patient to unlock the knee by pulling up or hooking the pawl on the back of a chair and pushing it up; adds bulk and may unlock inadvertently with posterior knee pressure. |
| Sagittal knee stability | achieved by bands or straps used to provide a posteriorly directed force. |
| Anterior band or strap(knee cap) | attaches by four buckles to metal uprights; may restrict sitting, increases difficulty in putting on KAFO. |
| Anterior bands | pretibial or suprapatellar or both. |
| Frontal plane controls | Control motion in the frontal plance. Genu varum or genu valgum. |
| Posterior plastic shell | controls for genu varum and genu valgum. |
| Frontal plane brace | older frames utilize valgum (medial) or varum (lateral) correction straps which buckle around the opposite metal upright:less effective as controls than plastic shell. |
| Quadrilateral or ischial weight bearing brim | reduces weight through the limb |
| Patten bottom | a distal attachment added to keep the foot off the floor; provides 100% unweighting of the limb; a lift is required on the opposite leg, e.g. used with Legg-Perthes disease. |
| Craig-Scott KAFO | commonly used appliance for individuals with paraplegia; consists of shoe attachments with reinforced foot plated, BiCAAL ankle joints set in slight dorsiflexion, pretibial band, pawl knee locks with bail release, and single thigh bands. |
| Oregon orthotic system | a combination of plastic and metal components allows for triplanar control in three planes of motion (sagittal, frontal, and transverse). |
| Fracture braces | a KAFO device with a calf or thigh shell that encompasses the fracture site and provides support. |
| Functional electrical stimulation (FES) orthosis | orthotic use and functional ambulation is facilitated by the addition of electrical stimulation to specific muscles; requires full passive range of motion (PROM) good functional endurance; in limited use with paraplegia, drop foot; scoliosis |
| Parapodium | allows for ease in sitting with the addition of hip and knee joints that can be unlocked; e.g., used with children with myelodysplasia |
| Articulated KOs (knee orthoses) | control knee motion and provide added stability |
| Fuctional knee orthoses | is worn long-term in lieu of surgery or during selected activities (sports competitions). |
| Swedish knee cage | provides mild control for excessive hyperextension of the knee. |
Created by:
watsdny
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