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Orthotic review

QuestionAnswer
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