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ORTHOTIC SYSTEMS

ORTHOTIC SYSTEMS. Ankle-Foot Orthoses (AFOs). ORTHOTIC PRINCIPLES. Description. An Orthosis is an external device with specialized functions that acts upon the musculo-skeletal system. Orthotics is the field of study concerned with the design, fabrication and application of such devices.

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ORTHOTIC SYSTEMS

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  1. ORTHOTIC SYSTEMS Ankle-Foot Orthoses (AFOs)

  2. ORTHOTIC PRINCIPLES Description • An Orthosis is an external device with specialized functions that acts upon the musculo-skeletal system. • Orthotics is the field of study concerned with the design, fabrication and application of such devices

  3. ORTHOTIC PRINCIPLES Terminology • Orthoses are described or referred to by the joints or regions they encompass • The major joints (Hip, Knee, Ankle, etc.) are combined in various ways along with the ending Orthosis to designate a particular orthosis • Commonly the first letters of the joint names are combined to form acronyms (KAFO, AFO,KO, etc.)

  4. ORTHOTIC PRINCIPLES Functions • Substitution and/or enhancement of motor function • Control of joint alignment in sagittal and frontal planes • Immobilization and protection of affected areas

  5. ORTHOTIC PRINCIPLES • 3-point force systems • Reduction in unwanted angular rotation • Stabilization about a joint, bone or skeletal segment

  6. ORTHOTIC PRINCIPLES • 3-point force systems • Reduction in unwanted angular rotation • Stabilization about a joint, bone or skeletal segment

  7. CG Heel Lever Toe Lever Axis ofrotation Center of Gravity (Body Weight) ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum generated by push-off of contralateral limb • Forward motion generated by rotation of lever system

  8. CG ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum generated by push-off of contralateral limb • Forward motion generated by rotation of lever system

  9. Axis of rotation ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum generated by push-off of contralateral limb • Forward motion generated by rotation of lever system

  10. Axis of rotation ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum generated by push-off of contralateral limb • Forward motion generated by rotation of lever system

  11. CG ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum diminished by resistance of ipsilateral forefoot • Backward motion generated by rotation of lever system Axis ofrotation Center of Gravity (Body Weight)

  12. ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum diminished by resistance of ipsilateral forefoot • Backward motion generated by rotation of lever system Axis of rotation

  13. ORTHOTIC PRINCIPLES • Lever systems and rotation • Momentum diminished by resistance of ipsilateral forefoot • Backward motion generated by rotation of lever system Axis of rotation

  14. ORTHOTIC SYSTEMS • Ankle-Foot Orthoses (AFOs) • Indications • Substitute for/enhance weak or absent dorsi/plantar flexors • Stabilize foot/ankle in coronal and sagittal planes • Provide some knee stability in sagittal plane

  15. Ankle-Foot Orthoses (AFOs) Plastic Metal

  16. Metal AFO • Indications • Wide fluctuaton in edema • At-risk foot (absent or diminished sensation w/edema, visual inpairment, etc.)

  17. Metal AFO • Uprights • Aluminum - lightweight • Stainless Steel - strong

  18. Metal AFO • Stirrups • Solid - stability • Split – shoe change

  19. Metal AFO • Ankle Joints • Free Motion

  20. Metal AFO • Ankle Joints • Dorsi-flexion Assist

  21. Metal AFO • Ankle Joints • Double-action

  22. Metal AFO • Auxillary Controls • Varus/Valgus Control Strap • Controls varus or valgus of rearfoot during weight-bearing

  23. Metal AFO • Auxillary Controls • Laminated Footplate

  24. Metal AFO • Auxillary Controls • Pre-tibial Shell

  25. A B C Fitting Criteria for Metal AFOs • Height • Top of calf no less than 1 1/8” below fibular head • Width • (A) – Calf band is of sufficient width to control tibia in frontal plane yet not cause undue pressure • (B) – Uprights follow contours of M&L calf outline with >1/4” clearance from skin • (C) – Ankle joints are spaced>3/8” & 1/4” from M&L malleoli, respectively

  26. Metal AFO Considerations • If the orthosis is articulated then insure that the orthotic ankle joint axis is aligned with the anatomical ankle joints • Plantar and/or dorsiflexion stops should be adjusted equally within medial and lateral ankle joints • Uprights should be situated mid-line on M&L sides of lower leg; calf band should be deep enough to allow this • If patient supplies own shoes insure that they fit well before attaching orthosis • Check skin integrity (esp. at calf band, ankle joints and shoe) after 1/2 hr. of use. If there are no problems resume use, checking every 4 hours for the first few days

  27. Plastic AFOs (PAFOs)

  28. Plastic AFOs (PAFOs) • Solid • One-piece with no separate components; rigidity determined by thickness and shape • Articulated • Incorporates ankle joints and other components to allow controlled ROM

  29. Plastic AFOs (PAFOs) • Solid • Rigid

  30. Plastic AFOs (PAFOs) • Solid • Posterior Leafspring (PLS)

  31. Solid PAFOs • Thickness • Typically between 1/8” & 1/4” • Angle • Û dorsiflexion = Û knee flexion • Û plantarflexion = Û knee extension

  32. Solid PAFOs • Material • Polyproplyene for strength • Co-Polymer for flexibility • Cross-sectional shape determines rigidity Flexible Solid

  33. Articulated Plastic AFOs Ankle Joints

  34. Articulated Plastic AFOs • Free or limited motion • Variable motion

  35. Tamarack DF Assist Neutral Articulated Plastic AFOs • Free or limited motion

  36. Articulated Plastic AFOs • Free or limited motion Oklahoma

  37. Articulated Plastic AFOs • Variable Motion Friddle VM

  38. Articulated Plastic AFOs • Variable Motion • Camber Angle

  39. Plastic AFOs Auxiliary Components

  40. Plantar Stop Dorsi-Assist Plastic AFOs • Auxiliary components • Posterior ROM Components

  41. Plastic AFOs • Auxiliary components • Compcore • Reinforces plastic in stress-sensitive areas

  42. Plastic AFOs • Auxiliary components • Pre-tibial shell • Enhances knee extension • PTB modifications can reduce weight bearing below

  43. Plastic AFOs • Auxiliary components • Anterior shell • Best for immobilization of foot/ankle

  44. Plastic AFOs • Varus/valgus modifications • Creates effective 3-point system to control varus/valgus

  45. Plastic AFOs • Molded footplate • Adds foot control • Facilitates use of metal AFO ankle joints

  46. Fitting criteria for Plastic AFOs • Trim Lines • Around proximal calf area shell is closely contoured • Side trim line placement determined by use although a + 3/16” gap between the orthosis and the skin is desirable to accommodate volume fluctuation • Along the foot the medial and lateral walls are high enough to control any pronation/supination • The medial and lateral distal edges terminate just proximal to the 1st and 5th metatarsal heads, respectively

  47. Fitting criteria for Plastic AFOs • Height -Top of AFO is > 1 1/8” below fibula head • Width - Proximal calf area is of sufficient width to control tibia in frontal plane yet not cause undue pressure • Since heel height influences function of orthosis type of footwear should be determined prior to fabrication • Athletic footwear w/removable insoles and velcro straps instead of laces is preferred • Patients w/vision and/or sensory impairment require close monitoring to insure skin integrity

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