Orthotics and Devices

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  1. Metatarsal pad
    • Located posterior to the metatarsal heads
    • Takes pressure of the metatarsal heads onto the metatarsal shaft
    • Allows more push off
  2. Cushion heel
    • Cushions and absorbs forces at heel contact
    • Relieves strain on plantar facia
  3. UBCL
    Semi rigid plastic insert molded to correct for pes planus
  4. Scaphoid pad
    Used to support the longitudinal arch
  5. Thomas Heel
    Heel wedge with an extended anterior medial border used to support the logitudinal arch for flexible pes planus
  6. Varus Post/Medial wedge-Rearfoot
    Used to limit or control eversion of the calcaneus and IR of the tibia after heel strike
  7. Valgus post/lateral wedge-Rearfoot
    Controls calcaneus and subtalar joint that are excessively inverted and supinated at heel strike
  8. Forefoot posting-Medial wedge
    Controls forefoot varus
  9. Forfoot posting Lateral wedge
    Controls forfoot valgus
  10. Anterior DF stop AFO
    • Limits ankle DF
    • If it is set to allow slight DF knee flexion results, can be used to control knee hyperextension
  11. Posterior PF Stop AFO
    • Limits PF of the ankle
    • If the AFO is set to allow slight PF Knee extension results, used to contol an unstable knee
  12. Trunk and Hip Deviations Stance Phase
    • Lateral trunk bending: Weak glute med. Lateral bending to side of weakness
    • Backward trunk lean: Weak glute max, difficulty going up stairs or ramps
    • Forward trunk lean: Weak Quads, Hip and knee flexor contractures
    • Excessive hip flexion: Weak hip extensors or tight hip/knee flexors
    • Limited hip extension: Tight or spastic hip flexors
  13. Knee deviations during stance phase
    • Excessive knee flexion: Weak quads or flexor contracture, too much DF in AFO. Difficulty going down stairs or ramps, may see forward trunk bending
    • Hyperextension: Weak quads, PF contracture, Extensor spacticity, Too much PF in AFO
  14. Ankle and Foot deviations during stance phase
    • Toe first: Toes contact at heel strike, weak DF, Tight PF, Shortened leg length, Painful heel
    • Foot Slap: Weak DF or Hypotonia
    • Foot flat: Entire foot contacts ground as a result of weak DF, Dec ROM, Immature gait pattern
    • Excessive DF and uncontrolled motion of the tibia: Weak PF
    • Excessive PF: Heel does not touch ground, Spacticity of the PF, Poor eccentric contraction and advancement of the tibia
    • Supination: Spastic inverters, Weak everters, Pes Varus, Gunu Varum
    • Pronation: Weak inverters, spacticity, Pes Valgus, Genu valgum
    • Toe claw: Spastic toe flexors, hyperactive plantar grasp.
    • Inadequate push off: Weak PF, decreased ROM, pain in the fore foot
  15. Trunk and hip deviations- swing phase
    • Insufficient forward pelvic rotation: Weak abdominals, weak flexors.
    • Insufficient hip and knee flexion: Weak hip and knee flexors: Inability to lift leg and move it forward
    • Circumduction: Weak hip and knee flexors
    • Hip Hiking: Compensation for weak hip or knee flexors, or extensor spacticity.
    • Excessive hip and knee flexion: Compensatory responce to a short leg, weak DF
  16. Knee Deviations: Swing Phase
    • Insufficient knee flexion: Extensor spacticity, pain/dec ROM, weak hamstrings
    • Excessive knee flexion: Flexor spacticity, flexor withdrawl reflex.
  17. Ankle/Foot Gait Deviations: Swing Phase
    • Foot drop: Weak DF/ Spactic PF
    • Varus or inverted foot: Spastic inverters, weak peroneals, abnormal synergistic pattern
    • Equinovarus: Spacticity of posterior tib and or gastroc soleous, developmental abnormality
  18. Othotic Gait Dev- Lateral trunk bending
    • Patient leans towards orthotic side during stance phase.
    • Causes: KAFO medial upright too high, insuffient shoe lift, hip pain, weak or tight abductors on the orthotic side, short leg, poor balance
  19. Orthotic gait Dev- Circumduction
    Causes: Locked knee, excessive PF, Weak hip flexors or DF-These could also cause vaulting.
  20. Orthotic Gait Dev- Ant Trunk Bending
    • Patient leans forward during stance.
    • Causes: Inadequate knee lock, weak quads, hip or knee flexion contracture.
  21. Orthotic Gait Dev-Posterior Trunk Lean
    • Inadequate hip lock
    • Weak glute med
    • Knee ankylosis
  22. Orthotic Gait Dev-Hyperextended knee
    • Inadequate PF
    • Inadequate knee lock
    • Poor fit of calf band
    • Weak quad
    • Loose knee ligaments
    • Extensor spacticity
  23. Orthotic Gait Dev- Knee Instability
    • Excessive knee flexion during stance
    • Inqadequate DFstop, Inadequate knee lock, knee or hip flexion contaction, weak quads, knee pain.
  24. Orthotic Gait Dev- Foot Slap
    • Foot hits ground too early in stance
    • Inadequate DF assist, Inadequate PF stop, weak DF
  25. Orthotic Gait Dev- Toes First
    • Inadequate PF stop
    • Inadequate DF assist
    • Inadequate heel lift
    • Heel pain
    • Extensor spacticity
    • Pes Equinous
    • Short leg
  26. Orthotic Gait Dev- Flat Foot
    Inadequate longitudinal arch support, Pes Planus
  27. Orthotic Gait Dev- Pronation
    • Transverse plane malalignment
    • Weak Inverters
    • Pes Valgus
    • Genu Valgum
  28. Orthotic Gait Dev- Supination
    • Transverse planemalalignment
    • Weak everters
    • Pes Varus
    • Genu Varum
  29. Immediate post op dressing
    • Ridgid cast
    • Plaster of paris is fabricated
    • Promotes early WB
    • Limits swelling and pain
  30. Prosthetic Dev-Circumduction
    • Long Prosthesis
    • Locked Knee
    • Small or loose socket
    • Inadequate suspension
    • Foot PF
    • Abduction contracute
    • Poor knee control
  31. Prosthetic Gait Dev- Abducted Gait
    • Medial wall discomfort
    • Long prosthesis
    • Low lateral wall
    • Tight hip abd
  32. Prosthetic Gait Dev-Vaulting
    • Patient rises up on sound leg
    • Prosthesis too long
    • Inadequate suspension
    • Socket too small
    • Prosthetic foot in too much PF
    • Too little knee flexion
  33. Prosthetic Gait Dev- Lateral trunk bending
    • Bend towards prosthetic side
    • Low lateral wall
    • Short prosthesis
    • High medial wall
    • Weak abd
    • abd contracture
    • hip pain
    • short amputation limb
  34. Prosthetic Gait dev- Forward flexion during stance
    • Unstable knee
    • Short amb aids
    • hip flexion contracture
  35. Prosthetic Gait dev- Lumbar lordosis
    • Insufficient support from ant and post walls
    • Painful isheal WB
    • Hip Flexion contracure
    • Weak hip extensors or abdominals
  36. Prosthetic gait dev- High heel rise
    • Inadequate knee friction
    • Too little tension on extension aide
  37. Prosthetic gait dev- Terminal swing impact
    • Prosthesis comes to a stop as the knee extends durng late swing.
    • Insufficient knee friction, too much tension on extension aid.
    • Fears of knee buckling
    • Forcefull hip flexion
  38. Prosthetic Gait Dev- Swing phase whips
    • Named for the heel direction
    • Rotated socket
    • knee bolt is rotated
    • foot is malaligned
  39. Prosthetic Gait Dev- Excessive knee flexion during gait
    • Socket aligned too far forward or tilted ant
    • PF bumper too hard
    • High heel shoe
    • Knee flexion contracture
    • Weak Quad
  40. Prosthetic Gait Dev- Inadequate knee flexion during stance
    • Socked aligned too far back or tilted post
    • PF bumper or heel cusion too soft
    • Low heel shoe
    • Weak quad
  41. Prosthetic Gait Dev-Lateral thrust at midstance
    Foot inset too much
  42. Prosthetic Gait Dev-Medial thrust at midstance
    Foot outset too much
  43. Prosthetic Gait Dev-Early Knee flexion late in stance
    • Socket too far forward
    • DF bumper too soft resulting in excess DF
    • Prosthetic keel too short
    • Knee flexion contracture
  44. Prosthetic Gait Dev-Late Knee flexion late in stance
    • Pt feels like they are walking uphill
    • Socket too far back
    • DF bumper too stiff causing excessive PF
    • Long prosthetic keel
Card Set
Orthotics and Devices
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