Lower Extremity Orthosis

Noel R. San Antonio, PTRP MSCPD

Shoe
• The foundation of
lower extremity
orthosis
Shoe
sole
Shoe
 Shoe modifications

• External Modifications
• Internal Modifications
 External Modifications
• Rocker bar: this is a convex strip placed across
the sole just posterior to the metatarsal
heads. It is longer than the metatarsal bar.
 External Modifications
• Metatarsal bar: This is a simple bar placed in the
sole just posterior to the metatarsal heads; it
relieves pressure from the metatarsal heads by
transferring load to the metatarsal shafts during
stance.
 External Modifications
• Sole wedge: lateral sole wedge promotes
forefoot eversion; medial wedge promotes
forefoot inversion
 External Modifications
• Sole flare: provides greater stability by
widening the base of support of the shoe; a
medial flare resists eversion, while a lateral
flare resists inversion of the foot
 External Modifications
• Heel wedge: can be placed either medially (to
rotate hindfoot into inversion) or laterally (to
rotate hindfoot into eversion).
 External Modifications
• Heel flare: applied either medially (to resist
hindfoot eversion) or laterally (to resist hind
foot inversion).
 External Modifications
• Heel extension: can project anteriorly either
medially (Thomas heel) or laterally (reverse
Thomas heel). The Thomas heel provides
support to the medial longitudinal arch; the
reverse Thomas heel provides support to the
lateral longitudinal arch.
 External Modifications
• Cushioned Heel (“SACH” heel): is a heel with the
posterior portion replaced by a rubberized,
compressible material to absorb shock at heel
(foot) strike. Cushioned heel with shift weight line
(line of gravity) anterior to the knee joint at initial
contact causing an extension moment of the knee
(thus stabilizing knee).
 Internal Modifications
• Heel cushion-relief/excavation: is a soft pad with
excavation under painful part of heel
• Inner sole excavation/relief: is a soft pad with
excavation under one or more painful
bonyprominence (usually metatarsal heads). The
excavation is usually filled with
compressiblematerial
• Scaphoid pads/arch cookies/navicular pad: a
rubber, cork, or plastic foam wedge used to provide
medial longitudinal arch support
 Internal Modifications
• Univ. of California Biomechanics Lab orthosis
(UCBL): custom-molded orthosis used to realign
flexible flat foot; it encompasses the heel and
hindfoot, providing very effective longitudinal arch
support.
• Ankle-Foot Orthosis (AFO)—Commonly
prescribed for weakness affecting the ankle
andsubtalar joints. These can be made of
plastic, metal, or a hybrid of both.
 Plastic AFO
• Posterior Leaf Spring–PLS
design is the most flexible
plastic AFO with a very thin
plastic band behind the ankle
allowing the patient to
overpower the brace during the
push-off or plantar flexion phase
and yet allowing dorsiflexion
position of the foot during swing
phase. This design is typically
used for flaccid foot drop.
 Plastic AFO
• Rigid or solid plastic AFO used
most commonly for patients
that have the highest levels of
spasticity or tone when
complete immobilization of the
ankle is necessary.
• In this case the plastic trim line
may be at the malleoli or
anterior to the malleoli with no
motion allowed at the tibiotalar
or subtalar joint.
Plastic Vs Metal AFO
 Plastic Vs Metal AFO
• Plastic • Metal
– light weight – patients with insensate
– intimate fit foot
– cosmetic appeal – fluctuating edema
– lack of attachment to
the shoe
 Metal AFO
• Metal uprights
• Calf band
• Shoe attachment
– Stirrup
– Caliper
– Shoe insert
 Ankle joints
• Most ankle joints are single axis
• Designed to either control or assist
plantarflexion and dorsiflexion by means of
stops or springs.
Ankle stops
Ankle joint assists
• Posterior ankle stop