Floor Reaction Orthosis

FLOOR REACTION ORTHOSIS (FRO) Revolutionary orthoses: Custom fabricated, moulded plastic device that supports the ankle and foot area of the body and extends from below the knee down to and including the foot. It was described by Saltiel for the use of weak quadriceps or plantar flexors in 1969 It holds the ankle in equinus to prevent the heel from touching the ground. As the body weight brings the heel downwards, the suprapatellar band will press the knee back preventing knee from buckling during stance phase It allows the knee to flex during swing phase when the foot is off the ground Use: It can be used in lower limb paralyses with weak quadriceps like post polio residual paralysis

Advantages over other AK Orthosis: Light weight-300gms Swing phase is not laboured Floor reaction prevents knee from buckling 2 weeks training is enough to use it. Stabilises knee without muscle action Ground clearance is easier Good patient compliance Cosmetically acceptable-can be worn under shoe Disadvantages: Must be correct fitting or else it wont function Has to be custom made The FRO is designed to lock the ankle and to provide maximum resistance to ankle dorsiflexion. It is a stance phase control orthosis. Indication- Management of a crouch gait, which is characterized by excessive ankle dorsiflexion, increased knee flexion, and increased hip flexion in midstance. Contraindications - Hip flexion contracture >30, Knee flexion contracture >20, and a Thigh-foot angle > 15 external. Ref: J Am Acad Orthop Surg 2007;15:178-188

Principal of FRO When a polio patient with paralyzed quadriceps, comes initial contact at heel it causes the weight line to pass posterior to the knee axis. Here quadriceps action is needed to prevent keen from buckling. This action is absent in polio afflicted limb. Where as a fixed equines (On planterflexon the

angle at the toe between floor and sole of the foot) lead to an initial fore foot contact and weight line shifts anterior to the knee axis. Now the reaction forces due to the body weight lock the knee, conferring alignment stability. FRO loading takes places in mid stance posture and it works on a cantilever principle. When body weight is applied , the frail forces from the floor causes turning moment which locks the frail knee joint as shown in the following figure.