Introduction to Orthotics

Lower Limb Orthotics

What is an orthosis?
- An orthosis is a device which is fitted to the outside of the body to support
a weakness, correct a deformity, prevent a deformity/contracture, promote
healing, direct growth, enhance function with better positioning, maintain
joint stability, decrease pain and/or inflammation, and/or to rest and
support weakened structures.

Classification of Lower Extremity Orthoses

FO (Foot Orthosis)
A foot orthosis is a device that is applied to the foot. It will prevent, correct or
accommodate deformity of the foot. Pathologies that we will make an FO for include:
Pes Planus, Pes Cavus, Metatarsalgia, Painful heel.

AFO (Ankle Foot Orthosis)

This orthosis will include the foot, ankle and covers part of the leg below the knee.
There are several designs of AFO. Pathologies that we can use an AFO for include:
Drop Foot, Cerebral Palsy, Club Foot, Polio, Spina Bifida, Muscular Dystrophy,
Multiple Sclerosis, Stroke, Spinal Cord Injury, and Osteoarthritis.

KAFO (Knee Ankle Foot Orthosis)

This orthosis covers the whole leg, from the foot to below the hip. The mechanical
knee joint can be free or locked, and ankle can be rigid or articulated. Deciding
between using an AFO and a KAFO can be difficult. This can be determined during
the evaluation by assessing the Knee strength, the Knee stability and also with an
understanding of the diagnosis. Pathologies that we can use a KAFO for include:
Polio, Spina Bifida, Muscular Dystrophy, Spinal Cord Injury, and Osteomyelitis.

KO (Knee Orthosis)
This orthosis is for problems around the knee. This orthosis does not restrict ankle or
hip joint motion. Pathologies that we can use a KO for include: Osteoarthritis,
Rheumatoid Arthritis, Ligament tears, Menisci injuries.

HKAFO (Hip Knee Ankle Foot Orthosis)

This orthosis will have its upper border on the patient’s pelvis, above the hip joint.
The hip joint can be locked or free. Below the hip joint level there is a standard knee
ankle foot orthosis. Pathologies that we can use an HKAFO for include: Hip
dislocation, Spinal Cord Injury, Spina Bifida.

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HO (Hip Orthosis)
This orthosis covers only the hip joint, The knee and ankle joint will not be restricted
by this orthosis. Pathologies that we can use an HO for include: hip dislocation,
post-op hip replacement surgery, congenital hip dysplasia.

The Orthotic Prescription

The aim of orthotic treatment is to restore or maintain function. It is not based solely
upon the pathology, but is focused upon function. It will take into consideration the
patient’s age, activity level, functional deficit and the diagnosis – whether it be
progressive/nonprogressive, involve spasticity or flaccid paralysis.

Goals of Orthotic Systems:

The orthotic prescription aims:
o to support a muscular weakness - to increase stability
o to support arches of the foot
o to stabilise joints – to support the bony architecture
o to provide a stable base of support
o to provide a rigid lever arm
o to correct, prevent or reduce a deformity/contracture
o to enhance function with better positioning
o to promote healing
o to relieve unwanted pressure
o to direct growth
o to decrease pain and/or inflammation
o to rest and support weakened structures
o to improve balance, gait
o to increase independence
o to compensate leg length discrepancy
o to reduce energy expenditure

Functions of Lower Limb Orthoses (Atlas of Orthotics, p 5)

A lower limb orthosis can provide one or more of the following functions:

1. To control joint motion. This is the most common purpose of an orthosis and
may include the following goals:
– allow free movement in selected planes
– assist motion in selected planes
– resist motion in selected planes
– stop motion in selected planes
– hold motion in selected planes

2. To correct alignment of a joint.

3. To offload weight from a body part

4. To provide circumferential pressure; to provide hydrostatic pressure.

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 This is especially important for fracture bracing. Circumferential pressure will
provide stabilization to bony fragments.

5. To accommodate deformity and prevent further deformity

The orthosis can prevent the joint from becoming further damaged.

Sometimes it is necessary to compromise on your bracing decision in order to obtain

the most effective treatment. Try to find a balance

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