Unit V

Calipers
 Lower Extremity Orthosis

• Foot Orthosis(FO)
• Ankle Foot Orthosis(AFO)
• Knee Ankle Foot Orthosis(KAFO)
• Hip Knee Ankle Foot Orthosis( HKAFO)
 Foot Orthosis(FO)- Special shoes

Function
- Protect foot
- Warm foot
- Modified to transfer body weight during walking from sensitive
area to pain free area
Characters
Comfortable

Fit : correspond shape of foot proper room for foot expanding during
weight bearing longer 1cm than longest toe
Foot Orthosis(FO)- Special shoes
Foot Orthosis (FO)

• Specially designed shoe that help

support the feet and improve foot
posture.
• Conditions to be treated with FO
• Corns and calluses
• Foot ulceration
• Tendonitis
• Recurrent ankle sprains
Recurrent stress fractures of foot
and leg bones
• Heel pain
• Front-of-knee pain
• Some hip and low back pains
 Foot orthosis

• When foot cannot attain neutral, FO may shim the gap to that fixed
position-Accommodative FO
• May help the foot attain a neutral position-Corrective FO
• Either may unload compromised tissue; or may provide total contact
• May be full custom or Off The Shelf (OTS)
 Foot
Orthosis

Soft Semi Rigid Rigid

Internal Modifications
External Modifications
Out Sole Correction
 Foot orthosis

Clinical conditions Objectives of modification Modification

Limb shortening Provide symmetric posture Heel elevation:
If < ½ in: internal
If < ½ in: external
Heel and sole elevation (if > 1
in:) High quarter shoe

Arthritis or instability of Improve gait Support and limit High-quarter shoe Reinforced r.
subtalar joints joint motion counters Long steel shank
Rocker bar

Pes plano-valgus (flat foot) Reduce eversion support For children

longitudinal arch  High quarter shoe with broad
long medial counter, medial
heel wedge
For adults:
Medial heel wedge
Medial longitudinal arch
support
 Foot orthosis

Clinical conditions Objectives of modification Modification

Pes equinus (fixed) Provide heel strike Contain foot in shoe High-quarter shoe
Reduce pressure on MT head Heel lift & Metatarsal pads or
Ease putting on of shoe Equalize leg b<- Heel and sole elevation on
length other shoe depending on LLD

Pes equinovarus Realign for flexible deformity and High-quarter shoe

accommodate a fixed deformity Increase Long lateral counter
medial and posterior weight bearing on Lateral sole and heel wedges for
foot flexible deformity
Medial wedges for fixed
deformity.

Pes cavus Distribute weight over High-quarter shoe High toe box
entire foot Restore antero- posterior foot Lateral heel and sole wedges
balance Reduce pain and pressure on Metatarsal pads or bars Molded
MT Heads inner sole
Foot orthosis
Foot orthosis
 Foot orthosis

Clinical conditions Objectives of modification Modification

Calcaneal spurs, Relieve pressure on painful area Heel cushion
calluses and corns Inner relief in heel and fill
with soft sponge

Metatarsalgia Reduce pressure on MT heads Metatarsal pad Metatarsal or

Support transverse arch rocker bar
Inner sole relief

Hallux valgus Reduce pressure on 1st MTP joint
and big toe Prevent forward foot
slide
Immobilize 1st MTP joint Shift
weight laterally
Soft vamp with broad ball
and toe Relief in vamp with
cut-out
Low heel
Metatarsal or sesamoid pad
Medial longitudinal arch
support Soft vamp
 Foot orthosis

Clinical conditions Objectives of modification Modification

Hammer toes Relieve pressure on painful areas Soft vamp, extra-depth shoe
Support transverse arch with high toe box or balloon
patch Metatarsal pad

Foot fractures Improve push off Immobilize fractured long steel shank Longitudinal
part arch support
Metatarsal pad, metatarsal bar
Foot orthosis
Ankle Foot Orthosis (AFO)

• Orthosis or brace that surrounds

the ankle and at least part of the
foot.
• AFO’s are L shaped and are
externally applied to the leg and
foot.
• An AFO can be constructed from
• Metal,
• Plastic,
• Leather, Synthetic
fabrics or Non articulated Articulated
combination.
 Ankle Foot orthosis

Most common orthosis

1. Metal bars
2. Total Contact
3. Floor reaction
4. Unweighting
5. Immobilizing
– Most AFO’s can be articulating or non-articulating
 Ankle Foot orthosis - Metal AFO

The AFO is boot to which an ankle is fixed through

the stirrup are metal uprights (medial and lateral
bars) ascending up to the calf region.
the components are:

•Proximal calf band with leather straps

•Medial and lateral bars articulating with medial and
lateral ankle joints help in control of plantar and
dorsiflexion
•Stirrups anchor the uprights to the shoe.
•Other modifications to the shoe, like medial and
lateral supports can also be prescribed for the AFO
concomitantly.
 
Ankle Foot orthosis - Metal AFO
 Ankle Foot orthosis

Metal AFO Plastic AFO

Shoe and Foot Attachments
 Ankle joints

• Free ankle, given when there is normal ankle power

• Limited ankle joint is prescribed when the muscles operating the ankle
are totally flail and have no power.

• 90° foot drop stop

• is when the ankle joint allows dorsiflexion but stops short at the
neutral position that is at 90 degrees.
• Thus it does not allow plantar flexion.
• It is recommended when there is foot drop when the dorsiflexors
are weak and plantar flexors are normal,
• when the dorsi flexors are normal or near normal and plantar
flexors are spastic.
 Ankle joints

• Reverse ankle 90° joint:

• it allows plantar flexion but stops short at the neutral position that
is at 90 degrees.
• it does not allow dorsiflexion and is prescribed to prevent a
calcaneus deformity.
• happens when plantar flexors are weak, while dorsiflexors are
normal.
• It is not commonly used.
• Fixed ankle joint:
• Sometimes the foot needs to be protected and weight is taken off
injured portions as in fracture calcaneus when in combination with
a weight relieving orthosis it takes the weight off the foot.
• It is not very commonly used.
Ankle Joints
Valgus and Varus Correction
 Ankle Foot orthosis - Total Contact AFO

• provide sleek, intimate fit with total contact to provide better control
• Subtypes are thermoplastic and thermosetting
• higher patient acceptance possibly due to light weight & concealment (150-200gms);
• may be hotter
• more common today
 Ankle Foot orthosis - Floor reaction AFO

• Uses floor reaction force through toe aspect of foot plate to prevent
forward tibial progression & subsequent knee collapse;
• May be articulated

Courtesy of Westcoast
http://www.scheckandsiress.com/orth
otic_care/AFO_Floor_Reaction.pdf Brace & Limb
http://www.beckerorthopedic.com/ce
nfab/cfp.htm
 Ankle Foot orthosis - Unweighting AFO

• May be patella tendon bearing (PTB), specific weight bearing or total

surface bearing, TSB (inverted cone with lace closure) to unweight the
ankle foot using prosthetic principles

Example of a TSB unweighting AFO from

Example of a specific weight bearing AFO
http://www.arizonaafo.com/weightbearing.h
from
tml
http://www.pttd.com/PhotoGallery.html
 Ankle Foot orthosis - Immobilizing AFO
Commonly used with a lower extremity deficiency when ankle immobilization is
desired
– distal tibia/ fibula fracture
– foot bone fractures
– tendocalcaneus rupture
– Diabetic Foot (Charcot Foot)

Crow Walker CAM Walker AFO for Fracture Management.

http://www.orthopedictechreview.co http://www.orthoactive.com/downlo
www.towerortho.com m/issues/octnov99/productivity.htm ads/pdf/fractureBracing.pdf
 Ankle Foot orthosis - Articulated or Non-articulated AFO
• May be designed for progressive increases or decreases in sagittal plane
ROM and control
• An articulating option may be available in many designs of AFO’s

Non-Articulating (Solid Ankle) Articulating

 Knee orthosis (KO)

• Useful for malalignment

– genu varum,
– valgum,
– recurvatum,
• to protect knee structures from undue loading/stress
• may be preventative or corrective
• may be permanent treatment for repaired/compromised knee structures
• Types
– Athletic KO
– Non-articulated KO
– Custom or OTS KO
 Knee orthosis (KO) -Athletic
Athletic KO-
• Preventative.
• It is beneficial in several ways; when used properly, a knee
brace may help an athlete to stay in training
 Knee orthosis (KO)- non-articulated
Non-articulated KO-

• usually for short term use Knee Immobilizer KO

• difficult to transfer

Swedish knee cage for Genu Recurvatum

 Knee orthosis (KO)- Off-the-Shelf
Off-the-Shelf KO-

• Offers limited control of the knee.

• Restricts gross motion
Knee Orthosis (KO)
Knee Ankle Foot Orthosis (KAFO)

• A KAFO is a long-leg orthosis that

spans the knee, the ankle, and the
foot in an effort to stabilize the
joints and assist the muscles of the
leg.
• The most common causes of
muscle weakness include:
• Poliomyelitis
• Muscular dystrophy
• Multiple sclerosis
• Spinal cord injury
Hip Knee Ankle Foot Orthosis (HKAFO)

• The HKAFO provides maximum

stability at the hip, knee, foot and
ankle complex.
• It can be fabricated from plastic,
carbon composites, hybrid
variations, leather and metal.
• The HKAFO is used for a number
of conditions like
• Muscular imbalance and/or
weakness,
• Paralysis (spinal cord injury, spina
bifida, myelomeningocele),
• Cerebral palsy,
• Muscular dystrophy and MS