EVALUATION PROCEDURES FOR

LOWER LIMB ORTHOSES

By:Dr.Saima Asghar
ORTHOTIC EVALUATION
PROCEDURE
Orthotic evaluation is an essential part of rehabilitation.
The orthosis should be evaluated when it is delivered to
the patient and before the individual wears it on regular
basis.
Evaluation of the adequacy of a particular orthosis for a
given patient involves a static and a dynamic
examination.
There are two types of evaluation in orthosis
Static evaluation
Dynamic evaluation
STATIC EVALUATION
Static evaluation consists of observing the orthosis on
the patient as the individual stands and sits, as well as
examining the device off the patient.
Prior to assisting the patients into the orthosis, team
members should check that it conforms with the
prescription.
The patient is the only individual who can judge the
comfort of the orthosis, regardless of whether or not
the clinic team is satisfied with the contour and
alignment of the appliance.
SHOE INSPECTION
Ball of the shoe (widest part of the sole) lies at the ball
of the foot (metatarsophalangeal joints).
Shoe is 1 cm longer than the foot
Heel counter hugs the posterior heel
Toe box covers the dorsum comfortably
Provision for adjusting to increased foot volume
during the day
Foot is well supported medially and laterally
Shoe insert lodges snugly in the shoe
ANKLE-FOOT ORTHOSIS
INSPECTION
Shell and calf band is comfortable
Shell or uprights conform to the contour of the leg
Fibular head sustains minimal or no pressure
 mechanical ankle joints coincide with the anatomical
ankle
Varus or valgus correction strap supports the foot
Patellar tendon-bearing brim reduces weight-bearing
at the heel
In adults orthosis, Calf band that is less than 8cm
wide is apt to induce excessive pressure concentration
CONT.
A metal ankle joint should be set at the level of the
distal tip of the medial malleolus
KNEE-ANKLE-FOOT, HIP-KNEE-ANKLE-
FOOT, AND TRUNK-HIP-KNEE-ANKLE-
FOOT ORTHOSES INSPECTION
In addition to examining the shoe and distal
components of the orthosis, the clinic team Should
inspect proximal elements of the KAFO and higher
orthoses:
Medial upright terminates below the perineum
Lateral upright terminates below the greater
trochanter
Knee and hip orthotic joints coincide with anatomical
counterparts
Cont.
Distal thigh band and calf shell or band are
equidistant
Ischial bearing brim is comfortable
Trunk components are comfortable
DYNAMIC EVALUATION
Dynamic evaluation is performed while the patient walks
If the individual can walk without the orthosis, then gait
should be compared with and without the device
The most effective way of performing observational gait
analysis is to focus attention only on the foot and ankle as
the patient walks for several passes along the walkway.
Next, observe only the action of the knee, then the hip,
and finally the torso and upper limbs.
Watch for movements during early stance, late stance,
and swing phase, comparing the person’s performance
with normal gait kinematics.
Cont.
Gait analysis should be related to the purpose for
which the orthosis was prescribed. For example, if the
patient exhibits foot drag during swing phase without
an orthosis, then the orthosis should correct this
problem either by assisting dorsiflexion or preventing
plantar flexion.
A second consideration in dynamic evaluation is
recognizing gait disorders that can be attributed to
the orthosis.
CHECKLIST FOR OBSERVING GAIT
Sagittal plane deviations: observe from the side of the patient
Foot slap
Toe contact
Flat foot contact
Excessive knee flexion
Hyperextended knee
Anterior trunk bending
Posterior trunk bending
Inadequate transition
Toe drag
Steppage.
Cont.
Frontal and transverse plane deviations: observe from the rear of
the patient
Lateral trunk bending to affected side
Lateral trunk bending to unaffected side
Wide walking base
Excessively narrow walking base
Circumduction
Hip hiking
Valuting
Knee adduction
Knee abduction
Excessive medial (lateral) foot contact
Gait Disorder During Early Stance
Foot Slap
Anatomical factor: weak dorsiflexors.
Orthotic factor: inadequate dorsiflexors assist or
planter flexion stop.
Toe Contact
Anatomical factor: short leg, pes equines, extensor
spasticity, weak dorsiflexors, heel pain, knee/or hip
flexion contracture.
Orthotic factor: inadequate heel lift, dorsiflexion
assist, planter flexion stop and relief for heel pain.
Gait Disorder During Early Stance (cont.)
Flat Foot Contact
Anatomical factor: poor balance.
Orthotic factor: inadequate traction from shoe sole,
dorsiflexion assist and planter flexion stop.
Excessive medial/lateral foot Contact
Anatomical factor: weak invertor/evertor, pes
valgus/varus, genu varum/valgum.
Orthotic factor: transverse plane malalignment.
Gait Disorder During Early Stance (cont.)
Excessive Knee Flexion:
Anatomical factor: weak knee extensors, short
contralateral leg, knee pain, knee/hip flexion
contracture, flexor synergy, pes calcaneus, weak
planter flexors.
Orthotic factor: inadequate knee lock, dorsiflexion
stop, planter flexor stop and contralateral heel lift,
requires AFO with anterior band and solid ankle,
requires resilient or beveled heel.
Gait Disorder During Early Stance (cont.)
Posterior Trunk Bending
Anatomical factors: weak hip extensor, knee ankylosis.
Orthotic factor: inadequate hip lock/ knee lock.
Lateral Trunk Bending
Anatomical factor: weak hip abductors, abduction
contracture, dislocation of hip, hip pain, poor balance,
short ipsilateral leg, amputation.
Orthotic factor: excessive height of the medial upright
of KAFO; excessive abduction of the hip joint of
HKAFO.
Gait Disorder During Mid and Late
Stance.
Knee Adduction(abduction)
Anatomical factor: ligamentous laxity, weak
medial/lateral quadriceps or hamstring, arthritic
changes.
Orthotic factor: malalignment of uprights of KAFO,
medial/lateral calf shell extension or five strap knee
pad.
Gait Disorder During Swing Phase
Steppage:
Anatomical factor: weak dorsiflexors. Pes equinus,
ankle ankylosis.
Orthotic Factor: inadequate dorsiflexion assist or
planter flexion stop.
Vaulting:
Exaggerated planter flexion of the contralateral leg
enables the ipsilateral limb to swing forward.
Hip Hiking:
Pelvis elevates to enable the limb to swing forward.
 Thanks you