ORTHOTIC REVIEW

SEAN VINCENT L. BADILLO, PTRP

 Types: SOMC
Spring (1/8”)
Oxford (6-8/8”)
Military (10/8”)
Cuban (12/8”)

 Orthotics-
 An external device that improves function by:
 Stabilizing unstable segments
 Assisting weak functions
 Stopping undesired motions

 Parts of the shoe:

 *Ball= fulcrum for toe
off

 Throat styles:

1. Balmoral= vamp covers the quarter

2. Blucher (MC for orthopedic)= quarter lies over the
vamp
3. Lace to toe= greatest ease of donning (ex. Surgical
boot)
 *Last: refers to the shape of
the shoe

 Parts of the sole M L

Ball (widest)

sole

Shank
(Narrowest) breast
Reverse
Thomas Thomas
heel: heel:
 MLA  LLA
 valgus  Ankle
Steel shank heel
Varus
For MLA/LLA
weakness
 Closures:

A. Adjustable
 Orthotic prescriptions: modification
 Shoe lace
(external/internal
 Velcro
1.) heel stress/ pain
 Post. Entrance
 Heel cushion (internal)
B. Adjustable
 SACH (external
 Zipper
2.) metatarsalgia
 (INT)= MT pad = 2nd to 4th MT heads
 (INT)= U-shaped pad= 3rd MT head
 (INT)= sesamoid pad = prox to 1st MTT head
 (INT)= mortons extension = Distal to “ “ “
 (EXT) Metatarsal Bar= 1st to 5th MT heads
 4.) MLA weakness
3.) Toe pain  (INT) > scaphoid, navicular, cookie pads
> INT = toe crest = sulcus behind 2nd to 4th toes  (EXT) > steel shank
 (Ext) > Thomas heel
 *ex. R RF valgus, FF varus
(Corrective) (adaptive)
Med. Heel wedge medial sole wedge
R RF varus & FF varus posting

5.) LLD
 a. Heel wedge/ Flare (RF/HF)
 Heel elevation = <1inch
 Medial = corrects valgus
 Sole/ shoe elevation = > 1 inch
 Lateral = Corrects varus
 b. sole wedge (FF)
6.) Valgus- Varus correction (LAVARUS-MEDIEVAL)
 Medial = corrects valgus
 Valgus= ABD/EV/PRON
 Lateral = Corrects varus
 Varus= ADD/INV/SUP
AFO

 Shoe/ foot attachments:

 Components (CATS) 1.) Stirrup (MC) = Attached to the shank; mech. Ankle jt
corresponds to the anatomic ankle jt.
 Calf band
2.) Caliper = Attached to the heel ; Mech. Ankle jt
 Ankle Jt.
located distal to the anatomic ankle jt.
 Two lateral uprights
3.) Shoe insert = attached to stirrup; used for extensive
 Shoe/ foot attachments ankle control
  Assists:

1. DF assist
2. PF assist
 Ankle Jt.
3. Springwire DF assist
 Axes:
4. VAPC clasp-type (Vet. Admin. Prosthetic center)
1. Single axis = DF (Most stable) (MC)
2. Polycentric = DF-PF; INV-EV, & slight transverse  Stops:
rotation • T-straps:
1. Post stop/ PF stop
1. Medial=
2. Ant/ DF stop
corrects
3. Limited stops (DF-PF stops) ankle valgus
2. Lat= corrects
ankle varus
PLASTIC DESIGNS AFO

1. Post. Leaf spring (PLS)

 Weak DF’s
 Restricts PF
2. Modified PLS
 Restricts DF+PF
3. Spiral
 Full turn around leg
 Restricts DF-PF, inv-ev but allows transverse rotation
4. Hemispiral
 Makes half-turn around pt’s leg
 For equino varus
5. Solid ankle
 Restricts PF-DF, EV-INV; holds ankle to predetermined pos.
6. AFO c flange
- For maximum ankle valgus-varus control
KAFO

 Knee joint:
 Axes
 Components (ATTK) a. (MC) single = knee flex-Ext
 AFO b. Polycentric (rotation) = flex-ext, slight transverse rot
 Two thigh uprights
 Two thigh bands  Knee locks:
 Knee jt 1. Free motion = no restraint to motion but c hyper ext.
stop
2. Drop-ring lock = (MC) used to control knee flex.
3. Paul lock = easier to use 2 to presence of (+) bail
control
4. Offset knee jt= mech knee jt/ lock loc. Post to the
anatomic knee jt.
5. Adjustable knee lock= ex. Serrated A.K.L = used for
gradual stretching of a knee flex. contracture
 Knee orthoses
 I. for patella-femoral d/o:

1. Palumbo knee orthosis = supra & infrapatellar straps

2. Patella – femoral knee straps = foam padded
infrapatellar strap
II. For control of knee in frontal & sagittal planes
3. Swedish knee cage = genu recurvatum
4. Three-way knee stabilization = genu Recurvatum
5. Typical knee orthosis = c lat. Uprights & thigh/ calf
bands; for extensive knee control
4. Miami knee orthosis = Thermoplastic degin c
polycentric knee axis
5. C.A.R.S – U.B.C knee orthosis
 Canadian arthritis & Rheumatism society university
of British Columbia
6. Supra condylar knee orthosis = for Genu recurvatum
  Scott-Craig Orthosis
 A variation of a typical KAFO that helps SCI pt. to
stand & walk s an additional hip orthosis
 Key design: 10 deg DF (NYU)
 III. For rotation control 15 deg. (Braddom)
1. Lenox-Hill = derotation knee orthosis
2. Lerman Multi-ligamentous knee orthosis
HKAFO

 Hip Joint
 Axes:
a. Single: hip flex- ext jt.
 Components
b. Double (MC) : flex – ext, ABD-ADD
 KAFO
 Hip joints  Hip locks

 Pelvic band (Rotation control) 1. D.R.L = control hip flex

2. Paul lock = easier to use than DRL bec. Of (+) bail control
 Silesian belt (Rotation & M-L controls)
3. Two-pos’n-hip lock
 0 deg. Standing
 90 deg. (sitting)
SPECIAL PURPOSE ORTHOSIS

1. PTB orthosis = to reduce wt. diposition through

ankle & Tibia
2. Ischial WB orthosis = to reduce wt. transmission
through knee & femur
3. Patten Bottom Orthosis ***= for total elimination of
WB on the whole lower limb.; No ankle jt.; toes
suspended in mid-air; uprights terminate on the
floor.; Shoe lift to the opposite lower extremity
 Fracture Orthosis
 Used to stabilize fracture site while allowing motions
on adjacent jts & ambulation possible.
= 2 types:
1. Femoral Orthosis
2. Tibial Orthosis
UE ORTHOTICS

1. Swan neck/ Buotonierres= silver/plastic ring splint

2. Mallet finger = MSSS (mallet splioverplastic splint
3. Trigger finger = PIP sleeve > to compress swollen
tendon
4. De Quervains Dse. = Thumb spica/ thumb post.
Splint c wrist strap
5. carpal tunnel syndrome = resting hand splint/ cock-
up splint

*BFO- balanced FA orthosis ( for feeding)

ORTHOTICS FOR CHILDREN

 I for angular & rot. Control

3. Torsion shaft= for mild scissoring, spastic
1. Denis Browne Splint = for clubfoot, pronated foot, & hemiplegia, & abnormal toe-in/ toe-out
AbN Tibial torsion
4. Hip. Rot control orthosis
(+) spreader bar (Valgus-varus control)
= for AbN hip. Rot during ambulation
(+) Foot plates (Rot. Control)
5. Hip ER control orthosis
2. A-Frame Orthosis = for more prox. Torsional AbN
6. Hip IR “ “
C A-Frame uprights & 3 pads (Thigh pad/Calf
pad/pressure pad)
 II CHD

1. Von Rosen (FAB)

2. Ilfeld (FAB)
3. PavlikHarness (FABER)

 LCP dse

1. Trilateral (ABIR)
2. Toronto (ABIR)
3. Scottish-Rite (lightest) FAB
 Severe paralytic disorder (SPR)

1. Standing frame(Swivel ortho)= helps SCI pt to stand

& perform swing through gait
2. Parapodium = helps young paraplegics to stand s
crutches
3. RGO (Reciprocating gait orthosis)*=For SCI & SB
T12-L1 levels
SPINAL ORTHOTICS

 I. For Scoliosis
 Apex above T6 = Milwaukee (T6)
 Below T6 = MIAMI (T7) (T6-T8)
 Below T8 = Boston/ Wilmington/ Yamamoto
 CERVICAL & C-T ORTHOTICS

Flexion Extension Lat. Flex. Rotation

Cerv. / / FE
Cervical Collar
SOMI / / / FER4-

4 Poster / / / / FELR
appliance
Custom / / / / FELR
Orthoses
C-T (Crupfas &
Minerva)
HALO / / / / FELR
 L-S & TLS ORTHOTICS
Flexion Extension Lat. Flex. Rotation
William / / EL
L-S Chairback / / FE
Knight / / / FEL
Taylor / / FE
Knight / / / FEL
Taylor
Cowhorn / / / FLR
Plastic body / / / / FELR
TLS jacket
Jewet brace / Flex
Cruciform / Flex