6
Phase: all phases
Description: external rotation of femur
Possible causes: spasticity or contractures of ER, weakness of IR
Analysis/examine: tone, ER ROM, strength of IR
Hip external rotation
Gait deviation: both legs affected, can be crouched or LE in extension, tight muscle movement pattern, typically in PF and knee extension
Spastic diplegia
Orthosis: Applied to the foot and placed inside or outside a shoe
Foot orthoses (FOs)
1. Ataxia
2. Hemiplegic
3. Spastic diplegia
4. crouch
5. toe walking
6. scissoring
General deviations
Gait deviation: half the body; typically on toe of the affected side and arm is in contracted flexion synergy
Hemiplegia
Gait deviation: crossing feet over midline
Scissoring
Orthosis: Encompass a shoe and terminate below the knee
Ankle foot orthosis (AFOs)
Phase: all phases
Description: internal rotation of femur
Possible cause: spasticity or contractures of IR; weakness of ER; excessive forward rotation of contralateral pelvis
Analysis/examine: tone, IR ROM, strength of ER
Hip internal rotation
Gait deviation: ankle in DF, knee flexion, hip flexion; LE can begin to bow
Crouch
Gait deviation: INCONSISTENT, cerebellum issues, drunken gait, wide base of support, core weakness, may compensate with arms
Ataxia
Orthosis: KAFO with a pelvic band that surrounds the lower torso
Hip-knee-ankle-foot orthosis (HKAFO)
Orthosis: foot level; foot control only; stops inversion and eversion; heel cup
University of California Berkley (UCB)
Orthosis: Covers part of the torso and the lower limbs
Trunk-hip-knee-ankle-foot orthosis (THKAFO)
Female shoes are what width size?
B width
Orthosis: Extends from the shoe to the thigh
Knee-ankle-foot orthosis (KAFOs)
Metatarsal bar and rocker bar can be best used for which diagnosis?
Diabetic neuropathy
Composed of a foundation, an ankle control, a foot control, and a supersculpture; control of the foot; can control the knee; limiting or assisting PF and/or DF; clear toes during swing
Foundation: shoe
Insert: plastic, carbon fiber, metal
AFO
Orthosis: Stops right above malleoli, medial and lateral stability of the ankle, does not control the knee, we use this for lower tone children, not typically covered by insurance, can be the step down of an AFO
Super malleolar orthotic (SMO)
U-shaped steel fixture; center portion riveted to bottom of shoe; heavy and bulky; long term users
Stirrup
Males shoes are which width size?
D width
Plastic insert; prefabricated or custom made; streamlined and lightweight; early stance - posterior upright acts as a spring bending backward slightly; swing phase - upright recoils "springing" forward to lift the foot; adjustment limited; can remove to weaken spring but cannot add to increase rigidity ; lowest level of AFO
Posterior lead spring AFO
Prevent toe drag; PF resistance with metal ankle with posterior stop; imposes flexion force at knee during early stance; prevent knee hyperextension; limiting PF
AFO with posterior stop
Limits active muscle activation; very stable
Solid ankle foot orthosis
Adjustable motion assistance; steel DF spring assist; incorporated into each stirrup near ankle; spring compresses in stance and rebounds during swing; tightness of spring adjusted by turning screw on top of spring; bulkier than posterior leaf spring; yield slightly into PF at heel contact; slight protection against inadvertent knee flexion
Articulated spring assist AFO
Hinge limits DF; achieve propulsion during late stance; prevent knee collapse; trimlines are anterior to the malleoli ; not common
Anterior stop AFO