Foundations for Ankle Foot Orthoses: Difference between revisions
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* Paediatrics: | * Paediatrics: | ||
** Neural Tube | ** Neural Tube Defect / [[Spina Bifida]] | ||
** Cerebral Palsy | ** [[Cerebral Palsy Introduction|Cerebral Palsy]] | ||
** Muscular Dystrophy | ** [[Muscular Dystrophy]] | ||
* Cerebral Vascular Accident – Early intervention | * [[Stroke|Cerebral Vascular Accident]] – Early intervention | ||
* Multiple Sclerosis – Progressive | * [[Multiple Sclerosis (MS)|Multiple Sclerosis]] – Progressive | ||
* Polio | * [[Poliomyelitis|Polio]] | ||
* Neuropathy | * Neuropathy | ||
** HMSN | ** HMSN | ||
** Diabetes | ** [[Diabetes]] | ||
** Tumor | ** Tumor | ||
* Trauma | * Trauma | ||
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== Goal setting/ Prescription == | == Goal setting/ Prescription == | ||
# Positioning | |||
# Provide Support | |||
# Prevent contractures | |||
# Improve mobility | |||
# Increase stability | |||
# Patient Needs | |||
=== 3 point force system === | === 3 point force system === | ||
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• Pressure= Force /Area | • Pressure= Force /Area | ||
== | == Commonly Used Ankle Foot Orthosis == | ||
# Flexible A.F.O. | |||
# Rigid A.F.O. | |||
# Jointed A.F.O. | |||
=== | == 1. Flexible AFO == | ||
==== Design/ Manufacture ==== | |||
# Custom made | |||
# Mostly manufactured from a plaster model | |||
# Polypropylene/ lamination/ Carbon Fibre | |||
# 3 point force system | |||
==== Foot/Ankle Position ==== | |||
=== | ==== Casting Procedure ==== | ||
==== Prescription Criteria For A Flexible A.F.O. ==== | |||
# Drop foot | |||
# Mobile foot/ankle | |||
# No tendency to valgus or varus | |||
== | ==== Common conditions include ==== | ||
# CVA | |||
# Nerve injury/dysfunction | |||
# Paediatrics | |||
=== OTS AFO === | ==== OTS Flexible AFO ==== | ||
== 2. Rigid A.F.O. == | == 2. Rigid A.F.O. == | ||
==== Prescription Criteria For A Rigid A.F.O. ==== | ==== Prescription Criteria For A Rigid A.F.O. ==== | ||
# Tightness in T.A. | |||
# Tendency to valgus | |||
# Tendency to varus | |||
# Excessive dorsiflexion | |||
# Slight tendency to flexion at knee | |||
==== Common Conditions ==== | |||
# CP | |||
# NTD | |||
# Stroke | |||
# Trauma | |||
# Pain | |||
==== Rigid AFO +/- Anterior Shell ==== | ==== Rigid AFO +/- Anterior Shell ==== | ||
# Tightness in T.A. | |||
# Tendency to valgus | |||
# Tendency to varus | |||
# Excessive dorsiflexion | |||
# Crouch/ Flexion at knees | |||
(Ries 2019) | (Ries 2019) | ||
==== | ==== Used for ==== | ||
# Muscle Tightness- Dynamic/Fixed | |||
Crouch/Excessive Dorsiflexion | ## Crouch/ Equinus | ||
## Gait Hyper-extension/ Escape Valgus | |||
# Valgus Deformities | |||
## Rocker Bottom Foot | |||
## Hyper-mobility | |||
## Escape Valgus | |||
### Compensatory movement | |||
### Driven by tight TA | |||
### Can alter foot structure | |||
### Can result in long term issues | |||
# Varus Deformities | |||
## Correctable deformity | |||
## Difficult to control | |||
## Accommodate deformity | |||
# Varus Deformity | |||
# Crouch/Excessive Dorsiflexion | |||
==== Tuning/ Optimising AFOs ==== | ==== Tuning/ Optimising AFOs ==== | ||
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==== Prescription Criteria For A Jointed A.F.O. ==== | ==== Prescription Criteria For A Jointed A.F.O. ==== | ||
# ROM in ankle joint | |||
# Tendency to valgus | |||
# Tendency to varus | |||
# Tendency to Crouch | |||
==== Prescription criteria for Jointed AFO and DAFO/SMAFO ==== | |||
# Hyper mobile foot/ankle | |||
# Ankle to plantargrade | |||
# Medio-lateral instability | |||
In Conclusion | In Conclusion | ||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Physioplus Content]] | [[Category:Physioplus Content]] |
Revision as of 14:49, 30 April 2022
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson and Tarina van der Stockt
Introduction[edit | edit source]
Types of AFO[edit | edit source]
- AFO - Ankle Foot Orthosis
- GRAFO - Ground Reaction Ankle Foot Orthosis
- DAFO - Dynamic Ankle Foot Orthosis
- SMAFO- Supramalleolar Ankle Foot Orthosis
- Custom Made
- Off the shelf
Orthotic Assessment [edit | edit source]
Passive Assessment:
- Range of Motion (ROM)
- Muscle Power
- Proprioception
- Sensation
- Leg Length
- ROM Foot/Ankle
Active Assessment:
- Level of mobility
- Gait Pattern
- Compensation Mechanisms o Instability
- Risk of injury
- Pain
Gait Cycle[edit | edit source]
Normal Gait Cycle:
Pathological Gait Cycle:
- Pain
- Joint ROM limitations
- Muscle weakness/ paralysis
- Neurological deficit
- Sensory deficit
- Leg length
Pathologies[edit | edit source]
- Paediatrics:
- Neural Tube Defect / Spina Bifida
- Cerebral Palsy
- Muscular Dystrophy
- Cerebral Vascular Accident – Early intervention
- Multiple Sclerosis – Progressive
- Polio
- Neuropathy
- HMSN
- Diabetes
- Tumor
- Trauma
- Nerve injury
- Pain
- Instability
Goal setting/ Prescription[edit | edit source]
- Positioning
- Provide Support
- Prevent contractures
- Improve mobility
- Increase stability
- Patient Needs
3 point force system[edit | edit source]
• Stabilizes a joint or segment
• Reduces angular rotation
• Medio-lateral or antero-posterior
• Longer the lever arm the greater the force
• Pressure= Force /Area
Commonly Used Ankle Foot Orthosis[edit | edit source]
- Flexible A.F.O.
- Rigid A.F.O.
- Jointed A.F.O.
1. Flexible AFO[edit | edit source]
Design/ Manufacture[edit | edit source]
- Custom made
- Mostly manufactured from a plaster model
- Polypropylene/ lamination/ Carbon Fibre
- 3 point force system
Foot/Ankle Position[edit | edit source]
Casting Procedure[edit | edit source]
Prescription Criteria For A Flexible A.F.O.[edit | edit source]
- Drop foot
- Mobile foot/ankle
- No tendency to valgus or varus
Common conditions include[edit | edit source]
- CVA
- Nerve injury/dysfunction
- Paediatrics
OTS Flexible AFO[edit | edit source]
2. Rigid A.F.O.[edit | edit source]
Prescription Criteria For A Rigid A.F.O.[edit | edit source]
- Tightness in T.A.
- Tendency to valgus
- Tendency to varus
- Excessive dorsiflexion
- Slight tendency to flexion at knee
Common Conditions[edit | edit source]
- CP
- NTD
- Stroke
- Trauma
- Pain
Rigid AFO +/- Anterior Shell[edit | edit source]
- Tightness in T.A.
- Tendency to valgus
- Tendency to varus
- Excessive dorsiflexion
- Crouch/ Flexion at knees
(Ries 2019)
Used for[edit | edit source]
- Muscle Tightness- Dynamic/Fixed
- Crouch/ Equinus
- Gait Hyper-extension/ Escape Valgus
- Valgus Deformities
- Rocker Bottom Foot
- Hyper-mobility
- Escape Valgus
- Compensatory movement
- Driven by tight TA
- Can alter foot structure
- Can result in long term issues
- Varus Deformities
- Correctable deformity
- Difficult to control
- Accommodate deformity
- Varus Deformity
- Crouch/Excessive Dorsiflexion
Tuning/ Optimising AFOs [edit | edit source]
o There is evidence that tuning AFOs can significantly improve gait and their effect at the proximal joints.
(Owen 2002, Stallard 2003, Butler 2007, Jagadamma 2009)
Tuning/ Optimising AFO’S - AFOFC
3. Jointed A.F.O.[edit | edit source]
Prescription Criteria For A Jointed A.F.O.[edit | edit source]
- ROM in ankle joint
- Tendency to valgus
- Tendency to varus
- Tendency to Crouch
Prescription criteria for Jointed AFO and DAFO/SMAFO[edit | edit source]
- Hyper mobile foot/ankle
- Ankle to plantargrade
- Medio-lateral instability
In Conclusion