Lower Limb Orthotics

An orthosis is any device added to the body to stabilize or

immobilize a body part, prevent deformity, protect against

injury, or assist with function.

The purpose of using an orthosis is to enhance normal

movement and to decrease abnormal posture and tone. Lower

extremity orthoses can be used to correct abnormal gait

patterns and to increase the efficiency of walking.

Some Basic Goals of Orthoses

a. Maintenance or correction of body segment alignment

b. Assistance or resistance to joint motion

c. Axial loading of the orthosis & therefore relief of distal weight bearing forces

d. Protection against physical insult

An orthosis is classified as a static or dynamic device

- A static orthosis is rigid and is used to support the weakened or paralyzed body parts in a particular position.

- A dynamic orthosis is used to facilitate body motion to allow optimal function. In all orthotic devices, 3 points of pressure are needed for proper control of a joint.

Principles A lower limb orthosis should be used only for specific management of a

selected disorder. The orthotic joints should be aligned at the approximate

anatomic joints.

The orthosis selected should be simple, lightweight, strong, durable, and

cosmetically acceptable. Considerations for orthotic prescription should

include the 3-point pressure control system, static or dynamic stabilization,

flexible material, and tissue tolerance to compression and shear force.

Lower Limb Orthoses:

FO ( foot orthoses)

AFO (ankle foot orthoses)

KO (knee orthoses)

KAFO (knee ankle foot orthoses)

HKAFO (hip knee ankle foot orthoses)

HO (hip orthoses)

FO (foot orthoses)

FOs affect the ground reactive forces acting

on the joints of the lower limb

In case of pes planus or flat foot which occurs due to ligamentous laxity and may be treated with a medial longitudinal arch support for alleviating pain

In case of pes cavus or claw foot there is excess pressure along the heel and metatarsal head areas, which can lead to pain.

This can be prevented by making the height of the longitudinal support just high enough to fill in the space of the shoe and the arch of the foot to distribute weight more effectively.

University of California Biomechanics Laboratory (UCBL)

A custom made foot orthoses deigned to prevent hyperpronation

Rigid plastic total contact design

Hind foot / mid foot correction

Heel cup extends proximal to inframalleolar area and distally to the

metatarsal heads

AFO (ankle foot orthosis)

Most common orthosis Types:

1. Metal bars

2. Total Contact

3. Floor reaction

4. Unweighting

5. Immobilizing

Most AFO’s can be articulating or non-articulating

Metal bars: It is a U shaped metal piece permanently attached to the

shoe. Its 2 ends are bent upwards to articulate

with the medial and lateral ankle joints. The proximal

stirrup attachment sites are shaped to enforce the desired

movements at the ankle joint. Commonly used in specific scenarios

i.e. Post-Polio, Neuropathic feet

Total Contact AFO’s: Provide sleek, intimate fit with total

contact to provide better control Subtypes are thermoplastic and thermosetting types Higher patient acceptance possibly due to light weight More commonly used today

Metal bars

Total Contact AFO

Floor reaction AFO

Uses floor reaction force through toe aspect of foot plate to prevent forward

tibial progression & subsequent knee collapse

May be articulated

Unweighting AFO

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

total surface bearing.

TSB (inverted cone with lace closure) which is used to

unweight the ankle foot using prosthetic principles.

Immobilizing AFO Commonly used with a lower extremity deficiency when

ankle immobilization is desired

Such as: distal tibia/ fibula fracture

foot bone fractures

tendocalcaneus rupture

Diabetic Foot (Charcot Foot)

KO (knee orthoses) Useful in cases of misalignment

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 of KO’s:

Athletic KO

Non-articulated KO

Custom or OTS KO (Off-the-Shelf KO)

Athletic KO Preventative.

Controversial as short lever arms may not be sufficient

to diminish the damaging forces.

Non-articulated KO

• Usually for short term use

• In order to stabilize the knee

Off-the-Shelf KO

• Offers limited control of the knee.

• Restricts gross motion

KAFO Knee Ankle Foot Orthoses

Indicated when lesser devices are biomechanically insufficient

Combines Knee Orthoses & Ankle Foot Orthoses

Subtypes: Single/Double bar (upright) KAFO Total contact KAFO Ischial Weight Bearing (unweighting) KAFO

Single/Double Bar KAFO: Accommodates volume fluctuation,

Highest material strength.

Several lock options.

Lock for ambulation and unlock for sitting.

Various knee joints are available

e.g. Weight activated stance control,

locking, polycentric, single axis, extension.

Total Contact KAFO: More customizable.

Better load distribution.

Double bar KAFO

Single bar KAFO

Total Contact KAFO

Ischial Weight Bearing (unweighting) KAFO:

Ischial containment or Quadrilateral style brim with high trim lines.

Generally used with paralytic limbs.

Not as effective with larger or obese individuals.

Hip Knee Ankle Foot Orthoses (HKAFO)

Very restrictive and laborious to swing-to or through in gait

causing high rejection rates

Includes Reciprocating Gait Orthoses (RGO), total contact, leather and metal upright, postural and others

Specific HKAFO: Reciprocating Gait Orthoses (RGO)

Commonly used in cases of spina bifida and spinal cord injury.

Combines flexion of one hip with extension of the opposite hip.

The flexion power of one hip is utilized to extend the opposite hip.

Hip Orthoses (HO)

Hip Abduction Orthoses

Standing Walking AND Sitting Orthosis (SWASH)

Some Orthoses can intervene at the hip without crossing the hip.

S.W.A.S.H Orthosis: Standing Walking And Sitting Hip Orthosis

Maintains femoral abduction in standing,

walking and sitting

Hip Abduction Orthosis

Commonly used post-operatively to position the femoral

head optimally within the acetabulum

Orthopedic Shoes The healing shoe and surgical cast shoe/boot supports

the foot and surrounding muscles, joints and tendons to 

help stabilize fractures, ulcers and for postoperative management.

Accommodative Foot Orthosis helps treat those with

vascular diseases and diabetic patients who has lost

sensitivity in their feet.  The proper foot wear can help to

prevent sores and blisters that may lead

to a more serious condition.

Functional foot orthoses

Treats biomechanical issues such as plantar fasciitis,

hyper-pronation, types of tendonitis and other conditions

of the foot that cause pain or overuse of certain planes

of the foot or muscles and tendons.

Functional foot orthoses is used both as a preventative treatment and post injury treatment.

CTEV Shoes Modified shoes used once child starts walking with club foot

Consists of straight inner border to prevent forefoot adduction

Outer shoe raise to prevent foot inversion

No heel to prevent equinus

Congenital hip dislocation orthoses

Pavlik harness, Ilfeld splint and von Rosen splint are used

to maintain the hip in flexion and abduction position to

hold the femoral head within the acetabulum

Sequential Compression Therapy: These devices are placed around the limb that operative with intermittent compression to aid in controlling lymphedema and venous return. These are often used in hospitals following surgery to help prevent blood clots and aid in lower extremity circulation.

Compression Stockings: Compression stockings are

gradient stockings that help control edema/lymphedema

and aid in venous return.

Thank You