EASY WALK

A Project Submitted to UTKAL UNIVERCITY,

VANIBIHAR, BHUBANESWAR, ODISHA

IN PARTIAL FULFILMENT OF THE REQUIREMENT

FOR THE DEGREE
BACHELOR IN PROSTHETICS AND ORTHOTICS

SUBMITTED BY
Miss Harapriya Jena
Guide
Mr. Gourang charan Patro
( Prosthetist & Orthotist, SVNIRTAR)

SWAMI VIVEKANAND NATIONAL INSTITUTE OF

REHABILITATION TRAINING AND RESEARCH
 SEPTEMBER 2019

CERTIFICATE

This is to certify that to the best of my knowledge the project

entitled “EASY WALK” is the result of original work done
by Miss Harapriya Jena, final year, as per the course
curriculum and university requisites of final year examination
of Bachelor in Prosthetics and Orthotics degree conducted by
Utkal University, Vanivihar, Bhubaneswar, Odisha.

Date - _________ _________________________

Guide
Mr. Gourang Charan Patro
Prosthetist & Orthotist
S.V.NIRTAR
 DECLARATION

I hereby declare that the project entitled “EASY WALK”

embodies the original work done by me at Swami
Vivekananda National Institute of Rehabilitation Training and
Research, Olatpur, Cuttack. This work, in part or full has not
been submitted by anyone at any university to the best of my
knowledge and belief.

Date - _________ _________________________

Miss. Harapriya Jena
Final year, BPO
Roll. No. - 11
 DEDICATION

I dedicate this project work to my mother, Mrs. Sakuntala

Jena, who has offered unwavering support and encouragement
during the past few months of the journey. I would like to
offer my gratitude, for her support and counsel both
emotionally and financially, without which the work couldn’t,
came to real. You have been my best friend and the best
cheerleader I could ever have.

I would also like to thank my guide Mr. gourang Charan

Patro, for his support and valuable guidance which gave the
project work a proper direction to progress on. I have learned
so many things from him and still so many things yet to be
learned.
 ACKNOWLEDGEMENT

I am using this opportunity to express my gratitude to

everyone to support me throughout the course of this BPO
project. I am thankful for their aspiring guidance, invaluably
constructive criticism and friendly advice during the project
work. I am sincerely grateful to them for sharing their truthful
and illuminating views on a number of issues related to
project.

I would like to thank Dr. Shakti Prasad Das, DIRECTOR,

SVNIRTAR for giving me the permission to work on this
project.

I express my warm thanks to Mr. Srikant Moharana, HOD,

DPO, SVNIRTAR for his support throughout the study.
I am highly indebted to my guide Mr. Gourang Charan
Patro, Prosthetist & orthotist, SVNIRTAR for his
unwavering encouragement, valuable advice and expertise,
patience over many month of this study.

I would like to thank all the faculties and staff members of

DPO who helped me in shaping of this project with their
expertise.

Finally I thank all those who assisted, encouraged and

supported me during this research.
 CONTENTS

SERIAL NUMBER TOPIC PAGE NO.

1 Introduction
2 Aim and Objective
3 Review of Literature
4 Design, Material and
Methodology
5 Case study
6 Result and Discussion
7 Conclusion
8 References
 CHAPTER-1
INTRODUCTION
 The orthopaedic world has been divided into the ‘movers’ and the ‘resters’ in
the treatment of lower extremity fractures. But, in the past decades, the resters
predominated because it was thought necessary to immobilize fractures,
including the joints proximal and distal to the fractures, to insure fracture
healing.
Partially owing to the realization that joint function is improved with motion
rather than immobilization, the movers became prominent in orthopaedic sector
in more recent decades. The advantage of functional bracing of lower extremity
fractures in the 1960s has emphasized early weight bearing and early motions of
joints in the treatment of the lower extremity fractures. The basis for functional
bracing is that immobilisation of adjacent joints in a long bone fracture is not
necessary for fracture healing. By use of the soft tissue envelope surrounding a
fractured limb, functional bracing achieves fracture stability and controlled
motion, which enhances osteogenesis. Functional bracing uses compressibility
of the soft tissue envelope surrounding a fractured limb to provide psudo-
hydroulic environment that maintains fracture alignment and stability.

1.1 RELEVANT ANATOMY

TIBIA AND FIBULA
The tibia is known as the shin bone or shank bone, is the larger, stronger, and
anterior of fibula below the knee and it connects the knee with the ankle bones.
It is found on the medial side of the leg and is closer to the median plane or
central line. Tibia is connected to fibula by the interosseous membrane of the
leg, forming a type of fibrous joint called as syndesmosis with very little
movement. It is the second largest bone in human body next to femur. The tibia
is part of four joints; the knee, ankle, superior and inferior tibio-fibular joint.

The fibula or calf bone is located on the lateral side of the tibia. It is the
slenderest of all the long bones. It inclines a little forward, so as to be on a plane
anterior to that of upper end; it projects below the tibia, and forms the lateral
part of ankle joint.
 1Fig.

The tibio-fibular joints are the articulations between the tibia and
fibula which allows very little movement. The proximal tibio-fibular joint is
formed between the under surface of the lateral tibial condyle and the head of
fibula. The distal tibio-fibular joint is formed by the rough, convex surface of
the medial side of distal end of fibula, and a rough concave surface on the
lateral side of the tibia.

ANKLE JOINT
The ankle joints include three joints; the subtalar joint, the talocrural joint, and
the inferior tibio-fibular joint. The main bones of the ankle region are the talus,
the tibia and fibula. The talocrural joint is a synovial hinge joint that connects
the distal end of tibia and fibula with the proximal end of talus. The articulation
between the tibia and the talus bears more weight than that between the smaller
an that between the smaller fibula and the talus.
 1Fig.2 1fig.3
(ANTOMYFHEKLJI)

The ankle joint is bounded by many ligaments like the deltoid ligament, the
anterior and posterior tibio-fibular ligament, the calcaneofibular ligament etc. It
is surrounded by other necessary structures like the superior extensor
retinaculum, tendons of the anterior and poster group of muscles, their synovial
sheath, vessels and nerves etc. Mechanoreceptors of the ankle send
proprioceptive sensory input to the central nervous system. Muscle spindles are
thought to be the main type of mechanoreceptors responsible for proprioceptive
attributes from ankle

The role of ankle joint in locomotion is ankle push-off, which is significant

force in human gait. The movements produced by the joint are dorsiflexion-
plantar flexion of foot, occurring in the sagittal plane, adduction-abduction in
the transverse plane and inversion-eversion in the frontal plane. During a
normal gait cycle, the stance phase can be split into three sub phases based on
the sagittal motion of the ankle; 1) the heel rocker, 2) the ankle roker and 3) the
forefoot rocker. The heel rocker phase begins at heel strike, where the ankle is
in a slight plantar flexed position pivoting around the calcaneus (the
continuation of plantar flexion) until the end of the heel rocker phase when the
foot is flat on the ground. During this sub-phase the dorsiflexors are
eccentrically contracting to lower the foot to the ground. The ankle rocker phase
is where the ankle moves from plantar flexion to dorsiflexion during which the
shank (tibia and fibula) rotate forward around the ankle allowing forward
progression of the body. During the forefoot rocker phase, the foot rotates
around the forefoot phase, starting when the calcaneus lifts off the ground
evident by the ankle beginning to plantar flex and continuing until maximum
plantar flexion (approximately 14°) being achieved at toe-off, where power
generation is achieved for the leg to begin the swing phase. During swing phase
the ankle dorsiflexes enabling the foot to clear the ground and avoiding
stumbling/tripping, before returning to slight plantar flexion at heel strike. This
flexion motion is complemented by motion at the sub-talar joint, with
approximately 15° of eversion/inversion. For the majority of individuals,
inversion occurs at heel-strike, and progresses to eversion during mid-stance
phase, allowing the heel to rise and push off into swing.

1.2 FRACTURE
Distal tibial fracture
There have always been significant variances in the criteria for acceptable
alignment after a tibial fracture. Despite the multiple criteria for acceptable
alignment in tibial fractures, there are a few scientific data about the clinical
sequelae of malunited tibial fractures. Ankle impairment, both clinically and
experimentally, occurs more frequently than knee impairment with tibial
malunions. Also fractures with significant bone loss or tibial fractures in
patients unable to ambulate because of associated injuries are in general not
candidates for functional bracing.
Foot and ankle fracture
Treatment for broken foot depends on the exact site and severity of the fracture.
A severely broken foot or ankle may require surgery to implant plates, rods, or
screws into the broken bone to maintain proper position during healing.
Most of the ankle fractures depend on how severe they are, it takes 4-8 weeks
for the bones to heal completely and up to several months to regain full use and
range of motion of the joints. After the swelling decreases, and the patient is re-
examined, than the doctor may place a better fitting cast or splint on the ankle or
foot.
Depending on the type of fracture, one may be placed in a walking cast, which
can bear some weight, or one may still need a non weight bearing cast that will
require the use of crutches or other aids.
Calcaneal fracture
It is a break of the calcaneus and usually occurs when a person lands on their
feet following a fall from a height or during a motor vehicle collision. Diagnosis
is suspected based on symptoms and conformed by x-rays and CT scanning. If
the bones remain normally aligned, treatment is done by casting without weight
bearing for around eight weeks. If the bones are not properly aligned surgery is
generally required. Returning bones to their normal position results in better
outcomes.
About 2% of all fractures are calcaneal fractures. However, they make upto 60%
of the fractures of the mid foot bones. Undisplaced fractures may heal around
three months while more significant fractures can take 2 years. Difficulties such
as arthritis and decreased range of motion of the foot may remain. Non-surgical
treatment is for extra-articular fractures and sanders type-1 intra-articular
fractures, provided with closed reduction with or without fixation ( casting), or
fixation alone( without reduction), depending on the individual case. Displaced
intra-articular fractures require surgical interventions within 3 weeks of fracture.
Open reduction with internal fixation (ORIF) is usually the preferred surgical
approach when dealing with displaced intra-articular fractures.
Tarsal bones fracture
The tarsal bones of the foot are located in the midfoot and rearfoot areas. These
bones are also known as the tarsus collectively. There are seven bones within
this group: 1) Talus, 2) Calcaneus, 3) Navicular, 4) Cuboid, 5) Medial cuniform,
6) Intermediate cuniform, 7) Lateral cuniform.
Midfoot fractures and dislocations are relatively uncommon. They can have
significant associated long-term morbidity, however, accurate diagnosis and
appropriate treatment can help to decrease this morbidity. The general principles
of treating midfoot fractures are identical to other orthopaedic fractures. An
adequate reduction of the midfoot until satisfactory healing has occurred.
Displaced fractures often require surgery to reduce and fix. Stable fixation and
primary arthrodesis of smaller midfoot articulations often is required because
the ligament injuries associated with midfoot fractures can be debilitating.

1.3 POST OPERATIVE CASES

These include bony operation procedures of distal tibial, ankle and foot bones
due to some infection, inflammation or tumour. After the surgery, the
rehabilitation period comes where different braces, casts along with different
aids are prescribed for the recovery to normal gait. Some of the conditions are
as following,
Osteomyelities
It is an infection to bone. Bones can be infected in a number of ways like,
infection in one part of the body may spread through the blood stream into the
bone, or an open fracture or surgery may expose the bone to infection.
Along with medication, there are many managements are done like, debriment,
dead space management, ilizarov’s technuque and vascularised reconstruction.
After operation, the patient is not mobilized. But, during the rehabilitation
period, the patient cannot put whole body weight instead of some with a cane,
crutch or knee scooter in distal tibial and ankle infections.

Bone tumours
A mass of unusual cells growing in a bone is called bone tumour. Causes of
bone tumours include abnormal healing of an injury, inherited condition by
bone cancer or another cancer that has been spread to the bone from other part
of the body.
Different surgical procedures are done depending upon the stages like, bone-
grafting, arthrodesis, wide local excision etc. are processed on different stages.
After the medical procedure, one is not allowed to put weight on the affected
limb. A functional brace with an mobility aid or only wheel chair is prescribed.

1.4 COMMON FOOT AND ANKLE SPORTS INJURIES

Most people suffer from foot and ankle injuries in everyday life as well as in
sports. Athletes put a lot of strain and pressure on the joints of ankle and feet.
Some of them are,
Ankle sprain
These are very common in athletics and occur most often when a ligament in
the ankle tears. The tear is caused by the rolling of the foot under the leg or
ankle. It usually happens on the outside of the ankle and causes pain, swelling,
and bruising.
Treating ankle sprain promotes recovery and prevents further discomfort. It’s
important not to put weight on the injured area while recovering. For mild
sprains, home care can be taken like: using elastic bandages to wrap the ankle,
wearing brace for support, using crutches, putting ice etc. Surgery for sprained
ankle is rare. It may be performed when the damage to the ligaments is severe
and there is evidence of instability. The surgical options include: arthroscopy,
reconstruction etc. In most cases, an ankle isn’t serious and will completely heal
with proper treatment. The amount of time required for a full recovery will
depend on the severity. Most ankle sprains take a few weeks to heal and more
severe ones may take months.
Peroneal tendonitis
The peroneal tendons are located on the outside of the ankle behind the fibula,
and they control how a person moves the ankle to the outside .when these
tendons become enlarged and swollen, it’s called tendonitis. Repetitive use of
these tendons during sports activity causes pain and swelling.
Stress fracture
A stress fracture is a tiny crack in the bones from overuse. Tired muscles stop
absorbing the added shock of the repetitive movements, and that shock is then
distributed to the bone. The most common symptom of a stress fracture is pain
goes away when athlete rests.
Plantar faciitis
Plantar faciitis is a condition that causes inflammation and pain in the tissue that
connects the heel to toes. The pain occurs at the bottom of the heel when one
person gets out of the bed, when someone stands after sitting for an extended
period. Initially, the pain is mild, but gradually becomes worse. This commonly
causes stabbing pain that usually occurs with the first steps in the morning. The
diagnosis is made based on the medical history and physical examination.
Most of the people who have plantar facities recover with conservative
treatments, including resting, icing, stretching, in several months. Stretching and
strengthening exercises with specialized braces may provide symptoms relief
which includes, physiotherapy, night splints, off-the-self or custom fitted arch
support to distribute pressure more evenly.
Achilles tendonitis
The condition occurs when the big tendon that is tendoachilles becomes
swollen. This can be caused by an intense or repetitive activity. This causes
burning, swelling, enlargement and tenderness of the tendon.
Other then the sports injuries, some common lesions of foot and ankle are heel
pain, tendonitis and foot strains, which are common in day to day life. Most
these injuries need a cast or a crape bandaging with no or little weight bearing
through the affected extremity. For the ambulation, an axillary crutch or walker
is provided along with the cast or splint.

1.5 CONVENTIONAL SOLUTIONS

1.5.1 Tibial fracture brace
This is a protective device worn on the lower leg to aid in healing and alignment
of the injured bone. The brace promotes fracture healing by compressing the
soft tissue in the to limit its motion. It is imperative that the straps and plastic
shell stay tight over the tibia to allow for proper healing. The brace is treated
like a cast that is, it is worn full time. There are many types of fracture braces
are there, as
L code Types
L2102 Tibial fracture orthosis, plaster material
L2104 Tibial fracture orthosis, synthetic casting material
L2106 Tibial fracture orthosis, thermo plastic casting material
L2108 Tibial fracture orthosis, light weight plastic, molded to
patient model
L2114 Tibial fracture orthosis, semi rigid, rigid, custom fitted
The brace functions as,
One force system applies force around the entire circumference of the leg,
extending from knee joint to ankle joint. Another force system by containing
and compressing the soft tissue, creates hydrostatic pressure which provides
stabilization.
 Fig.1.4
1.5.2 Walking boot
A walking boot is a type of medical shoe to protect the foot and ankle after an
injury or surgery. The boot can be used for broken bones, tendon injuries, sever
sprains, or shin splints. It keeps the foot stable and keeps the weight of the
affected area off. It is different than fracture brace in forms of trimline, weight
bearing, and structure. The wearer only uses this while going for walk or
outdoor. Most of the boots have 2 to 5 adjustable straps and go up to mid of the
shin. One can walk in wet surfaces with specific designed boots. But, one have
to remove for bathing.
.
Fig.1.5
(WALKING BOOT USED WITH WALKER)

1.5.3 Crutches, canes and walker

Fig.1.6
(AXILLARY CRUTCHES USED WITH CASTING)
These devices are prescribed alone with injured leg or ankle having cast or
crepe bandaging and also as an axillary device with a fracture brace. It is least
expensive and light weight. They bear up to 40-50% of the body weight. It has a
single point of contact with the ground.
These walking aids serve to increase the size of an individual’s base of support.
It transfers weight from the affected legs to the upper body. There are many
designs and type of crutches are available according to the need and severity,
like axillary crutches, forearm crutches, gutter crutches etc. There are several
walking pattern which develop during the gait cycle while walking with these
devices.
1.5.4. Knee scooter
This is a two, three or four wheeled alternative to crutches or a traditional
walker as an ambulatory aid. It is also known as knee coaster, knee crutch, knee
cruiser, orthopaedic scooter etc. This device is suitable for outdoor, grass lane
and paved surfaces.
It creates a safe, comfortable and easy to manoeuvre alternative to the
traditional crutch. it is very light weight, foldable. With the flexed knee, it
supports the sin of the unstable knee. The opposite foot makes contact with the
floor, providing propultion. it is often used while the users recovers after
surgery or had broken leg or feet.

Fig. 1.7
(KNEE SCOOTER USED AS AXILLARY AID)
 CHAPTER-2
AIM AND OBJECTIVES
 Aim
 To provide a post-operative immediate weight relieving orthosis
 The orthosis is prefabricated and of universal design
 To provide hands-free mobility
 Design a immediate prefabricated device for temporary and easy
ambulation
 Eliminating the non weight bearing idea

Objectives

 To promote healing by weight relieving, which will enhance fracture

healing
 Easy ambulation
 To maintain joint range of motion
 Provide a device which doesn’t need any other axillary aids
 easy wear-ability and functionality
 decease stress on the affected part
 not only standing and walking, also provide a sitting option
 reduce strain on thigh and calf muscles
 increase the productivity of an injured person in everyday life
 CHAPTER-3
REVIEW OF LITERATURE
  Sarmento A, et al. 1989.
Reviewed results with functional bracing of tibial shaft fractures in adults
in order to define its role in management. Shortening of less than 5 degree in
any plane were our parameters for successful treatment. The average time
before applying a brace was 3.8 weeks for closed fracture and 5.2 weeks for
open ones. Varus angulations and posterior angulations were the most common
deformities encountered at the union. There is no association between fracture
healing and the patient’s age, the mechanism of injury or the fracture location.
Fracture comminution and initial displacement, the condition of fibula and the
from injury to bracing also appeared to affect the spread of union.
 A. Sermiento, A, et al. 1995
Functional fracture bracing, described in 1967, was inspired by the patellar-
tendon-bearing prosthesis which had recently been developed for below knee
amputees. The technique allows full range of motion to knee but immobilized
ankle but, shortly afterwards it was realized that inclusion of the ankle and foot
was unnecessary. This shows a low rate of non-union, no increase in shortening
of limb and angular deformities which were within acceptable levels.
Laboratory studies revealed that neither the patellar tendon nor the tibial
condyles participated in the avoidance of shortening. The soft tissues
surrounding the fracture, firmly compressed by the supporting walls of the
brace, prevented shortening and angulations by the principle of compressibility
of fluids.
 Lisa chin, MS
Foot and ankle injuries are extremely common among athletes and other
physically active individuals. Rehabilitation programmes that emphasize the use
of compression, reduction, therapeutic exercise to restore joint ROM and
walking with aids for various foot and ankle pathologies. When injuries to foot
and ankle occur athletes are limited in their abilities to run, jump, kick and
change directions. Thus, rehabilitation programme is crucial in weight bearing
and staging active in returning athletes to full ROM.
The patients, coaches and parents should have the mindset for the programme
and return to normal condition quickly or slow depends on the severity.
 john P. Cunha, DO, FACOEP, et al. 1999.
Since antiquity humans have fashioned support devices to hold themselves up
when they became sick or injured. For lower-limb injuries such as a broken leg,
broken ankle, sprained ankle and other injuries, as well as after surgery on the
leg, knee, ankle or foot, crutches remain useful today to decease discomfort,
reduce recovery time, and assist in walking. Often when you get a cast put on
for a period of time. Crutches may also be used by amputees, and people with
other disabilities that make walking difficult.
 Jane yeoh, MDFRCSC, et al. 2003

Patients use assistive devices to mobilize during periods of non- or partial-

weight bearing after lower extremity surgery or injury. The knee scooter has
86% of high satisfaction rates overally with low fall rate. There is an association
between fall and secondary factors like gender, age, duration of use, BMI.
 Kentaro Amaha, et al. 1988

Ankle fractures, even if treated surgically, usually take a long time to heal. For
all patients with ankle fracture, immobilization is a critical part of treatment.
Short leg walking boots have been reported to be an effective alternative to
plaster casts that could shorten this postoperative recuperative of a conventional
PC with that of a WB after surgery for ankle fracture.
 CHAPTER-4
METHODOLOGY
 Methodology is the systematic, theoretical analysis of the methods
applied to a field of study. It comprises the theoretical analysis of the body of
methods and principles associated with a branch of knowledge.
Tibial shaft fracture is usually treated with a cast and splint. A cast or splint will
immobilize the bone in order to encourage the bones to align and to prevent use
of the bones. In some cases when the bone is small, no cast is needed and the
fracture is immobilized by wrapping crape bandage. Traction may also be used
to stabilize and realign fractures. Traction uses a system of pullys and weights to
stretch the muscles and tendons around the broken bone. Like fracture, sprain
and strain have also similar kind of managements as,
R.I.C.E that is,
 Rest. Its import to rest the injured part to prevent further damage and
keep the weight off it.
 Ice. Using the ice will help to slow or reduce the swelling and provide a
numbing sensation that will ease the pain.
 Compression. Wrapping the injured part with an elastic bandage or off-
the-shelf compression wrap will help in keeping it immobile and
supported.
 Elevate. Elevating the injured part to at least the level of the heart will
reduce swelling and pain.
The RICE approach for several day until the pain and swelling is improved.
Physiotherapy for range of motion, strength and balance are done. A brace is
provided for support during activities.
Immediate casting is done for immobilization of affected part. These are made
up of PLASTER OF PARIS or fibreglass that can be easily moulded to shape of
the injured part.
Splints, we can also say half-casts, provide less support, but are faster and easier
to use. They also can be tightened or loosened easily if the swelling in the
affected part increases.
PROBLEMS
  Wearing a cast for too long can, in some cases, result in muscle atrophy,
loss of proprioception and incorrect activation pattern of muscles both
before and during movement.
 It increases load on the upper extremity, as with the cast, canes, crutches,
walkers are used for mobility.
 They can’t be removed daily for activities like bathing or physiotherapy
 Risk of injury is more in crepe bandaging
 In other kind of fracture braces, weight has to be put on the affected area,
which effects the alignment of the fractured bone or joints
 Stair case climbing and walking on ramps are difficult
 The need of axillary mobility aid is more in braces and cast which affects
the freedom of movement

4.1 DESIGN CONCEPT

This device is made on the concept of “HANDS FREE MOBILITY “for below
knee lesions. So, wearing this device one can ambulate freely without the need
of any axillary aids. No weight comes over the affected area, it is simply
transferred to the ground through the knee by the pylon and prosthetic foot.
To make it easy, for wearing regularly and in most of the time of a day, the
device provides knee flexion feature and easy wear-ability. Also, it
accommodates a wide range of sizes in a single piece with height adjustment
and flexible socket so that, it can be used temporarily by different persons with
different below knee lesions.
- As the device is a multi-purpose temporary kind, persons having many types
of below knee lesions can be benefitted by this. Here, a ankle sprain client was
taken for the fabrication of the device.
4.2 ASSESMENT AND EVALUATION
ON OBSERVATION- The client was reported to the hospital with his sprained
ankle on the right side, wrapped with a crepe bandage up to the mid-shank level
and with a elbow crutch.
ON PALPATION- The person was asked to remove the crepe bandage. There
was pain, redness and swelling at the ankle area along with foot.
ON EXAMINATION- The range of motion of knee and hip were normal.
Motion at the ankle was limited due sprain. Exaggerated pain was seen due to
passive motion of ankle.
4.3 MEASUREMENT
After assessment and evaluation, following measurements were taken.
1. TOOLS REQUIRED
-Measuring tape
-M-L calliper
-Outside calliper
-Marking pencil
-Steel ruler
-Measurement form
PROCEDURE
The client was asked to stand in a erect position and the following
measurements were taken and recorded on the form,
Longitudinal measurements-
1. Perineum to floor
2. Knee to floor
3. Length of the calf area, during flexion of the knee (for distal trim line)
Circumferential measurements
1. At the perinial area
2. Maximum thigh
3. Minimum thigh
4. At 2inches intervals
Width measurements-
1. M-L and A-P measurements at perineum
2. M-L at the femoral condyles and tibial condyles

4.4 CASTING
MATERIALS REQUIRED
-15cm. POP bandage
-Water
-Copying pencil
-Vaseline
-Casting socks
-Plaster cutter
-Leather strip
-Plaster scissors
PROCEDURE
After getting the permission of the client, a fair amount of Vaseline was applied
over the groin area (or, we can the client to it by himself) and the cast socks was
applied on the affected limb. Then, the important land marks were marked with
the help of a copying pencil with person in erect position. The important
landmarks are,

1. Adductor longus tendon

2. Greater trochanter
3. Perinial area
4. Femoral condyles
5. Tibial condyles
6. Outline of patella

The client was asked to stand straight and flex the about .
with a leather strip placed inside the socks, 15cm. POP bandage was saturated in
the water and was applied over the perineum going downwards towards the
thigh and knee up to the calf are and immediately pressure was applied over the
pressure tolerant areas. After the hardening of the negative cast, at the poster
aspect of the cast a vertical and some horizontal lines were marked over the
strip and with a cutter and scissors the cast was removed. The client was all
cleaned up and was discussed for the dates of meeting for the trial and other
problems if he does have any. The landmarks over the cast were strengthened
again and gone for pouring.

Before pouring cast rectification was done. According to the needs and
functions to be achieved the components and their materials were selected.
4.5 COMPONENT SELECTION

The device has the following components,

(Components are selected according to an average adult person)

 PROSTHETIC FOOT: A SACH (solid ankle cushion heel) foot
was selected of size-23R , as the length of the foot of the client.
There was no ankle joint movement was required so that, a solid
design will give required strength.
Fig.4.2
(PROSTHETIC SACH FOOT)

 ANKLE AND SOCKET ADAPTERS: The prosthetic below knee

(B.K) adapters were chosen for the attachment to the distal and
proximal end of the pylon tube. For the insertion of the pylon tube,
both of these have mm. slots and slits which ultimately
expand the slots by means of mm. screws. They also have
threading to receive the bolt of 10M. of the foot and socket
attachment plate.

Fig.4.3 fig.4.4
 (ANKLE ADAPTER) (PYLON TUBE)

 PYLON TUBE: An aluminium tube of mm. external and mm.

internal diameter was to be attached between the adapters. This
gives the means of height adjustment for specific clients.
 SOCKET ATTACHMENT PLATE: Made up of mild steel and
mm. width bar was to be attached between the socket and adapter.
It holds the socket medially and laterally and carries & transfers the
weight to the pylon. At the centre of its length, it has a mm. bolt
attached or welded to it for receiving the socket adapter and the
both ends receive the knee lower bars.

Fig.4.5
(SOCKET ATTACHMENT PLATE)

 ORTHOTIC DROP LOCK KNEE JOINTS, UPPER AND

LOWER BARS: Size-3   knee joints and bars were chosen to
acquire knee flexion activity. The knee upper bars with the socket
and lower bar with the socket attachment plate has to be attached.

Fig.4.6
(ORTHOTIC DROP LOCK KNEE JOINTS WITH BARS)

 THE SOCKET: A 15mm. thick thermoplastic polypropylene sheet

was taken for the fabrication of the socket through drape moulding.
As the casting is done with quadrilateral brim, this has to be made
first as a above knee socket and then modified.

(Fig.4.7. A, B, C, D)
(ANTERIOR, POSTEROIR, MEDIAL & LATERAL VIEW
OF THE SOCKET)
  ELASTIC AND STRAPS: inch elastic straps and 2inch hook and
loop straps were arranged for holding and flexibility of the socket.

Table 4.1

SERIAL COMPONENT MATERIAL DIMENTIONS

NO.
1. Prosthetic foot Wooden keel  Size-23

2. Ankle and socket Aluminium  Pylon slots-

adapters alloy 25mm.
 Foot and
socket
attachment
bolt
threading-
10mm.
 Adjustment
 screw-4mm.

3. Pylon tube aluminium  Inner

diameter- 20
mm.
 Outer
diameter-
mm.25
4. Socket attachment Mild steel  Bar width-
plate 2inch
 Bolt
diameter- 10
mm.
5. Orthotic drop lock Mild steel  Size- 3
knee joint &  Size- 3
bars aluminium
6. socket Polypropylene  Thickness-
sheet 15mm.
7. Elastic band  Width- 70
mm.
8. Hook and loop Plastic and  Width- 2
straps leather lining inch
 3. POURING

The distal end of the cast was sealed and wall of quadrilateral brim was
made along. Mixing POP powder with water, a slurry was made and
poured in to the negative cast which was placed inside the sandbox
before. A removable mandrel was put inside vertically at the centre.

1. MODIFICATION
TOOLS AND MATERIALS REQUIRED
-Flat and half round surform file
-Sharp knife
-Marking pencil
-Spatula
-Mixing bowl
-POP powder

Fig.4.11

PROCEDURE
The hardened cast was then placed horizontally and securely with a vice. The
outer POP bandage was removed by a sharp knife and all the landmarks were
strengthened again. According to the quadrilateral principle, the four walls were
modified with their measurements. At the distal end, some amount of material
was added on the patella and was made cylindrical for better functioning and
accommodation. Lastly the cast was smoothened with a wire-mesh and taken
for moulding procedure.
5. DRAPE MOLDING
REQIRED MATERIAL, TOOLS AND MACINES
-15mm. polypropylene sheet
-Hot air oven
-Vacuum pump
-Zig saw
-Above knee frame and clamps
-Sharp knife
PROCEDURE
Before moulding the hot air oven was preheated up to 240 degree Celsius.
During this, a by the help of a zig saw. The mould was placed upside down
over(distal end upwards) the vacuum platform. At appropriate temperature the
molten sheet was taken out of the oven when the sagging was about one-third
length of the mould and draped over the mould with the suction so that every
detail was contoured and transferred over the socket. Excess material was
removed and after cooled down the inside POP was removed.
6. TRIMMING
As the knee has to be placed in a flexed position, a window was made postero-
distally with the A-P measurement of the calf by drilling and cutting. The
quadrilateral brim was preserved proximally. For the flexibility, about 5mm.
width slits in the u-shape were cut at the centre of the four walls up to the two-
third length of the socket. Posteriorly the cut was merged in the window,
making an opening for the donning and doffing of the thigh in side the socket.
After that the edges were smoothened cleanly.
7. FABRICATION
REQUIRED COMPONENTS
- Prosthetic foot
- Ankle adapter and socket adapter
- Pylon
- Socket attachment plate
- Orthotic drop lock knee joint and side bars
- Control cable
- Pulley
- Cross bar assembly
- Cable adapters
- Copper reverts
- Foam cushion
- Elastic bands
- Hook and loop straps
- Press buttons
- D-rings
REQUIRED TOOLS
- Allen keys
- Hack saw
- Aluminium files
- Screw driver
- Steel ruler
- Hammer
- Player
- Scissors
- Vice-grip player
SPECIAL TOOLS USED
- Apparatus bending brace
- Bending iron
PROCEDURE
First of all, the foot- ankle assembly was made with attaching the foot with the
ankle adapter by the 10M bolt. Then, the knee joints were attached with their
upper and lower bars and reverted. The upper bars were bent according to the
lateral and medial contour of the socket with the apparatus bending brace and
fixed temporarily by the screws. Then keeping the centre of the knee joints with
the measurements and anatomical axis, some extra length was added below the
knee axis for the smooth flexion of the knee, preventing blockage of the socket
below, by the attachment plate. So, keeping the provision for the knee flexion,
the knee lower bar and the two ends of the socket attachment plates were bent,
according to the M-L measurements of the thigh and knee condyles, making it
almost like square and temporarily fixed by screws. Then, the pylon was cut
according to the length and the socket adapter was attached below the
attachment plate. The socket-assembly and foot-ankle assembly were aligned
together by placing the pylon between them and tightened.
8. BENCH ALIGNMENT
It was done on the work station. According to the measurements all the
placements were checked. In the linear alignment, the sagittal and coronal
placements of the components were seen. In transverse plane, the placement of
the foot was checked. In the extended and flexed position, everything is
thoroughly marked.
The path for the control cable was decided in this step. The cable adapters were
welded to the drop locks to receive the cable. The control cable was fixed to the
knee drop locks with the adapters. Then medially, the path was taken straight up
to the pulley and then its direction was changed towards control or pulling point
laterally. On the lateral side it was taken straight. At the connection point of the
two cables, a cross bar assembly was placed for the smooth function of
unlocking the knee joints.
9. INNITIAL CHECKOUT
It was done with the patient. The following things were checked,
- Height
- Proper fitting of the socket
- Easy donning and doffing
- Comfort during sitting
 Fig.412 Fig.4.13
(POSTERIOR AND LATERAL VIEW OF THE DEVICE)

10. FINAL FINISHING

After initial check out, a little bit alterations were done. In slits of the socket,
about five in number mm. elastic bands were attached for the flexibility of
the socket. Posteriorly, 2inch hook and loop straps were attached by press
button with the D-rings. Then, the socket with the bars and attachment plate
were fixed and tightened with the screws. Other components like the pylon,
adapters, foot and the attachment plate with the adapters were also tightened
with the screws, as they can be interchangeable and adjustable. The knee lower
bars and the socket attachment plates were fixed permanently with copper
riverts.
CHAPTER-5
CASE STUDY
5.1 CASE-1
DEMOGRAPHIC DATA
 Name
 Age
 Sex
 Address
 Occupation
MEDICAL HISTORY
 Date of injury-
 Cause of injury-
 How he/she arrived at the hospital
 Mechanism of the injury
 Any other previous injury or medication
PHYSICAL EXAMINATION
 On observation: - moderate swelling
- Instability
- reduced proprioception
- severe pain
 Joint range of motion[measured with gonimeter]: - Hip(normal on both
sides)
- Knee(normal on both sides
- Ankle - left side normal and
right side affected ROM due
pain
 Tests: - Anterior drawer test( for ankle instability)
- Prone anterior drawer test( for ligament instability)
- Talar tilt test( for integrity of the calcaneofibular ligament)
 - & others
 Radiography: shows stretched ligaments
DIAGNOSIS
- Grade-2 ankle sprain
PRECSRIPTION

Fig.5.1
- crepe bandaging
- a elbow crutch for ambulation
- RICE and cold compress( as selfcare)
- for swelling and pain, nonsteriodal anti-inflammatory drugs.
TREATMENT PLAN
while he was using crepe bandage and crutch about last 15 days of prescription,
the easy walk was introduced to him. So, with crepe bandaging on the affected
ankle, he wore the device and stood up without any axillary support. He was
asked to use it regularly with his ongoing treatment for about one month. He
wear it to his collage and other social places without hindering his active
lifestyle.

Fig.5.2 FIG.5.3

5.2 CASE-2
DEMOGRAPHIC DATA
 Name
 Age
 Sex
 Address
 Occupation
MEDICAL HISTORY
 Date of injury-
 Cause of injury-
 How he/she arrived at the hospital
 Mechanism of the injury
 Any other previous injury or medication
PHYSICAL EXAMINATION
 On observation: - pain
- soft tissue swelling
- ecchymosis
- expanding haematoma
 Diagnostic factors: - altered nerve sensation
- impaired motor function
- bony crepitus
- callus
 Investigation: - radiography
- CBC
- noncontrast CT scan
 test: - compartment pressure testing
DIAGNOSIS
- distal oblique fracture of fibula
PRESCRIPTION
 Fig.5.4

- closed reduction with casting

- a walker for indoor ambulation

- nonsteroidal anti-inflammatory drugs

- high calcium and proteinous foot intake

TREATMENT PLAN
 Fig.5.5 Fig.5.6

Fig.5.7

Along with the leg cast, he was asked to wear the easy-walk during his recovery
period. As he was advised to take rest at home, he can wear the device for his
indoor activities. Even after the cast was removed, he can wear it as his outdoor
aid during the rehabilitative period.
CHAPTER-6
RESULTS
 In this project, there are angles of benefits and limitations. The benefits of
the easy-walk over the conventional solutions are,
Advantages:
 Provides immediate means for ambulation after lesions
 Gives hands free mobility
 Have knee flexion feature for sitting
 Easy for stair case climbing and walking in ramps
 Can be wore with casts and braces
 No need to bent down to unlock knee
 Easy donning and doffing
 Increases independency
 Have a Flexible socket and height adjustment facility
 Can be prefabricated and used by different patients
 Durable and cost effective
 A single device can be used at hospitals for different patients during their
rehabilitative period
 It can be used a personal device at home and used by different family
members in different below knee lesions
 Easy for transportation
Some major draw backs of the design are,
Disadvantages:
 The adapters can’t bear more weight (more than 165 pounds)
 The flexed knee increases risk of injury
 Not for bilateral cases
 Cumbersome
 No movement at the ankle and foot can give rise to spasticity
CHAPTER-6
DISCUSSION
 The management of below knee lesions like fractures, ankle sprains
etc. as described before have many directional solutions, as per the need,
severity and accessibility. There are many options available till now including,
most conventional to the most recent designs and many are also used as
combinations for better results. All of these also don’t have same principles like,
some have principle of immobilization, some have mobilization and transfer of
weight and some have principle of compressibility. But, all these have a
common goal of rapid healing, immediate ambulation and better accessibility
without interfering or affecting the mobility in day to day life.

The problems people faces in all of these managements are areas,

 Rigid POP casts immobilize the leg for a long time
 The immobilization leads a high impact on thigh muscles along with the
knee joint
 Unusual strain develops on the lower body segments
 Most of the solutions leads to a non-weight bearing life
 Semi-rigid braces may give mobility without any aids but excessive
weight bearing may lead to mal-alignment of the bones and joints
 As many of them comes with a axillary aid( as canes, crutches, walker),
- Which are hard to walk with
- Navigating stairs on crutches and walkers are dangerous
- The underarms get bruised and rubbed
- These make the upper body part painful and fatigue
- If these are not measured and fitted correctly, irritation and soreness
may result
- Some times may result in shoulder, neck and back pain
- The canes uses sometimes come out with symptoms of carpal tunnel
syndrome
 Taking this study into consideration, we have taken an attempt to develop
a design which fulfils the above written common goals and simplify the
problems. The easy-walk is fabricated and aligned in such a way that, the
weight of the upper body is transferred to the ground by the knee through the
mechanical components pylon and prosthetic foot without affecting the injured
shank or foot. It utilizes the concept of above knee prosthesis along with
orthotic drop lock knee joints for the knee flexion feature, which provides good
outdoor and indoor wear- ability in everyday life.
The device lets the person get back to work more quickly and continue to lead
an active life. By using EASY WALK, one can easily keep up with everyday
cares like grocery shopping and laundry. One can carry things while walking.
Learning to walk with this device takes no time and one can walk in all weather
situations. This can be used after surgery to instantly bring back the everyday
mobility. Taking the cost effectiveness in mind, EASY WALK was fabricated
with very simple and cost effective components which don’t compromise with
the strength and stability of the device. One can easily afford it and get back to
his/her active day to day life quickly.
CHAPTER-7
CONCLUSION
 The easy-walk designed by us, resolves much of the functional need of
the patients with below knee lesions. This compact and modular design makes it
easy for the patient to use it on a daily basis. Though the system have some
drawbacks of breakage on heavy weight and chances of spasticity at the ankle
but, still the functioning, flexibility, hands free mobility and height adjustability
make it a easier option to choose in everyday living. It can be fabricated
commercially as a prefabricated walking aid like canes and crutches at a very
effective cost and can be made readily available for both rehabilitative hospitals
and for personal use at home in surgical stores.
Further modifications like,
- Getting a telescoping mechanism without hindering strength
- A good support for the shank and foot
- A horizontal support for the proximal portion of the calf
- A holding component or station for extra balance on the lateral side of thigh,
Can be added for seamless and comfortable using experience.

Still the design is one of the most cost effective options for below knee lesions
with all these features in present scenario.
CHAPTER-8
REFERENCES
1. Tibial shaft fractures treated with functional brace
-Sarmento A, et al. J bone joint surgeon BR. 1989, Department of
orthopaedics, university of southern California, school of medicine,
Los Angeles 9000F
2. The evolution of functional bracing of fractures
-A. Sermiento, L. Latta, The journal of bone and joint surgery,
British volume. 88-B, No.2
3. Rehabilitation of ankle and foot injuries in athelets
–Lisa chin, MS, ATC and Jay Hertel, PhD, ATC
4. Crutches
-john P. cunha, DO, FACOEP and Charles Patrick Davis, MD, PhD
5. Post-operative use of knee scooter after foot and ankle surgery, A
retrospective study
–Jane yeoh, MDFRCSC, David ruta,MD and Benjamin gaer, MD
6. Shorter recovery can be achived from using walking boot after
operative treatment of an ankle
-Kentaro Amaha, Asia-pecific journal of sports medicine,
arthroscopy, rehabilitation and technology