OF

LOWER LIMB


LOWER LIMB
By :- Menka singh

Orthosis is derived from ortho meaning
straight
Orthosis is a mechanical device fitted to
the body to maintain it in anatomical or
functional position
[1]
Calipers are orthosis fitted to lower
limb
[1]

Brace is a synonym


Prevent deformity
Correct deformity (not correct fixed bony
deformity or fixed joint contracture)
Maintain correction
Control instability
Relieves weight bearing (axial loading)
Facilities ambulation
Relieves pain
Assist function ( by assistance or resistance
to joint motion )

Lack of cosmesis
Limit mobility and ROM of the joint
Movement is usually limited to certain
direction
Weakness of other muscle in opposite
direction
Muscle atrophy with prolonged use
Increased segmental motion at end of the
orthosis
Psycological and physical dependency
MATELS such as :-
Stainless Steel
Aluminum
( leather used for straps)

carbon graphite :- offers strength and
low weight increased durability


THERMOSETTING
MATERIAL
Molded into
permanent shape
after heating
Do not return to
their original
consistency even
after re-heated

THERMOPLASTIC
MATERIAL
Fabricated easily
and rapidly with
hot water
Return to their
original shape
when dipped
again in hot water
Thermosetting meterial orthosis
Thermoplastic material orthosis
Foot Orthosis (FO)
Ankle Foot Orthosis (AFO)
Knee Ankle Foot Orthosis ( KAFO)
Hip Knee Ankle Foot Orthosis ( HKAFO)
Foot orthosis is boot ( shoes) that has
components like supports and wedges
to manage different foot symptoms and
deformities
FO used to :-
1. Accommodate foot deformity or
pressure lessions
2. Cushion the foot
3. Alter sensory input or realing foot
pressure
Part of shoes
University of california at berkeley
laboratory (UCBL) insert



Heel cup
Sesamoid insert
Shoe modification
2 types :-
1. External shoe modification
2. internal shoe modification


External heel
modification
1. Cushioned heel
2. Heel flare
3. Heel wedge
4. Extended heel
5. Heel elevation
external sole
modification
1. Roker bar
2. Metatarsal bar
3. Sole wedge
4. Sole flare
5. Steel bar

Internal heel
modification
1. Heel cushion relief
2. Heel wedge
Internal sole
modification
1. Metatarsal pad
2. Inner sole
excauation
3. Scaphoid pad
4. Toe cest
Arch support
Metatarsal pads
Insole
medial/ lateral
wedge
Heel wedge
Ankle foot orthosis is a hard brace worn on
lower leg to support ankle and foot


This keeps the ankle in neutral position
during walking and other daily activities
AFOs can be articulating or non-
articulating
Made of thermoplastic or Metal or
metal-plastic

Posterior leaf spring
Spiral AFO
Hemi spiral AFO
Solid AFO
AFO with flange
Hinged AFO
Tone- reducing AFO (TRAFO)



Posterior leaf spring
AFO
Solid AFO
PTB- AFO
Spiral AFO
In this ankle joint is fixed through the
stirrup

there are metal uprights ( medial &
lateral bars ) ascending up to the calf
region
Fixed ankle
90
0
foot drop

Free ankle
Limited ankle
Reverse 90
0
5 types of artificial ankle joint[1]
Combination of KO & AFO
It provides stability to knee , ankle and
foot
It consist a shoe , ankle control , knee
control and superstructure
1) single / Double bar ( upright) KAFO
2) Total contact KAFO
3) Ischial weight bearing ( unweighting)
KAFO
o Accommodate volume fluctuation
o Coolar than total contact
o Highest material strenght
o Several lock options ( lock for
ambulation , unlock for sitting)
o May incorporate hyperextension stops
o Various knee joints are available ( i.e
straight set knee joint , polycentric knee
joint , posterior knee joint)
Double bar ( upright) KAFO
Single bar ( upright) KAFO
More customizable
Better load distribution


Ischial containment or quadrilateral style
brims with high trimlines
Generally used with paralytic limbs
Not as effective with larger or obese
individuals
Ischial weight bearing ( unweighting) KAFO
Addition of a pelvic band and hip joint
convert the KAFO to an HKAFO
usual hip joint is a metal hinge that
connects the lateral upright of the KAFO
to a plevic band


the joint prevents abduction and
adduction and hip rotation
2) To reduce internal rotation , the strap resembles
a prosthetic silesion bandage


3) To reduce external rotation , the strap joints the
lateral upright of the KAFOs & passes anteriorly at
the level of the groin
















0
A two position lock stabilizes the patient
in hip extension for standing & walking &
at 90
0
degree of hip flexion for sitting



HKAFOs are not used very often
because they are much more awkward
to don KAFOs & if hip joints are locked
they restrict gait to swing to or swing
through pattern

1. S Sunder , ch- 7 orthosis , copy right@
2010
2. Selina yingqi xing , lower limb orthotics
and Therapeutic footwear , copy right
@ 1994-2012 by wedMD
3. ppt:- orthotics overview , U.S
Department of Education ,
Rehabilitation services Administion
4. Ppt:- orthotics & prosthetics , Dr Munir
saadeddin