Orthotics and Devices

• Located posterior to the metatarsal heads
• Takes pressure of the metatarsal heads onto the metatarsal shaft
• Allows more push off

• Cushions and absorbs forces at heel contact
• Relieves strain on plantar facia

Semi rigid plastic insert molded to correct for pes planus

Used to support the longitudinal arch

Heel wedge with an extended anterior medial border used to support the logitudinal arch for flexible pes planus

Used to limit or control eversion of the calcaneus and IR of the tibia after heel strike

Controls calcaneus and subtalar joint that are excessively inverted and supinated at heel strike

Controls forefoot varus

Controls forfoot valgus

• Limits ankle DF
• If it is set to allow slight DF knee flexion results, can be used to control knee hyperextension

• Limits PF of the ankle
• If the AFO is set to allow slight PF Knee extension results, used to contol an unstable knee

• Lateral trunk bending: Weak glute med. Lateral bending to side of weakness
• Backward trunk lean: Weak glute max, difficulty going up stairs or ramps
• Forward trunk lean: Weak Quads, Hip and knee flexor contractures
• Excessive hip flexion: Weak hip extensors or tight hip/knee flexors
• Limited hip extension: Tight or spastic hip flexors

• Excessive knee flexion: Weak quads or flexor contracture, too much DF in AFO. Difficulty going down stairs or ramps, may see forward trunk bending
• Hyperextension: Weak quads, PF contracture, Extensor spacticity, Too much PF in AFO

• Toe first: Toes contact at heel strike, weak DF, Tight PF, Shortened leg length, Painful heel
• Foot Slap: Weak DF or Hypotonia
• Foot flat: Entire foot contacts ground as a result of weak DF, Dec ROM, Immature gait pattern
• Excessive DF and uncontrolled motion of the tibia: Weak PF
• Excessive PF: Heel does not touch ground, Spacticity of the PF, Poor eccentric contraction and advancement of the tibia
• Supination: Spastic inverters, Weak everters, Pes Varus, Gunu Varum
• Pronation: Weak inverters, spacticity, Pes Valgus, Genu valgum
• Toe claw: Spastic toe flexors, hyperactive plantar grasp.
• Inadequate push off: Weak PF, decreased ROM, pain in the fore foot

• Insufficient forward pelvic rotation: Weak abdominals, weak flexors.
• Insufficient hip and knee flexion: Weak hip and knee flexors: Inability to lift leg and move it forward
• Circumduction: Weak hip and knee flexors
• Hip Hiking: Compensation for weak hip or knee flexors, or extensor spacticity.
• Excessive hip and knee flexion: Compensatory responce to a short leg, weak DF

• Insufficient knee flexion: Extensor spacticity, pain/dec ROM, weak hamstrings
• Excessive knee flexion: Flexor spacticity, flexor withdrawl reflex.

• Foot drop: Weak DF/ Spactic PF
• Varus or inverted foot: Spastic inverters, weak peroneals, abnormal synergistic pattern
• Equinovarus: Spacticity of posterior tib and or gastroc soleous, developmental abnormality

• Patient leans towards orthotic side during stance phase.
• Causes: KAFO medial upright too high, insuffient shoe lift, hip pain, weak or tight abductors on the orthotic side, short leg, poor balance

Causes: Locked knee, excessive PF, Weak hip flexors or DF-These could also cause vaulting.

• Patient leans forward during stance.
• Causes: Inadequate knee lock, weak quads, hip or knee flexion contracture.

• Inadequate hip lock
• Weak glute med
• Knee ankylosis

• Inadequate PF
• Inadequate knee lock
• Poor fit of calf band
• Weak quad
• Loose knee ligaments
• Extensor spacticity

• Excessive knee flexion during stance
• Inqadequate DFstop, Inadequate knee lock, knee or hip flexion contaction, weak quads, knee pain.

• Foot hits ground too early in stance
• Inadequate DF assist, Inadequate PF stop, weak DF

• Inadequate PF stop
• Inadequate DF assist
• Inadequate heel lift
• Heel pain
• Extensor spacticity
• Pes Equinous
• Short leg

Inadequate longitudinal arch support, Pes Planus

• Transverse plane malalignment
• Weak Inverters
• Pes Valgus
• Genu Valgum

• Transverse planemalalignment
• Weak everters
• Pes Varus
• Genu Varum

• Ridgid cast
• Plaster of paris is fabricated
• Promotes early WB
• Limits swelling and pain

• Long Prosthesis
• Locked Knee
• Small or loose socket
• Inadequate suspension
• Foot PF
• Abduction contracute
• Poor knee control

• Medial wall discomfort
• Long prosthesis
• Low lateral wall
• Tight hip abd

• Patient rises up on sound leg
• Prosthesis too long
• Inadequate suspension
• Socket too small
• Prosthetic foot in too much PF
• Too little knee flexion

• Bend towards prosthetic side
• Low lateral wall
• Short prosthesis
• High medial wall
• Weak abd
• abd contracture
• hip pain
• short amputation limb

• Unstable knee
• Short amb aids
• hip flexion contracture

• Insufficient support from ant and post walls
• Painful isheal WB
• Hip Flexion contracure
• Weak hip extensors or abdominals

• Inadequate knee friction
• Too little tension on extension aide

• Prosthesis comes to a stop as the knee extends durng late swing.
• Insufficient knee friction, too much tension on extension aid.
• Fears of knee buckling
• Forcefull hip flexion

• Named for the heel direction
• Rotated socket
• knee bolt is rotated
• foot is malaligned

• Socket aligned too far forward or tilted ant
• PF bumper too hard
• High heel shoe
• Knee flexion contracture
• Weak Quad

• Socked aligned too far back or tilted post
• PF bumper or heel cusion too soft
• Low heel shoe
• Weak quad

Foot inset too much

Foot outset too much

• Socket too far forward
• DF bumper too soft resulting in excess DF
• Prosthetic keel too short
• Knee flexion contracture

• Pt feels like they are walking uphill
• Socket too far back
• DF bumper too stiff causing excessive PF
• Long prosthetic keel