An orthosis is an external device that is applied to the body to improve function, provide support, reduce pain, correct deformities, and prevent progression of fixed deformities. Lower limb orthoses include foot orthoses, ankle-foot orthoses, knee orthoses, knee-ankle-foot orthoses, and hip-knee-ankle-foot orthoses. The goals of lower limb orthoses are to maintain or correct body segment alignment, assist or resist joint motion, provide axial loading and relieve distal weight bearing forces, and protect against injury. Orthoses can be static devices that hold body parts in position or dynamic devices that facilitate motion.

1. LOWER LIMB
ORTHOSIS

2. • An orthosis is an external device applied or
attached to a body segment to:
 improve function by controlling motion
Providing support through stabilising gait
Reducing pain through transferring load to
another area
Correcting flexible deformities
And prevent progression of fixed deformities.

3. Some basic goals of orthosis
• Maintenance or correction of body segment
alignment
• Assistance or resistance to joint motion
• Axial loading of the orthosis & therefore relief
of distal weight bearing forces
• Protection against physical insult

4. Locomotion and gait
• The total mass of the body can be considered
concentrated at one point, called the center of
gravity.
• The center of mass is located in the midline, just
anterior to the second sacral vertebra while the
individual is standing and walking.
• The center of mass changes with the
configuration and function of the body.

5. • The line of gravity is a line passing through the center of
gravity to the center of the earth.
• This line (1) arises from the supporting surface between
the ball and heel of the foot, then (2) passes in front of
the ankle and knee joints and slightly behind the hip joint
to the center of gravity, then (3) passes through the
lumbosacral junction and behind the lumbar vertebral
bodies to intersect the spine at the thoracolumbar
junction, then (4) continues in front of the thoracic
vertebral bodies and through the cervicothoracic
junction, and, lastly, (5) travels behind the cervical
vertebral bodies to the occipitocervical junction.
• When the center of gravity does not fall through the area
of support, it is unstable at that moment.

6. • The average total displacement of the center of
gravity in the vertical and lateral directions is
less than 2 inches in normal gait. The increase in
displacement of the center of gravity increases
the amount of energy for walking.
• 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.

7. • 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

8. • 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. Most orthoses use
a 3-point system to ensure proper positioning of
the lower limb inside the orthosis.
• 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

9. Lower limb orthoses
• FO foot orthosis
• AFO ankle foot orthosis
• KO knee orthosis
• KAFO knee ankle foot orthosis
• HKAFO hip knee ankle foot orthosis
• HO hip orthosis

10. Foot orthosis
• When foot cannot attain neutral, FO may shim
the gap to that fixed position-
Accommodative FO
• May help the foot attain a neutral position-
Corrective FO
• Either may unload compromised tissue; or may
provide total contact
• May be full custom or Off The Shelf (OTS)

11. UCBL
• University of California Biomechanics
Laboratory (UCBL)
• Rigid plastic total contact design
• Hind foot / mid foot correction
• Heel cup extends proximal to inframalleolar
area and distally to the metatarsal heads

12. AFO
Most common orthosis
1. Metal bars
2. Total Contact
3. Floor reaction
4. Unweighting
5. Immobilizing
▫ Most AFO’s can be articulating or non-
articulating
• STABILIZES ANKLE IN STANCE
• HELPS CLEAR TOE IN SWING
• GIVES SOME PUSH OFF IN LATE STANCE TO
SAVE ENERGY

13. SMO
• Supra Maleolar Orthosis
• Low profile design that crosses the ankle
• Less invasive trim lines than a standard AFO

14. Metal bars
• Commonly used in specific scenarios
▫ i.e. Post-Polio, Neuropathic feet

15. Total Contact AFO’s
• provide sleek, intimate fit with total contact to
provide better control
• Subtypes are thermoplastic and thermosetting
• higher patient acceptance possibly due to light
weight & concealment (150-200gms);
• more common today

16. Floor reaction AFO
• Uses floor reaction force through toe aspect of
foot plate to prevent forward tibial progression &
subsequent knee collapse;
• May be articulated

17. Unweighing AFO
• May be patella tendon bearing (PTB), specific
weight bearing or total surface bearing, TSB
(inverted cone with lace closure) to unweight the
ankle foot using prosthetic principles

18. Immobilising AFO
Commonly used with a lower extremity deficiency when ankle
immobilization is desired
▫ distal tibia/ fibula fracture
▫ foot bone fractures
▫ tendocalcaneus rupture
▫ Diabetic Foot (Charcot Foot)
Crow Walker CAM Walker
AFO for Fracture
Management.

19. Articulated or non articulated
• May be designed for progressive increases or
decreases in sagittal plane ROM and control
• An articulating option may be available in many
designs of AFO’s

20. Nonarticulating(solid ankle) Articulating

21. Knee orthoses
• Useful for malalignment
▫ genu varum,
▫ valgum,
▫ recurvatum,
• to protect knee structures from
undue loading/stress
• Extends above and below knee
joint.
• may be preventative or corrective
• may be permanent treatment for
repaired/compromised knee
structures
Photo of a patient with Genu
Recurvatum courtesy of Westcoast
Brace & Limb

22. Several types of KOS
• Athletic KO-
• Non-articulated KO-
• Custom or OTS KO-

23. Athletic ko
• Preventative.
• Controversial as short lever arms may not be
sufficient to diminish realistic damaging forces.
• Proprioception thought to play a role.

24. Off-the–shelf KO
• Offers limited control of the knee.
• Restricts gross motion
Dynamic Extension assist KO to
prevent contractures

25. KAFO
• Indicated when lesser devices are
biomechanically insufficient;
• Combines KO & AFO

26. Subtypes
▫ Single/Double bar (upright) KAFO-
▫ Total contact KAFO-
▫ Ischial Weight Bearing (unweighting) KAFO-

27. Single/Double Bar KAFO-
▫ Accommodates volume fluctuation,
▫ Cooler than total contact,
▫ Highest material strength.
▫ Several lock options.
 Lock for ambulation, unlock for
sitting.
▫ May incorporate hyperextension
stops.
▫ Various knee joints are available
 e.g. Weight activated stance control,
locking, polycentric, single axis,
extension assist, etc.

28. Total contact KAFO
• More customizable.
• Better load distribution.
• Includes Sarmiento Style
Fracture Bracing

29. Ischial Weight Bearing (unweighting)
KAFO-
• Ischial containment or
Quadrilateral style brims with
high trimlines.
• Generally used with paralytic
limbs.
• Not as effective with larger or
obese individuals.

30. HKAFO
Hip Knee Ankle Foot Orthosis
• 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

31. Specific HKAFO: Reciprocating Gait
Orthosis (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.

32. Hip arthroses
• Hip Abduction Orthosis
• Standing Walking AND Sitting Orthosis
(SWASH)
• Some Orthoses can intervene at the hip without
crossing the hip. Select examples:
Dennis Brown Bars
A-Frame Orthosis

33. Hip abduction orthosis
• Commonly used post-operatively to position the
femoral head optimally within the acetabulum
Hip Abduction orthoses can be an HO
only or can have a KAFO extension.
www.pelsupply.com

34. Specific Case Hip Orthosis (HO):
S.W.A.S.H Orthosis
 Standing Walking And Sitting Hip Orthosis
 Maintains femoral abduction in standing,
walking and sitting

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