Lower extremity orthoses

- Foot orthoses ( FO )
▪ Inframalleolar foot orthoses
▪ UCBL
▪ Supramalleolar foot orthoses
▪ Supramalleolar orthoses (SMO)
▪ Dynamic AFO (DAFO)
- Ankle-foot orthoses ( A F O )
▪ Solid AFO
▪ Hinged AFO
▪ Ground force AFO ( GRAFO )
▪ Reflex AFO (Posterior leaf spring-
PLSO)
- Knee-ankle-foot orthoses ( KAFO )
- Hip-knee-ankle-foot orthoses (HKAFO)
AFO
Ankle-foot orthosis is a brace, usually plastic, worn on the lower leg and foot to
support the ankle, hold the foot and ankle in the correct position,
and correct foot drop.
Purpose:
To control alignment and motion of the joints of foot and ankle.
For patients affected with muscular dystrophy, cerebral palsy, etc.
Construction:
Consists of a shoe attachment, ankle control, uprights and a proximal leg
band.

Controls the alignment and motion of the foot and ankle

Applies a three- point pressure system

TYPES OF AFO
o Static AFO
o Dynamic AFO
o Supramalleolar Orthosis
o Tone reducing Orthosis
o Floor reaction Orthosis
o Posterior leaf spring Orthosis
Types of AFO
• Dorsiflexion assist AFO:
− In case of moderate foot drop.

• Plantar flexion assist AFO:

• Posterior leaf spring AFO:
• Patellar tendon bearing AFO:
• Spiral AFO:
• Solid AFO:
− In case of severe foot drop.

Leather and Metal AFO Plastic AFO

* Non-articulated • No edema
• Edema • No sensory deviation
• Sensory deviation • Paralysis
• Paralysis

* Articulated Same as above except

• Weakness brought about by an orthopedic or neurologic problem

STATIC AFO
DYNAMIC AFO

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

Ankle-Foot Orthoses (AFOs)

Metal AFO
Auxillary Controls
o Varus/Valgus Control Strap
o Controls varus or valgus of rearfoot during
Uprights
o Aluminum -lightweight
o Stainless Steel -Strong
Stirrups
o Solid - stability
o Split – shoe Change
Ankle Joints
o Dorsi-flexion Assist

UCBL Orthosis
Indication subtalar joint instability.
− Controls flexible rearfoot valgus o r varus as well as forefoot abduction or
adduction.
− Holds the calcaneus & supports the midfoot with high medial
and lateral trim lines.
− It realigns the calcaneus, improving the angle of pull of the
Achilles tendon.
− Provides a more stable foundation for the articular surfaces of
the talus, navicular & cuboid bones.

Supramalleolar Orthosis (SMAFO)

− Corrects the ankle position; mainly used in valgus deformation
− Allows full plantarflexion and dorsiflexion.

Supramalodar Orthos SMO

− Increase ankle stabily
− Supportarches f the foot
− Improve lignment
Rigid Ankle-Foot Orthosis (Rigid AFO)
• Correction equinus
• Equinus & valgusdeformity: Rigid AFO (pp or carbon)
• May be used to stimulate knee flexion.

Floor Reaction Orthosis FRO Hinged Ankle-Foot Orthosis (Hinged

• Correct knee-flexion to knee-extension AFO)
Allows some ankle movement.

Articulated or Hinged AFO:

The adjustable ankle hinges can be set to the desired range of ankle dorsiflexion or
plantar flexion.

Hinged Ankle Foot Orthosis

▪ Indicted for resist the excessive planter flexion & dorsi-flexion.
▪ Control the suitable planter flexion at early
stance phase.
▪ Control the suitable dorsi flexion at swing
phase.
▪ Also control the valgus and varus moment.

Commercially DF Assist Designs

• Carbon fiber design (Off Shelf)
• Lighter than thermoplastic braces
• Designed to assist anterior compartment weakness
• Cushioned anterior shank designed
• Assist first rocker of gait
• Minimal assistance medial and lateral
• Minimal ground reaction assistance

Solid Plastic AFO

o Holds the ankle in as close to optimal static alignment as possible.
o Mediolateral ankle stability i s a result of trim lines at the midline
of the malleoli.
o The high medial border a t the foot and the slight flaring just
proximal to the medial malleolus is used to counter act an
abnormal, flexible subtalar valgus.
o The crossed Velcro strap anterior to the ankle helps position the
rear foot appropriately within the heel section of the orthosis,

Posterior Leaf Spring AFO

o The posterior position and arc of the trim lines at the ankle, as well
a s the thickness of thermoplastic material used, determine t h e
degree of flexibility of the posterior leaf spring AFO.
o Support the weight of the foot during swing phase as a means of
enhancing swing limb clearance .
o Assist with controlled lowering of the foot during loading response
in stance as
o part of the first/heel rocker.

Thermoplastic AFOs
- Tone-reducing AFO (TRAFO):
o The broad footplate Is used to provide support around most of the foot,
extending distally under the toes and up over the foot medially and laterally to
maintain the subtalar joint in neutral foot position and hyperextending the
toes.
o The TRAFO is Indicated for patients with spastic hemiplegia.
Spiral AFO
A molded plastic AFO that winds (spirals) around the calf; provides
limited control of motion in all planes.

hermoplastic AFOs
-Spiral AFO:
o This AFO consists of a shoe insert, a spiral that starts medialy, passes around the
leg posteriorly. then passes anteriorly to terminate at the medial tiblal
flare where a calf band is attached.
o The spiral AFO allows for limited rotation in the ankle transverse
plane while controlling ankle dorsiflexion and plantar flexion, as well
as eversion and inversion.
o These orthosis are indicated in the presence of weal ankle dorsiflexors
or plantar flexors with moderate mediolateral instability & mild
weakness of knee extensors.
o They are contraindicated in pronounced imbalance of forces acting on
the foot-ankle complex, moderate to severe spasticity, severe
mediolateral Instability & fixed ankle deformity.

Patellar Tendon Bearing (PTB) Fracture Brace

• It decreases the amount of a person's weight being placed on their
bones, joints and tissues and can also immobilise painful joints of the
foot.
• It permits joint mobility and early return to normal activities.
• It is used for tibia and fibula fractures.
• It allows movement of adjacent joints (Knee, Ankle and Foot).
• It helps to increase blood flow, ontogenesis and function.

KAFO: METAL DESIGN

Components:
•AFO
•Two metal uprights
•Mechanical knee joint
•Two thigh bands
KNEE ANKLE FOOT ORTHOSIS (KAFO)
KAFO extends from thigh to foot and may be used to control motion and
alignment of knce and ankle or provide support to femur/tibia or both
Indications.
o Muscle weakness
o Lower mofor neuron lesions
o Lass of structural integrity

Knee Orthoses could help!

A Knee Orthosis is a brace worn to
• Protect
• Correct
• Unload
• Realign the knee.

Principle
• Three point pressure Principle
Types of knee joints
• Free motion knee joint: allows unrestricted flexion & extension.
• Off-set k n e e joint: the hinge is located posterior to the knee joint
stabilize knee during stance.

Knee joints in lower limb orthoses

Single axis knee joint
o Restriction in hyperextension
o Drop lock
o Variant- Posterior offset type
Stance control knee joint
o No flexion during weight bearing
 ORTHOTIC KNEE JOINT
Polycentric Knee Joint Posterior Offset Knee
Straight Set Knee Joint
- Uses a double-axis Joint
- Allows free flexipn but
system to simulate the - For patients with weak
prevents hyperextension
flexion - extension knee extensors.
- Used in combination
movements of the femur - Allows free flexion &
with a drop lock, which
and tibia at the knee joint. extension of the knee
ceeps the knee in
- No proved advantage, during the swing phase of
extension throughout all
adds bulk & used in sports gait
phases of gait .
knee orthosis. - Helps keep the orthotic
GRF in front of the knee
axis for stabily .

Knee orthosis
Swedish knee cast 3-way knee stabilizer Extension knee orthosis
orthosis Similar to Swedish knee It consists of two long metal
For angular motion in cage orthosis but has upright providing thigh and
the frontal and sagittal more pivotable strap calf cuffs
plane attachment To protect the knee against
For mediolateral
mediolateral force
stability
Specialized Knee Orthoses (KO)
Swedish Knee cage:
• provides mild control for excessive hyperextension of
the knee
Patellar stabilizing braces:
• Improve patellar tracking; maintain alignment
• Lateral buttress o r s t r a p positions patella medially
• A central Patellar cut-out may help positioning a n d minimizes compression

Hinge knee brace (KO)

Supports knee laterally throughout the knee range
Indication:
•Knee instability due to med. & lateral ligament injury
• Post operative Rehabilitation

KAFO (Knee Ankle Foot Orthosis)

• Encompass the knee and ankle
• whole foot or part of the foot.
HKAFO (hip-knee-ankle-foot orthosis)
• Mainly KAFOs that extend across the hip joint connecting to a pelvic
band
• Trunk stability is required, lumbar or thoracic spinal support
HIP KNEE ANKLE FOOT ORTHOSIS
INDICATIONS
• motor neuron disease
• central nervous system
• joint disease
• Congenital or acquired deformities of limbs
FEATURES AND BENEFITS
• strong support
• God adjectivity
• high stability
• Wide range of applications

A reciprocating gait orthosis (RGO)

A reciprocating gait orthosis (RGO) Is also a HKAFO however it allows one leg to be
placed ahead of another
- more like normal walking. This is achieved by linking the
two KAFOs together by a band, two cables or a push-pull rod
which transfers movement energy from one leg to the other
(see diagram). Therefore, as one leg is flexed or brought
forward, it causes a reciprocal extension of the other leg. This
allows a much smoother gait and greatly reduces the amount
of effort that is needed to walk. A walker can often be
abandoned for forearm crutches.

The RGO is commonly used for individuals with a lesion level

of T12 to L3 (although higher levels are possible) who lack
adequate strength to maintain hip extension.
Good upper extremity strength, high motivation levels, good family support and
minimal contractures definitely contribute to t h e successful use of t h e device

EXOSKELETON
It is a gait training device developed for Rehabilitation treatment for
patients with lower limb walking disorders. It is an innovative, wearable
Robot product that can be installed and utilised without restriction of
space and helps in complete or partial gait restoration as well as
improvement of social and emotional condition of patients.
The exoskeleton provides with the possibility of not only getting back on
their feet, but also with the vision of being able to gain full motor
function
Exo Rehabilitation is a combination of training with exoskeletons with
other rehabilitation methods, such as physiotherapy, which leads to the
fastest complete or partial gait restoration, as well as improvement of
social and emotional condition of patients.

Gait Analysis and Robotic Therapy (locomote)