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2. Walking Aids And
Orthotics
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3. Presenters:
Afifa Munaf
Jaweriah Mahmood
Fatima Bhutto
Presented to:
Sir Saad
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4. Walking
• walking together with its
variants is a skilled
coordinated action
which involves many
joints and muscles.
• The whole sensory input
is involved in walking
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5. Muscles involved in walking
• flexors and extensors of
the toes
• planterflexors and
dorsiflexors of the ankle
• flexors and extensors of
the knee and hip
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6. Walking Aids
• These are the appliances which may be a
means of transferring weight from upper
limb to the ground or which may be used
to assist balance.
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7. Continued..
Factors involved in choosing walking
aids:
• age of patient
• their disability
• general physical condition
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8. Walking Aids equipments
 The broad subdivision of walking aids
would be between:
• frames
• crutches
• sticks
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9. Walking frames
• Have very wide base
• Very stable
• Commonly used in
elderly
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10. Types of walking frames
• Rigid frames
• folding frames
• reciprocal frames
• forearm supporting frames
• wheeled frames
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11. Rigid frames
• It needs to be adjusted to
the correct height
• patient stand upright with
the elbows flexed at
approximately 15 degrees
• The frames should be of
light material i.e.
aluminum.
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12. Folding frames
• These frames are useful
if the patient is
regularly transported by
the car.
 Folding frames may
either be:
• three-legged
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13. Reciprocal frames
• Useful for those
patients who find it
difficult lifting a
traditional frame.
• It is hinged at the front.
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14. Forearm supporting frames
• These may also be
called pulpit or gutter
frames.
• They allow walking
training of patients
who has difficulty in
weight-bearing
through the upper
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15. Wheeled frames
• Most standard adjustable
height walking frames
• The front extension legs
are replaced with small
wheeled legs.
• They encourage a more
normal gait pattern
• They lack stability
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16. Rollators
• Have two fixed wheels at the front and two
ferrules at the rear.
• It is stable but not very maneuverable.
• Can be awkward in tight spaces and corners
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17. Walking patterns with a
frame
• patient lifts the frame forward
transfers their weight onto it
• takes two steps up to the frame
• keep the frame well forwards
• place all four legs of frame at a time on ground
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18. Crutches
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19. • A crutch is a mobility
aid that transfers
weight from
the legs to the upper
body.
• The muscles of the
arms, shoulders, back,
and chest work
together to manipulate
the crutches
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20. Categories of crutches
1.Axillary or underarm
crutches:
• These are usually
prescribed when nonweight bearing gait is
required
• The axillary top is
rested against the chest
wall while the bulk of
the patient’s weight is
borne through the
hands.
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21. 2.Elbow crutches or forearm
crutches
• These are the most
functional type of
crutches and are
• suitable for both non
and partial weight
bearing gaits.
• it consists of a metal
cuff and a handle fixed
at 97 degrees
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22. 3.Forearm/gutter crutches
• Useful for the
patients who are
unable to use
normal handgrips
• Velcro straps fix
the forearm into
the tough and
weight is applied
via the forearm
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23. Walking sticks
• Provide support for the
patients with good grip
and sound joints of the
upper limb
• Suitable for partial weight
bearing
• To be used in the contra
lateral hand in most cases
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24. Tetrapods/tripods
• These are four or three-legged sticks which
give greater stability than a traditional stick
• They are prescribed for the patient with poor
balance and confidence
• Commonly used by hemiplegic patients
• Quite heavy as compared with the sticks and
cant be used on stairs
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25. Tetrapod
Tripod
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26. Effects of walking Aids
•
•
•
•
•
Increases confidence
Relief of weight-bearing from affected leg
Psychological support
Relief of pain
Provides support
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27. Walking Aid Height
• Measure the height of walking aid, from the
ulnar styloid to the ground, with the patient
standing erect , shoulders relaxed & elbows
flexed to 15°.
• crutches must be settled at either 77% of
reported height or height minus 16 inches.
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28. Advantages of Contralateral Gait
• Reduce the force through affected leg
• Prevents tilting of the pelvis.
• Facilitates a reciprocal gait pattern.
• Provide stability as it has a greater BOS.
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29. Advantages of Ipsilateral Gait
• If used in the
dominant hand,
feels more natural.
• May limit
hip and knee
flexion.
• Subjectively feels
to offer more
support as it is
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30. Metabolic Cost of Walking Using
Walking Aids
• A swing through
gait with crutches
requires a very high
rate of physical
effort compared
with normal
walking.
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31. Continued..
• With time, crutch users become adapted so that
their energy expenditure & heart rate dec. as
they become habitual walking aid users,
suggesting the presence of both upper limb
conditioning & training response.
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33. Forces through the Upper limbs when using
Walking Aids
• If a person is utilizing a walking aid in a nonweight bearing or partial weight bearing
manners, then most of the body weight will
be transmitted through the upper arms via
the walking aid to ground.
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34. Continued..
• Such a gait style creates joint moment forces
on the shoulder of a similar magnitude to
those on the hip joint during non-aided gait.
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35. Pre-walking Exercise
Programmes
• As crutch walking
is a learned skill,
the patient must
demonstrate
adequate muscle
strength, balance
& co-ordination.
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36. Continued..
• The strength of the upper extremities can be
increased by weight-resistive exercises
graduated springs, the use of theraband &
PNF techniques, etc.
• Balance exercises can occur in bed or by
mat work.
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38. Gait Patterns with
Walking Aids
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39. Swing-to Gait
• In this gait both crutches are
brought forward together.
• The trunk & lower
extremities lean forwards, weight
is transferred to the upper limbs &
walking aids & both lower limbs
are lifted & swung forwards to the
level of crutches
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40. Continued…

41. Swing-through Gait
• Both crutches are
taken forward, then
both lower limb are
lifted & swung past
the crutches, so that
the crutches are left
behind the point
where the feet land
on the floor.
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42. Continued..
• This gait is most commonly used by those with
no lower limb control such as Spinal cord
injury patients.
• Unsuitable for those with painful lower limbs.
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43. Ipsilateral Two-point Gait with
One Stick
• Stick in the ipsilateral
hand is move forward,
together with the
affected leg.
• Followed by the nonaffected leg.
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44. Contralateral Two-point Gait with
One Stick
• Contralateral hand and
stick are moved,
together with the
affected leg.
• The weight is shared b/w
the stick and affected
side as the non-affected
leg is brought through.
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45. Three-point Gait
• It requires two walking aids, either crutches
or sticks followed by the affected leg then
unaffected leg.
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46. Continued..
• If a minimal weight-bearing gait is required,
e.g toe touching only, then a delayed three
point gait must be utilized where the
walking aid makes contact with the ground
before the affected leg touches the floor.
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47. Continued..
• Partial weight bearing is often prescribed in
orthopaedic conditions, with a gradual
progression on weight bearing over time.
E.g uncemented hip arthroplasty.
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48. Four-point Gait
• In this gait two walking
aids are used, one for
each leg.
• The right walking
aid is put forward,
followed by the left leg,
then the left walking aid
and the right leg.
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49. Continued..
• A Four-point gait is ideal for balance & as a
step to relearning a normal reciprocal gait
pattern.
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50. Reciprocal Two-point Gait
• It uses two sticks, right
leg and left stick being
placed on the ground
together, followed by
left leg and right stick.
• It provides a style of
walking that allows fast
walking speeds to be
achieved.
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51. Orthotics
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52. • Orthotics (Greek: ortho, "to straighten" or
"align") is a specialty within the medical field
concerned with the design, manufacture and
application of orthoses.
• An orthoses is a device applied directly and
externally to the patient’s body with the object
of supporting, correcting or compensating or
an anatomical deformity or weakness
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53. Uses of orthoses
• Control, guide, limit and/or immobilize
an extremity, joint or body segment
• To restrict movement in a given direction
• To assist movement generally
• To reduce weight bearing forces for a
particular purpose.
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54. Foot orthoses
• Foot orthoses are
specially designed
shoe inserts that help
support the feet and
improve foot posture
• the foot is the point at
which contact is made
with the ground and
reaction forces are
generated
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55. 1.Foot instability due to muscle
weakness or imbalance
A. weak supinators:
• On weight bearing, if supinators are weak it
will result in a pronated foot
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56. Corrective measures
• Usage of medial flares
• Wedge building into an insole
• Heel cup or a flexible insole
Heel cups
Medial flare
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57. B.Weak pronators
• A foot with a weak or
absent pronators will
adopt a supinated
position at foot contact.
 Correction:
• Valgus moment required
by a lateral flare or a
wedge
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58. C.Weak extensors/flexors
• Claw toes: it consists of
subluxation at the
metatarsophalangeal joint,
and flexion at the proximal
(and distal interphalangeal
joints)
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59. Continued….
• Hammer toes: plantar flexion deformity of the
proximal interphalangeal joint, the abnormal plantar
flexion of the distal phalanx may occur.
• Corrective measures includes Moulding using
polyurethane or silicone materials
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60. Continued….
• Metatarsalgia:it is a condition marked by pain
under the metatarsal heads
• You may experience metatarsalgia if you're
physically active and you participate in
activities that involve running and jumping
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61. Corrective measures
• An insole with either a metatarsal dome
or bar
• A metatarsal bar fixed to the bottom of
the shoe
• conservative treatments, such as ice and
rest
Metatarsal bar under
the shoe
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62. 2.Foot instability or deformity due to
structural
misalignments
• Structural misalignments are often
congenital and generally result in a foot
with mobile joints but function about
abnormal positions.
• Heel cup can be used to re align the foot in
children
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64. 3.foot instability or deformity due to loss of
structural integrity
• Pain may result from joint instability or
excessive motion
• The patient will try to avoid this pain by
changing the portion of their foot that they
present to the ground
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65. Heel pain causing diseases
Abnormal walking styles
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66. Pain relief measures
• Usage of shock absorbing insoles
• Flexible medial arch support
• Rose-parker insole
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67. Ankle-foot orthoses (AFO)
• An ankle-foot orthoses (AFO)
is a most common orthoses or
brace that encumbers
the ankle and foot.
• They are also used to
immobilize the ankle and
lower leg in the presence of
arthritis or fracture, and to
correct foot drop.
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68. Types of AFOs
1.metal and leather: these
have a leather covered cuff
band with metal bars
inserting into the heel of
the shoe
2.plastic moulded:
thermoplastic splints
moulded to fit the limbs
and inserted inside the
shoe
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69. Knee-ankle-foot
orthose(KAFOs)
• A knee-ankle-foot orthoses (KAFO) is an orthoses
that encumbers the knee, ankle and foot.
• A KAFO can have a great effect on motion at these
lower limb areas
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70. Metal and leather
Thermoplastic moulded
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71. Cast braces
• These are used to maintain normal limb
function while fracture healing occurs
• Most cast braces run parallel to the broken
bone to provide a protective structure and
guide during the healing process.
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72. Knee orthoses(braces)
• A knee orthoses (KO) or
knee brace extends above
and below the knee joint
and is generally worn to
support or align the knee
• Biomechanically difficult
as they have to act with a
short lever arm
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73. Trunk and limb braces
• The HKAFO is a knee-ankle-foot-orthoses
with an extension of hip joint and pelvic
components. These are used on patients
requiring more stability of the hip and lower
torso
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74. Types of HKAFOs
1.Hip guidance
orthoses(HGO):
• Also called the pace
walker has free hip joints
between stops at the limit
of flexion and extension
• The patient walks by
using the arms and
walking aids to move the
trunk forward the weight
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75. 2.Reciprocating gait orthoses
• It has hip joints linked by a
cable so that extension
occurs on one side causes
flexion on the other side
• The patient pushes down
both the crutches and pulls
pelvis forward leaning on
one side
• Non-weight bearing leg
moves forward with the help
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76. Hip guidance
Reciprocating gait
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77. Advantages
HGO
• Has low energy
consumption
• Allows user to
achieve walking
speed of 50% of
normal individual
• Easy to wear and
take off
RGO
• Cosmetically
acceptable
• Lighter
• Gives ability to the
patient to stand
unsupported
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