A complete description of the lower limb orthosis is available in the following presentation with an in depth understanding of the same.It covers the ankle foot orthosis,Knee orthosis the knee ankle foot orthosis and hip orthosis.
1. Lower Limb orthosis
Lower limb orthotics are external devices that are attached or applied to a lower limb to
improve function by providing support, controlling motion, reducing pain, correcting
deformities and preventing progression of deformities.
2. Ankle foot Orthosis
The AFO is used to treat various neuromuscular
(nerve and muscle) diseases and disorders and to also
provide functionality after an injury or a surgery.
AFOs aim is to eliminate the problems related to foot-
to-ground placement that affect foot clearance and
heel contact.
It is also prescribed to restore stability to the foot
during the swing and stance phases of walking, and to
compensate for thigh muscle weakness so that the
knee does not buckle due to weakness.
3. Ankle Foot Orthosis
Various neuromuscular conditions causing either flaccid, athetoid, or weakly spastic
paralysis necessitate the use of ankle foot orthosis
The orthosis will provide:
Mediolateral stability during stance phase to prevent unwanted movement in ankle
‘Toe pick up’ during swing phase to prevent a stumble caused by ‘toe drag’ during swing
phase
Near Normal Gait
Ankle Arthritis Muscle Dystrophy of Ankle
4. Metal AFO: Parts
• The metal AFO consists of a proximal calf band, two
uprights, ankle joints and an attachment to the shoe to
anchor the AFO
• The posterior metal portion of the calf band should be
1.5 to 3 inches wide in order to evenly distribute
pressure.
• The calf band should be 1 inch below the fibular neck
to prevent a compressive common peroneal nerve
palsy.
• Foot Attachments:
- Stirrup / Calliper
- Ankle joint / controls
5. Metal AFO: Stirrup & Ankle Joints
A stirrup is a U shaped metal piece permanently
attached to the shoe. Its two ends are bent upward
to articulate with the medial and lateral ankle
joints. The proximal stirrup attachment sites are
shaped to enforce the desired movements at the
ankle joint.
Ankle joint motion is controlled by pins or springs
inserted into channels. The pins are adjusted with a
screw driver to set the desired amount of plantar
flexion and dorsiflexion by means of STOPS or
ASSISTS. The spring is also adjusted with a screw
driver to provide the proper amount of tension
necessary to aid motion at the ankle joint.
6. KNEE ORTHOSIS
Knee orthosis benefits the patients who requires control of knee
but not foot and ankle
Used in treatment of patellofemoral conditions and control
forces that tend to produce abnormal angulation and instability
of knee
INDICATIONS
• Weakness of muscles controlling knee flexion
• Patellar instability
• Abduction / Adduction instability
• Hyperextension of knee
• Rotatory instability
7. KNEE
ORTHOSIS
DYNAMIC PATELLAR ORTHOSIS
Used for patellofemoral
disorders
Consists of
• Patella cut out
• 2 rubber straps
o Crescent shaped patellar
pad
o Elastic counterforce strap
Purpose – To prevent lateral
subluxation or dislocation of
patella
8. KNEE
ORTHOSIS
SUPRACONDYLAR KNEE ORTHOSIS
This benefits patients requiring more control as well
as firm mediolateral stabilization.
Custom made plastic orthosis, laminated over a
plastic model
Provides rigid support for knee hindering flexion
On sitting there is awkward protrusion of
supracondylar portion
This is rectified by Lerman multi ligamentous
knee control & Lennox-Hill derotation device
Both use elastic straps that encircles the leg and
thigh
Designed to provide rotational control
9. KNEE ORTHOSIS
SWEDISH KNEE CAGE
ORTHOSIS
For angular motion in
frontal and sagittal
plane
For mediolateral
stability
Restricts hyperextension
3 WAY KNEE
STABILIZER
Similar to Swedish
knee cage orthosis but
has more pivotable
strap attachments
EXTENSION KNEE
ORTHOSIS
It consists of two long
mental uprights pivoting
thigh and calf cuffs
To protect the knee against
mediolateral forces
10. KNEE ANKLE FOOT ORTHOSIS (KAFO)
KAFO extends from thigh to foot and may be
used to control motion and alignment of
knee and ankle or provide support to
femur/tibia or both
Indications:
• Muscle weakness
• Lower motor neuron lesions
• Loss of structural integrity
11. Functions
• To relieve weight partially or totally from the hip
• To relieve stress in leg
• Stabilization of knee
• To combine the functional units of AFO
• To exert hip control function in traumatic paraplegia
Double Upright KAFO
It consists of:
• 2 metal uprights
• Thigh band
• Mechanical knee joint
• Foot attachment
• Accessory pads and straps
12. Mechanical Knee Joint
• Since anatomical knee joint is polycentric mechanical
knee joints have a fixed axis and they cannot move
incomplete motion
• Some shifting of orthosis relative to time occurs during
flexion extension of knee, but this can be minimized by
proper placement of mechanical knee joint
Types of Mechanical Knee Joint
• Free-motion knee joint: Allows unrestricted flexion
and extension
• Offset knee joint: Axis of the knee joint is placed
posterior to the uprights
13. Types of Mechanical Knee Joints
• Centric knee joint lock: Axis of rotation is in the
center. For movement patient has to lift the lock up
• Drop lock knee joint: This lock is most commonly
used knee lock to control flexion
• UCLA: Uses a quadrilateral socket and set back
joints used to prevent buckling of knee
• Spring loaded pull rod: Given to the patient who is
capable of walking a free knee but who may wish
to lock joint occasionally
14. Types of Mechanical Knee Joint
• Swiss lock: Used in patients where upper
extremity is also paralyzed and patient is unable
to carry out locking and unlocking
• Pawl lock: Easier to release when a flexion force
develop at knee
• Bail: Semicircular level placed unlocks both sides
simultaneously and allows flexion by a manual
upward force or when bail is at range of choice
15. Supracondylar KAFO
• Consists of moulded plastic KAFO to hunged or solid supra-condylar shell is
attached
• Prevents excessive hyper extension of knee
16. Hip Orthosis
The most common function of such an
orthoses is to resist femoral adduction
produced by the mildly spastic
adductor musculature of individuals
with cerebral palsy.
HO is also used for post-operative or
post-injury protection following
arthroscopic hip repairs, total hip
revisions, or other hip joint surgeries;
Injuries or problems that can benefit
from range-of-motion control
17. Hip Orthosis
The Hip Abduction Orthosis is affective at
resisting adduction and excessive flexion.
The joint features easy to adjust flexion and
extension stops.
Parts
Pelvic Band
Hip Joints
Thigh Bands
18. Hip Knee Ankle Foot Orthosis
(HKAFO)
Hip joint and pelvic band attached to the lateral upright of a KAFO
converts it to a HKAFO
A HKAFO provides additional repair and support for disorders
involving
Hip flexion/extension instability
Hip abduction weakness
Hip rotation instability
19. HKAFO Parts
Pelvic Band
Hip joints and locks
Ischial band
Uprights
Thigh band
Knee cap and knee joint
Calf band
Ankle joint
Ankle stirrup
20. Pelvic Bands
To enable the hip joint to accomplish its function of motion control
its upper arm must be stabilized by attachment by intimate contact
with the pelvis
The types of pelvic bands utilized depends upon the degree of control
required and whether one or both hip joints are involved
Types
Unilateral pelvic band
Bilateral pelvic band
22. Hip Joints and Locks
Single axis hip joint
Permitting flexion and extension and include and
adjustable stop to limit hyperextension.
By the nature of their design these joints also resist
abduction ,adduction and rotation.
The flexion extension capacity can be restricted by
including a pawl or a drop lock similar to that used
for a knee joint.
Two position hip locks
Provide locking for full extension and 90° hip flexion,
are of limited use for children which have difficulty in
maintaining the sitting position.
23. Double axis hip joint
If there is no need to block both
abduction and adduction a double axis
joint may be used.
The flexion extension axis must be free
or locked as required while the
adduction, abduction axis include
adjustable stops to place limit on these
motions as needed.
Hip Joints and Locks
