Lower limb orthoses

Lower Limb OrthosesLower Limb Orthoses

DefinitionDefinition

An orthosis is defined as a device An orthosis is defined as a device attached or applied to the external attached or applied to the external surface of the body to improve surface of the body to improve function, restrict or enforce function, restrict or enforce motion, or support a body motion, or support a body segment.segment.

Indications• Assist gaitAssist gait

• Reduce painReduce pain

• Decrease weight bearingDecrease weight bearing

• Control MovementControl Movement

• Minimize progression of a Minimize progression of a deformitydeformity

Lower Limb Orthoses assist Lower Limb Orthoses assist nonambulatory patients with nonambulatory patients with transfer and mobility skills and transfer and mobility skills and help ambulatory patients in help ambulatory patients in becoming safe walkers.becoming safe walkers.

PrinciplesPrinciples• Use only as indicated and for as long as Use only as indicated and for as long as

necessary. necessary. • Allow joint movement wherever possible Allow joint movement wherever possible

and appropriate.and appropriate.• Orthoses should be functional during all Orthoses should be functional during all

phases of gait.phases of gait.• The orthotic ankle joint should be centred The orthotic ankle joint should be centred

over the tip of the medial malleolus.over the tip of the medial malleolus.

Principles…Principles…• The orthotic knee joint should be centred over The orthotic knee joint should be centred over

the prominence of the medial femoral condyle.the prominence of the medial femoral condyle.• The orthotic hip joint should be in a position The orthotic hip joint should be in a position

that allows the patient to sit upright at 90 that allows the patient to sit upright at 90 degrees.degrees.

• Patient compliance will be enhanced if the Patient compliance will be enhanced if the orthosis is comfortable, cosmetic and orthosis is comfortable, cosmetic and functional.functional.

Principles…Principles…• Most orthoses utilize a three-point system Most orthoses utilize a three-point system

to ensure proper positioning of the limb to ensure proper positioning of the limb within the orthosis.within the orthosis.

• For e.g.., a knee that has a tendency for For e.g.., a knee that has a tendency for hyperextension can be treated with a knee hyperextension can be treated with a knee orthosis that applies force posterior to the orthosis that applies force posterior to the knee but also applies forces anteriorly knee but also applies forces anteriorly along the leg and thigh.along the leg and thigh.

Foot Orthoses (FOs)Foot Orthoses (FOs)

• FOs affect the ground reactive forces acting on the joints of the lower limb.

• They also have an effect over rotational components of gait.

FOs in Pes Planus…FOs in Pes Planus…

• Symptomatic control of pain can be obtained by Symptomatic control of pain can be obtained by controlling excess pronation of the foot.controlling excess pronation of the foot.

• Pronation of the foot can be defined as a rotation Pronation of the foot can be defined as a rotation of the foot in the longitudinal axis resulting in a of the foot in the longitudinal axis resulting in a lowering of the medial aspect of the foot.lowering of the medial aspect of the foot.

• It is also referred to as inrolling.It is also referred to as inrolling.• Eversion involves pronation and abduction at the Eversion involves pronation and abduction at the

subtalar joint and dorsiflexion at the ankle joint.subtalar joint and dorsiflexion at the ankle joint.

FOs in Pes Planus…FOs in Pes Planus…• The key to controlling excess pronation is The key to controlling excess pronation is

controlling the calcaneus to keep the subtalar controlling the calcaneus to keep the subtalar joint in a neutral position.joint in a neutral position.

• A custom-made foot orthosis designed to prevent A custom-made foot orthosis designed to prevent hyperpronation is also referred to as a UCBL hyperpronation is also referred to as a UCBL orthosis denoting the University of California orthosis denoting the University of California Biomchanics Laboratory where original work Biomchanics Laboratory where original work regarding this type of orthosis was performed in regarding this type of orthosis was performed in the 1940s.the 1940s.

FOs in Pes Planus…FOs in Pes Planus…

• Cases of pes planus due to ligamentous laxity Cases of pes planus due to ligamentous laxity may be treated with a medial longitudinal arch may be treated with a medial longitudinal arch support for alleviating pain.support for alleviating pain.

• A Thomas heel extension can also offer medial A Thomas heel extension can also offer medial support particularly for heavier individuals. support particularly for heavier individuals.

• For runners who have pronated feet, a firm For runners who have pronated feet, a firm medial heel counter and a wide last at the shank medial heel counter and a wide last at the shank can help prevent pronation at the subtalar joint.can help prevent pronation at the subtalar joint.

Thomas Heel & Reverse Thomas Thomas Heel & Reverse Thomas HeelHeel

FOs in Pes Cavus…FOs in Pes Cavus…• A typical problem with pes cavus is excess A typical problem with pes cavus is excess

pressure along the heel and metatarsal head pressure along the heel and metatarsal head areas, which can lead to pain.areas, which can lead to pain.

• This can be prevented by making the height of This can be prevented by making the height of the longitudinal support just high enough to fill the longitudinal support just high enough to fill in the space between the shank of the shoe and in the space between the shank of the shoe and the arch of the foot to distribute weight more the arch of the foot to distribute weight more effectively. effectively.

• The lift is extended just to the metatarsal head The lift is extended just to the metatarsal head area to help distribute and alleviate pressure over area to help distribute and alleviate pressure over the metatarsal weight-bearing area.the metatarsal weight-bearing area.

Pes Cavus Orthosis…Pes Cavus Orthosis…

Metatarsalgia (Forefoot Pain)Metatarsalgia (Forefoot Pain)

• Relief of pain in the forefoot is accomplished by Relief of pain in the forefoot is accomplished by distributing the weight-bearing forces to an area distributing the weight-bearing forces to an area proximal to the metatarsal heads.proximal to the metatarsal heads.

• This can be achieved by either internal or This can be achieved by either internal or external modification.external modification.

• A metatarsal pad also referred to as a ‘cookie’ A metatarsal pad also referred to as a ‘cookie’ can be placed inside the shoe just posterior to the can be placed inside the shoe just posterior to the second, third and fourth metatarsal heads. second, third and fourth metatarsal heads.

““Cookie”Cookie”

Metatarsalgia (Forefoot Pain)…Metatarsalgia (Forefoot Pain)…• A metatarsal bar is an external modification and A metatarsal bar is an external modification and

is indicated in metatarsalgia in cases in which is indicated in metatarsalgia in cases in which the foot is too sensitive to tolerate a pad inside the foot is too sensitive to tolerate a pad inside the shoe.the shoe.

• The metarsal bar is typically ¼ inch thick and The metarsal bar is typically ¼ inch thick and tapers distally.tapers distally.

• The distal edge should be proximal to the The distal edge should be proximal to the metatarsal heads.metatarsal heads.

• The bar can also be used for forefoot pain The bar can also be used for forefoot pain associated with pes cavus.associated with pes cavus.

Metatarsal BarMetatarsal Bar

FOs in Heel PainFOs in Heel Pain• Rubber heel pads inside the shoe can offer Rubber heel pads inside the shoe can offer

relief in minor discomfort.relief in minor discomfort.• A calcaneal bar is recommended for cases A calcaneal bar is recommended for cases

in which the foot is too sensitive to tolerate in which the foot is too sensitive to tolerate a pad inside the shoe and the heel pain is a pad inside the shoe and the heel pain is associated with a chronic condition.associated with a chronic condition.

• The calcaneal bar is placed distal to the The calcaneal bar is placed distal to the painful area to prevent the calcaneus from painful area to prevent the calcaneus from assuming full weightbearing status.assuming full weightbearing status.

FOs in Heel Pain…FOs in Heel Pain…• A common cause of heel pain along the A common cause of heel pain along the

anteromedial calcaneus is plantar fasciitis. anteromedial calcaneus is plantar fasciitis. • It is common in people who hyperpronate their It is common in people who hyperpronate their

feet, thereby placing excess stress on the medial feet, thereby placing excess stress on the medial longitudinal arch.longitudinal arch.

• Conservative treatment should include a pair of Conservative treatment should include a pair of shoes wih a firm medial heel counter and a wide shoes wih a firm medial heel counter and a wide shank.shank.

• In cases in which conservative management has In cases in which conservative management has failed, custom-made shoes such as the UCBL is failed, custom-made shoes such as the UCBL is indicated.indicated.

FOs in Heel Pain…FOs in Heel Pain…

• Plantar fasciitis is also common in patients Plantar fasciitis is also common in patients with high arches.with high arches.

• The medial longitudinal arch undergoes The medial longitudinal arch undergoes marked stress during weight bearing. marked stress during weight bearing.

• This can be treated with either an elevated This can be treated with either an elevated arch support or a heel well that helps arch support or a heel well that helps distribute pressure along the medial distribute pressure along the medial longitudinal arch.longitudinal arch.

FOs in Heel Pain…FOs in Heel Pain…

Heel liftsHeel lifts are of help in are of help in• Achilles enthesitis where it decreases the Achilles enthesitis where it decreases the

amount of stretch placed on th Achilles amount of stretch placed on th Achilles tendon by keeping the ankle joint plantar tendon by keeping the ankle joint plantar flexed, and inflexed, and in

• treating plantar flexor spasticity or treating plantar flexor spasticity or contracture by increasing the total heel contracture by increasing the total heel height to help ensure that the patient has a height to help ensure that the patient has a heel strike prior to toe touch during gait.heel strike prior to toe touch during gait.

FOs in Osteoarthritis of the KneeFOs in Osteoarthritis of the Knee

• Lateral heel wedgesLateral heel wedges can be used for can be used for conservative treatment of Osteoarthritis conservative treatment of Osteoarthritis when the medial compartment narrowing when the medial compartment narrowing results in genu varum.results in genu varum.

• The heel wedges used are ¼ inch thick The heel wedges used are ¼ inch thick along the lateral border and taper along the lateral border and taper mediallymedially..

Ankle-Foot Orthoses (AFOs)Ankle-Foot Orthoses (AFOs)

• AFOs were formerly called short leg braces.AFOs were formerly called short leg braces.• Metal or plastic AFOs can be used effectively to Metal or plastic AFOs can be used effectively to

control ankle motion.control ankle motion.• AFOS should provide mediolateral stability as a AFOS should provide mediolateral stability as a

safety feature.safety feature.• It should be remembered that It should be remembered that plantar flexion plantar flexion

creates a knee extension moment and creates a knee extension moment and dorsiflexion a knee flexion moment.dorsiflexion a knee flexion moment.

Metal AFOsMetal AFOs• The metal AFO consists of a proximal calf band, The metal AFO consists of a proximal calf band,

two uprights, ankle joints and an attachment to two uprights, ankle joints and an attachment to the shoe to anchor the AFO.the shoe to anchor the AFO.

• The posterior metal portion of the calf band The posterior metal portion of the calf band should be 1.5 to 3 inches wide in order to evenly should be 1.5 to 3 inches wide in order to evenly distribute pressure.distribute pressure.

• The calf band should be 1 inch below the fibular The calf band should be 1 inch below the fibular neck to prevent a compressive common peroneal neck to prevent a compressive common peroneal nerve palsy.nerve palsy.

Metal AFOs…Metal AFOs…

• Ankle joint motion is controlled by pins or Ankle joint motion is controlled by pins or springs inserted into channels.springs inserted into channels.

• The pins are adjusted with a screw driver to set The pins are adjusted with a screw driver to set the desired amount of plantar flexion and the desired amount of plantar flexion and dorsiflexion.dorsiflexion.

• The spring is also adjusted with a screw driver to The spring is also adjusted with a screw driver to provide the proper amount of tension necessary provide the proper amount of tension necessary to aid motion at the ankle joint. to aid motion at the ankle joint.

Metal AFOs…Metal AFOs…• A A solid stirrupsolid stirrup is a U shaped metal piece is a U shaped metal piece

permanently attached to the shoe. permanently attached to the shoe. • Its two ends are bent upward to articulate with Its two ends are bent upward to articulate with

the medial and lateral ankle joints. The proximal the medial and lateral ankle joints. The proximal stirrup attachment sites are shaped to enforce the stirrup attachment sites are shaped to enforce the desired movements at the ankle joint.desired movements at the ankle joint.

• The sole plate can be extended beyond the The sole plate can be extended beyond the metatarsal head area for conditions requiring a metatarsal head area for conditions requiring a longer lever arm for better control of plantar longer lever arm for better control of plantar flexion such as in plantar flexor spasticity.flexion such as in plantar flexor spasticity.

Double-action Metal Ankle Joint with Solid Stirrup

Metal AFOs…Metal AFOs…• A split stirrup can be used instead of a solid A split stirrup can be used instead of a solid

stirrup.stirrup.• It has a sole plate with two flat channels for It has a sole plate with two flat channels for

insertion of the uprights.insertion of the uprights.• The uprights are now called calipers as they The uprights are now called calipers as they

can open and close distally to allow can open and close distally to allow donning and doffing of the AFO.donning and doffing of the AFO.

• A split stirrup allows removal of the A split stirrup allows removal of the uprights from the shoes so that the AFOs uprights from the shoes so that the AFOs can be worn with other shoes.can be worn with other shoes.

Ankle Stops and Assists in Metal Ankle Stops and Assists in Metal AFOsAFOs

• Plantar Stop (Posterior Stop)Plantar Stop (Posterior Stop)

• Dorsiflexion Stop (Anterior Stop)Dorsiflexion Stop (Anterior Stop)

• Dorsiflexion Assist ( Posterior Dorsiflexion Assist ( Posterior Spring)Spring)

Plantar Stop ( Posterior Stop)Plantar Stop ( Posterior Stop)

• The plantar stop is used to control plantar The plantar stop is used to control plantar flexor spasticity or help incrementally flexor spasticity or help incrementally stretch plantar contractures.stretch plantar contractures.

• The plantar stop is most commonly set at The plantar stop is most commonly set at 90 degrees.90 degrees.

• An AFO with a plantar stop at 90 degrees An AFO with a plantar stop at 90 degrees produces a flexion moment at the knee produces a flexion moment at the knee during heel strike.during heel strike.

Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…

• Since the dorsiflexors cannot eccentrically activate to permit contact with the ground, the ground reactive force remains posterior to the knee after heel strike, which creates a flexion moment at the knee and possibly an unstable gait.

Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…• The proximal portion of the AFO also

has an effect on knee stability. • The posterior portion of the proximal

AFO exerts a forward push on the proximal leg to increase the knee flexion moment after heel strike.

• The opposite occurs at toe-off , with an extension moment at the knee.

Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…

• The greater the plantar flexion resistance, the greater the flexion moment at the knee at heel strike, and the greater the need for active hip extensors to prevent the body from collapsing forward on a buckling knee.

Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…

• The posterior stop should be set at the minimal amount of plantar flexion required to clear the foot during swing-through.

• Remember, the plantar flexion creates a knee extension moment at the knee after heel strike.

• This creates a more stable gait than when the ankle plantar stops are set in any degree of dorsiflexion.

Dorsiflexion Stop ( Anterior Stop)Dorsiflexion Stop ( Anterior Stop)

• An anterior stop is used to compensate for the An anterior stop is used to compensate for the function of the gastrocnemius /soleus complex. function of the gastrocnemius /soleus complex.

• It is used in conditions with weak calf muscles or It is used in conditions with weak calf muscles or weak quadriceps (because of its effect on the weak quadriceps (because of its effect on the knee).knee).

• Weak calf muscles allow the ankle to enter Weak calf muscles allow the ankle to enter dorsiflexion.dorsiflexion.

• The anterior stop set at 5 degrees of dorsiflexion The anterior stop set at 5 degrees of dorsiflexion best substitutes for gastrocnemius/ soleus best substitutes for gastrocnemius/ soleus function.function.

Dorsiflexion Stop ( Anterior Stop)Dorsiflexion Stop ( Anterior Stop)

• The anterior stop assists with push-offassists with push-off and assists the knee joint into extension. It should be used in combination with a stirrup with a sole extension to the metatarsal heads to simulate the action of the calf muscles.

• The dorsiflexion stop simulates the gastrocnemius / soleus function by causing the heel to rise during the latter part of stance rather than remaining flat on the ground.

• The shoe pivots over the metatarsal heads creating an extension moment at the knee that helps stabilize the knee from midstance to toe-off.

Dorsiflexion Assist (Posterior Dorsiflexion Assist (Posterior Spring)Spring)

The posterior spring serves two purposes.• It substitutes for concentric contraction of

dorsiflexors to prevent flaccid foot drop after toe-off.

• It also substitutes inadequately for the eccentric activation of the dorsiflexors after heel strike.

• The metal dorsiflexion assist ankle joint is also known as a Klenzak ankle joint.

Metal Dorsiflexion Assist Ankle JointMetal Dorsiflexion Assist Ankle Joint(Klenzak Ankle Joint)(Klenzak Ankle Joint)

Metal AFO Varus /Valgus ControlMetal AFO Varus /Valgus Control

• Valgus and varus deformities are associated with rotation of the subtalar joint.

• A T strapT strap is attached along the side of the shoe distal to the subtalar joint to help minimize this deformity.

• T straps are either medial or lateral.• A medial T strap is used to control a valgus

deformity. • The medial T strap is sown to the medial aspect

of the shoe and the belt is cinched around the lateral upright.

Metal AFO Varus /Valgus ControlMetal AFO Varus /Valgus Control

• The medial T strapmedial T strap helps create a force directing the subtalar joint inward which counteracts the pronation and abduction tendency at the subtalar joint.

• The opposite is true for a lateral T straplateral T strap used to control or minimize the tendency for varus at the subtalar joint.

Plastic AFOsPlastic AFOs • Advantages include cosmesis, light weight,

interchangeability with shoes, ability to control varus and valgus deformities, provision of better foot support with the customized foot portion and ability to achieve what is offered by the metal AFO.

• Energy consumption is equal with a plastic solid AFO or a metal double upright AFO.

Plastic AFOs…Plastic AFOs…• The weight of the orthoses is not as important as

the influence of the ground reactive force created by the presence of the orthosis.

• The same orthotic principles apply for plastic and metal orthoses.

• The plastic AFO prescribed for toe clearance should be just rigid enough to provide resistance for toe clearance. Excessive resistance to plantar flexion can make the knee unstable after heel strike and create a knee flexion moment.

Custom Plastic Solid AFO with Posterior Custom Plastic Solid AFO with Posterior Trimline to Allow Some Flexibility with Trimline to Allow Some Flexibility with

Plantar FlexionPlantar Flexion..

Plastic AFO ComponentsPlastic AFO Components

• The foot component of the AFO should extend beyond the metatarsal heads.

• The foot plate can be extended beyond the toes to reduce the spasticity aggravated by toe flexion..

Plastic AFO Components…Plastic AFO Components…

• Plastic AFOs can be hinged at the ankle.• Ankle hinges allow full or partial ankle motion,

which can permit a more natural gait.• Plastic ankle joints can be a good choice for

children and metal ankle joints for adults particularly heavy adults.

• Newer designs have a single midline posterior rod/spring mechanism which functions like the more traditional medial and lateral dual posterior spring assist mechanism.

(Plastic AFO Components)(Plastic AFO Components)Elite Midline Posterior Stop Articulated Elite Midline Posterior Stop Articulated

AFOAFO

The Solid Plastic AFOThe Solid Plastic AFO

• The term solid refers to an AFO that is made of a single piece of plastic and does not have ankle joints.

• Solid AFOs set at 90 degrees are commonly used for foot drop. Solid AFOs are also used to treat conditions of the knee.

• It should be remembered that plantar flexion creates knee extension and dorsiflexion knee flexion at heel strike.

The Solid Plastic AFO…The Solid Plastic AFO…

• The AFO can be fixed in a few degrees of plantar flexion to provide stability at the knee during the stance phase of gait.

• Genu recurvatum can also be treated with a solid AFO.• The more rigid the AFO, the greater the flexion moment

at the knee at heel strike which helps reverse the extension moment at the knee associated with genu recurvatum.

• The flexion moment of the knee also becomes greater if the ankle is placed in a few degrees of dorsiflexion.

Plastic AFO Varus /Valgus ControlPlastic AFO Varus /Valgus Control• An equinovarus or inversion deformity is

controlled by applying forces medially at the metatarsal head area and calcaneus.

• The next force is applied more proximally at the lateral aspect of the fibula. This helps prevent inversion at the subtalar and ankle joints.

• A more proximal medial tibial force is applied to provide stabilization of the leg portion of the plastic AFO by applying an opposing force to the fibular area.

Plastic AFO Varus/Valgus ControlPlastic AFO Varus/Valgus Control

• A three point system also exists at the foot level to help prevent supination of the foot related to the equinovarus deformity.

• A three point system is again applied to control plantar flexion deformity associated with equinovarus.

Patellar Tendon-Bearing AFOs• A PTB AFO uses the patellar tendon and the

tibial condyles to partially relieve weight bearing stress on skeletal structures distally, with more weight bearing distributed along the medial tibial condyle.

• It is often prescribed for diabetic ulcerations of the foot, tibial fractures, relief of the weight –bearing surface in painful heel conditions such as calcaneal fractures, postoperative ankle fusions and avascular necrosis of the foot or ankle.

Patellar Tendon-Bearing AFOs

• The orthoses are bivalved and fit snugly with the use of Velcro straps or buckles.

• A custom-moulded PTB AFO can reduce weight bearing in the affected foot by 50%.

Prefabricated Bivalved PTB AFO

Knee Ankle Foot OrthosisKnee Ankle Foot Orthosis

• KAFOs were formerly referred to as long leg braces.

• In addition to the components of an AFO, the KAFO also includes knee joints, thigh uprights and a proximal thigh band.

• KAFOs are used in patients with severe knee extensor and hamstring weakness, structural knee instability and knee flexion spasticity.

• The purpose of the KAFO is to provide stability at the knee, ankle and subtalar joints during ambulation.

Knee Ankle Foot Orthosis…Knee Ankle Foot Orthosis…

• They are most commonly prescribed bilaterally for patients with spinal cord injuries and unilaterally for patients with polio.

• Good trunk control and upper body strength are needed in order to ambulate with KAFOs because these devices are used in combination with ambulation aids, such as walkers and Lofstrand forearm crutches.

Ground Reaction or Floor Ground Reaction or Floor Reaction OrthosisReaction Orthosis

• Some paraplegic patients such as those with lower lumbar lesions with some knee extensor strength are able to ambulate without KAFOs. Ambulation in these patients can often be accomplished with the use of bilateral plastic ground reactionground reaction AFOAFOs with the ankles fixed in 10 to 15 degrees of plantar flexion.

Ground Reaction Orthosis…Ground Reaction Orthosis…

• The plantar flexion provides an extension momentextension moment at the knee during gait for stability with ambulation.

• The proximal anterior tibial shell closing provides further stability at the knee from midstance to toe-off.

Ground Reaction OrthosisGround Reaction Orthosis

Knee JointsKnee Joints

Three types

• Straight set knee joint

• Polycentric knee joint

• Posterior offset knee joint

Straight Set Knee JointStraight Set Knee Joint

• Provides rotation about a single axis

• Allows free flexion

• Prevents hyperextension

• Often used in combination with a drop lock

• The lock keeps the knee in extension through all the phases of the gait cycle.

Straight Set Knee JointStraight Set Knee Joint

Polycentric Knee JointPolycentric Knee Joint

• Uses a double axis system to simulate the flexion-extension movements of the femur and the tibia at the knee joint

• Adds bulk to the orthosis• Most frequently used in sport knee

orthosis

Polycentric Knee JointPolycentric Knee Joint

Posterior Offset Knee JointPosterior Offset Knee Joint

• Prescribed for patients with weak knee extensors and some hip extensor strength

• Allows free flexion and extension of the knee during the swing phase of gait

• Helps keep the orthotic ground reaction force in front of the knee axis for stability during stance

Knee OrthosesKnee OrthosesSwedish Knee CageSwedish Knee Cage

• Used to control minor to moderate Used to control minor to moderate genu genu recurvatumrecurvatum due to ligamentous or capsular due to ligamentous or capsular laxity.laxity.

• The articulated version of the orthosis allows full The articulated version of the orthosis allows full knee flexion and prevents hyperextension.knee flexion and prevents hyperextension.

• It uses a three point system with two bands It uses a three point system with two bands placed anterior to the knee axis (one above and placed anterior to the knee axis (one above and one below the knee) and a third band posterior to one below the knee) and a third band posterior to the knee joint in the popliteal area.the knee joint in the popliteal area.

• It also has a thigh band with longer uprights to It also has a thigh band with longer uprights to obtain better leverage at the knee joint.obtain better leverage at the knee joint.

Swedish Knee CageSwedish Knee Cage

Osteoarthritis Knee OrthosisOsteoarthritis Knee Orthosis

Uses the same orthotic three point principleThe three point system distribution is achieved by a strap that is applied across the knee joint.The limiting factor regarding this orthotic prescription is the patient’s weight and obesity.

Sport Knee OrthosisSport Knee Orthosis

Sport KOs can be divided into three types

• Prophylactic

• Rehabilitative

• Functional

Sport Knee OrthosisSport Knee OrthosisProphylacticProphylactic

• Prophylactic knee bracing attempts to prevent or reduce the severity of knee injuries.

• No evidence to support their use

• Associated with increased energy consumption which can impair athletic performance

Sport Knee OrthosisSport Knee OrthosisRehabilitativeRehabilitative

• Used to allow protected motion within defined limits

• Useful for postoperative and conservative management of knee injuries

Sport Knee Orthosis-Sport Knee Orthosis-FunctionalFunctional

• Designed to assist or provide stability for Designed to assist or provide stability for the unstable kneethe unstable knee

• Most commonly used to stabilize a laterally Most commonly used to stabilize a laterally subluxating patella or an anterior cruciate subluxating patella or an anterior cruciate ligament-deficient kneeligament-deficient knee

• Use has been shown to be effective only at Use has been shown to be effective only at loads much lower than those placed on the loads much lower than those placed on the knee during athletic participationknee during athletic participation

Sport Knee Orthosis-FunctionalSport Knee Orthosis-FunctionalLenox Hill Spectralite Knee OrthosisLenox Hill Spectralite Knee Orthosis

Reciprocating Gait Orthosis (RGO)Reciprocating Gait Orthosis (RGO)

• Formerly known as the Hip-guided orthosis Formerly known as the Hip-guided orthosis (HGO)(HGO)

• Its purpose is to provide contralateral hip Its purpose is to provide contralateral hip extension with ipsilateral hip flexion.extension with ipsilateral hip flexion.

• The RGO is appropriate for children who have The RGO is appropriate for children who have used the standing frame, developed good trunk used the standing frame, developed good trunk control and coordination, can safely stand and control and coordination, can safely stand and are mentally prepared for ambulation.are mentally prepared for ambulation.

• Good upper limb strength, trunk balance and Good upper limb strength, trunk balance and active hip flexion are important positive active hip flexion are important positive variables.variables.

Reciprocating Gait Orthosis (RGO)Reciprocating Gait Orthosis (RGO)

• Obesity, advanced age, lack of patient motivation Obesity, advanced age, lack of patient motivation scoliosis, spasticity and contractures are scoliosis, spasticity and contractures are significant negative factors.significant negative factors.

• Gait is initiated with active unilateral hip flexion Gait is initiated with active unilateral hip flexion and can be assisted by swaying the trunk when and can be assisted by swaying the trunk when hip flexion is inadequate.hip flexion is inadequate.

• Contralateral hip extension occurs passively with Contralateral hip extension occurs passively with each step employing either cables or the ‘teeter-each step employing either cables or the ‘teeter-totter’ concept. totter’ concept.

• Crutches are used with the RGO to provide a Crutches are used with the RGO to provide a control mechanism.control mechanism.

Isocentric Reciprocating Gait Isocentric Reciprocating Gait Orthosis (RGO)Orthosis (RGO)