Below knee orthosis prescription

Below knee orthosis prescriptionBasis for prescription:The focus is on pathomechanical abberation such as paresis, paralysis, spasticity, abnormal involuntary movement and abnormally pattered movements, sensory disturbances, fixed deformities and edema.Proper prescription:One should evaluate the patient systemicallyOnset of illnessOften indicates wether or not the motor disability is still evolving and if such is the case, one may elect to delay an orthotic decision or be prepared to change the prescription later.

Post stroke patient:It is usually safe to prescribe sometime between 8 and 12 weeksAnxiety, tension or apprehensionMay intensify a spastic pattern and change the motor picture episodically so that an orthosis which is adequate most of the time may be inadequate during period of increased spasticity.Patients with neurological disorder requiring afos (group I)Weakness or absence of dorsiflexors, without severe weakness or the plantar flexors.Good to fair mediolateral stability during stance (no marked varus or valgus)Passive ankle dorsiflexion at 90 degreesAbsent to moderate spasticityAdequate knee stability and motor power, with or without recurvatumAdequate hip strength Reduced or absent passive position sense at the ankle without mediolateral instability during swing or stance, ddespite adequate motor power at the ankle

orthosisPlantar flexion during swing (foot drop) and provide a mild degree of mediolateral stability in swing and stance, yet not hinder the physiological tendency to plantar flexion resulting in foot-flat immediately after heel-strike.Shoe clasp orthosisProvides the least assistance, is inconspicuous and is least expensive.

Wire spring afoAlso provides relatively modest assistance for dorsiflexion during swing phase; the shoe heel must be fitted with medial and lateral pins to receive orthosis.

Most GROUP I patients, however , are likely to be fitted with plastic posterior leaf spring AFOs.

Another alternative for GROUP I patient is the double metal upright AFOs with dorsiflexion (and plantarplantarflexion if required) spring asssist.The orthosis is considerably heavier than the other option.

Group iiSevere weakness or absence of ankle dorsiflexors and plantar flexorsA mild to moderately severe defect in mediolateral alignment during swing and or tendency toward varus or valgus during stanceAbsent to moderate spasticityAdequate motor power at the knee than in group IPassive position sense loss at the ankleDouble metal upright afo.Group II patients benefit from double metal upright AFO. The absence of plantar flexion power requires a dorsiflexion stop at 90 degrees so the patient will not drop off near the end of the stance phase.

If mediolateral stability during stance phase is not assured by the upright in the AFO, the uprights may be attached to an insert molded to realign the footSome patients with cerebral pathology demonstrate equinovarus position of the foot during the swing phase of gait which persists into the stance phasePlastic spiral afoPrevents foot drop, assist push-off by resisting dorsiflexion of the ankle during the stance phase and promotes mediolateral stability, particularly if the foot tends to collapse into valgus during stance

This may be done by a shoe insert, or a varus correction strap, with a double upright AFO or by a hemispiral AFO.RECURVATUM in the adult with neuromuscular disorder is not necessarily undesirable because eliminating recurvatum at the knee often includes buckling.The orthosis of choice for this group is the PLASTIC SOLID ANKLE AFOA DOUBLE UPRIGHT METAL AFO which allows no movement at the ankle can also be utilized , along with shoe insert or correction strap and a solid stirrup riveted to a strong shoe with a longer counter.Group IIIWeakness or absence of both ankle dorsiflexors and plantar flexorsSevere spasticity, resulting in marked equinovarus of the foot during swing and stance.Adequate hip and knee and hip musculature to permit weight bearing on the involved limb.Severe position sensory loss coupled with moderate to severe spasticity; these may be the only criteriaPain on movement of the ankle joint may be the only criterion.