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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Describe the types (categories) and functions of ankle–foot orthoses.

  2. Identify and describe the parts of ankle–foot orthoses, including the materials and componentry used.

  3. Discuss applications for ankle–foot orthoses to improve function.

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Physical Therapy students are expected to:

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  1. Determine the need for ankle–foot orthoses for a client based on examination findings.

    1. Evaluate client examination findings, including preorthotic prescription examination, lower quarter biomechanical assessment, and functional and gait analyses to diagnose impairments that may be improved by an ankle–foot orthosis.

  2. Develop appropriate goals for ankle–foot orthoses.

  3. Describe the biomechanical methods employed in ankle–foot orthoses to achieve the orthotic goals.

  4. Develop and execute a search strategy to identify research evidence for the effects and effectiveness of ankle–foot orthoses and to identify best practices for orthotic prescription.

  5. Recommend ankle–foot orthoses as part of a plan of care for individuals with impairments of the foot and ankle to optimize function.

  6. Recommend shoes with appropriate characteristics for use with specific ankle–foot orthoses.

  7. Examine and evaluate ankle–foot orthoses for acceptable fit, function, comfort, and cosmesis.

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CASE STUDIES

Harry Green is a 67-year-old African American widower who suffered a thrombotic cerebral vascular accident (stroke) that produced right hemiparesis. Mr. Green's case and clinical findings are described in Chapter 2.

Adam Pressman is an 18-year-old high school student who fell and landed outside the pit while practicing pole vaulting, fracturing his L4 vertebra. He was evacuated by helicopter to a trauma center and had surgery to stabilize the spine. After months of rehabilitation, he has recovered all his lower limb function, except bilateral ankle strength in dorsiflexion and eversion, which remain poor (2/5), and plantarflexion, which is fair (3+/5), but exhibits poor muscle endurance. His sensation and muscle tone are normal, and he does not experience any abnormal muscle spasms. His lower extremity range of motion (ROM) is full and pain free for all joints. Although he is able to walk, he has bilateral foot drop, which causes him to walk with a slow, steppage gait.

Malika Miller is a 30-year-old high school teacher with a chronic problem with her left ankle. She played soccer during high school and college and sustained several left lateral ankle sprains during that time. She responded typically to usual treatment, missing some games, but generally returned to play without impairment. This season she began coaching the girls' soccer team where she teaches. Four months ago while demonstrating some plays to the team, she resprained the ankle. She again received usual care and initially had her usual response. She received physical therapy for 3 weeks and was discharged with a home program 2 months ago. Currently she has full, pain-free passive ROM, and muscle strength on manual muscle testing is 5/5. However, she still is unable to run “normally,” experiences swelling at the end of the day even if only walking, and, ...

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