++
LEARNING OBJECTIVES
Relate the major parts of the shoe to the requirements of individuals fitted with lower extremity orthoses.
Compare the characteristics, advantages, and disadvantages of plastics, metals, and other materials used in orthoses.
Describe the components of contemporary foot, ankle-foot, knee-ankle-foot, hip-knee-ankle-foot, trunk-hip-knee-ankle-foot, and trunk orthoses.
Explain the orthotic options available for patients with paraplegia.
Identify the features of lower extremity and trunk orthoses that are considered during the examination process.
Outline the physical therapist's role in management of patients fitted with lower extremity and trunk orthoses.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
++
An orthosis is an external appliance worn to restrict or assist motion or to transfer load from one area of the body to another. The older term, brace, is a synonym. A splint connotes an orthosis intended for temporary use. An orthotist is the health care professional who designs, fabricates, and fits orthoses for the limbs and trunk, and a pedorthist is the health care professional who designs, fabricates, and fits only shoes and foot orthoses. The term orthotic is an adjective, although some use the word as a noun. Archaeological evidence indicates that orthoses have been used at least since the fifth Egyptian dynasty (2750 to 2625 BC).1 The term orthosis appears to have been coined in the mid-20th century.
++
This chapter presents the most frequently prescribed orthoses for the lower extremity (LE) and the trunk, as well as new developments in the field. Key elements in preparing patients to use orthoses are discussed. Focus is placed on orthotic design characteristics, their biome-chanical rationale, merits of specific materials, and criteria for judging the adequacy of orthotic fit, function, and construction. Although every attempt is made to use evidence-based research to guide clinical practice, the heterogeneity within the population of orthotic users and within orthotic designs confounds this effort.2
++
TERMINOLOGY AND TYPES OF ORTHOSES
++
Generic terminology is superseding the traditional use of eponyms (surname of developer). Naming orthoses by the joints they encompass and the type of motion control facilitates communication among clinicians and consumers. Thus, foot orthoses (FOs) are appliances applied to the foot and placed inside or outside the shoe, such as metatarsal pads and heel lifts. Ankle-foot orthoses (AFOs) encompass the shoe and terminate below the knee. The knee-ankle-foot orthosis (KAFO) extends from the shoe to the thigh. A hip-knee-ankle-foot orthosis (HKAFO) is a KAFO with a pelvic band that surrounds the lower trunk. A trunk-hip-knee-ankle-foot orthosis (THKAFO) covers part of the thorax as well as the lower extremities (LEs). Knee orthosis (KO) and hip orthosis (HO) are other applications of the same system of nomenclature.
++
LOWER EXTREMITY ORTHOSES
++
Lower extremity orthoses range from shoes used for clinical purposes to THKAFOs. Characteristics and functions of ...