Lower Extremity Foot Orthotics

Foot Orthotics (Shoe Inserts): Foot orthotics are designed to evenly distribute the pressure over the entire
plantar surface of the foot, alleviate areas that may be sensitive or painful, accommodate/correct for
deformities, and improve the overall alignment of the foot, ankle complex and lower limb.


Foot Orthoses Designs:
Accommodative: An accommodative foot
orthoses is used to accommodate rather than
correct a deformity of the foot. These orthoses
can be used to prevent or heal skin abrasions or
breakdowns, ulcerations, or aid in preventing
further deformity from occurring. (Fig.1)
Fig.1

Indications
Rigid deformities
Diabetic patients
Charcot joint
Some cavus foot deformities


Fig.2
Correcti ve: A corrective foot orthosis is
fabricated to correct a current deformity or mal-
alignment of the lower extremity. (Fig.2)

Indications
Flexible foot deformities i.e. pes planus,
metatarsalgia







Foot Orthoses
Fig.1
Rigid Orthoses: Rigid orthoses are fabricated from
materials that are stiff, strong, and durable. They are
effective in transferring weight, limiting motion and
stabilizing flexible deformities. (Fig.1)

Indications
J oint laxity
Over-use syndromes
Sesamoiditis
Mortons neuroma

Semi-rigid Orthoses: Semi-rigid orthoses usually refer to a hybrid orthosis
manufactured with a combination of rigid, semi-rigid, and soft materials.
They are effective in stabilizing and supporting certain areas of the foot while
the softer materials allow for increased comfort and shock absorption. (Fig.
2-3)

Indications
Athletes with flexible foot deformities
Metatarsalgia
Planar fasciitis
Fig.2
Fig.3




Soft Orthoses: Soft orthoses are commonly prescribed for
patients who have limited or absent sensation. They are
effective in providing support and may help to reduce shearing
and pressure areas that can cause ulcerations and skin
breakdown. (Fig.4)

Fig.4

Indications
Diabetes
Charcot joint
Sensory deficits
Peripheral neuropathy
Ulcerations
Skin breakdown


Lower Extremity Ankle Supports
Lower Extremity Ankle Supports: These orthoses are designed primarily to aid in ankle stability and for
chronic ankle sprains/strains.


University California Berkley Laboratory Orthosis (UCBL):
A UCB orthosis is designed to control the heel, mid foot, and
longitudinal and transverse arches. It provides additional
medial and lateral support of the foot complex. (Fig.1)

Indications
Excessive inversion or eversion
Excessive pronation or supination
Posterior tibial tendon dysfunction/rupture

Semi-rigid/Rigid Ankle Orthosis: This orthosis is designed to provide medial and
lateral ankle stability. It can be fabricated to allow for free motion, limited or fixed range of motion.
Fig.1

Indications
Ligamentous Instabilities
Ankle Instabilities (secondary to chronic sprains/strains)
Tendonitis
Posterior tibial tendon dysfunction or rupture
Inversion/eversion (medial/lateral) instabilities
Chronic sprains/strains
Posterior tibial tendon dysfunction/rupture






















Fig.1

Custom Ankle Orthosis: This orthosis is designed from the cast
or scan of the patients foot and ankle. This type of orthosis can be
fabricated with a solid (static) or articulated ankle (Fig.1)

Indications
Severe pes planus (flat foot)
Posterior tibial tendon dysfunction/rupture
Medial/Lateral Instabilities
Neuropathic involvement (i.e. drop foot secondary to neurological
pathology)
Osteoarthritis
Post-operative stabilization

Fig.2
Fig.1
Gel/Air Ankle Support: These orthose are
designed to provide medial-lateral stability and
compression. Some are available with hot/cold
gel packs for therapy regimens.
Indications
Acute sprains or strains
Chronic ankle instability with associated
swelling/edema
Tendonitis



Plantar Fasciitis Orthosis: These orthoses are designed to
provide a passive stretch on the foot and ankle at night and during
non-weightbearing. They have adjustable range of motion to
accommodate for various positions (Fig.3)
Fig.3

Indications
Plantar Fasciitis
Slight Ankle Contractures/Tightness
























Ankle Foot Orthoses (AFOs)

Ankle Foot Orthoses (AFOs): AFOs are designed to provide support, proper joint alignment to the foot
and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb.


AFO designs: AFOs can be fabricated from plastic or in a conventional
manner from metal and leather components.
Metal or Conventional Orthoses: Metal orthoses are
designed to control instability, paralysis and weakness of the
foot and ankle complex. The conventional design utilizes metal
bands, bars and metal calipers that are attached directly to
shoe wear. These designs have been used for many years and
are very effective for patients who experience volume
fluxuations and swelling. The adjustable straps and buckles
can accommodate for volume changes throughout the day.
This style is also used in areas where the temperature is very
high; the open construction allows the skin to breathe. (Fig.1)

Plastic: Plastic orthosis are designed to fit inside a shoe and
are effective in controlling instabilities, paralysis or weakness at
the foot and ankle and aid in pressure distribution. Utilizing this
design allows the practitioner to apply corrective or stabilizing pressure over a
large area rather than in one specified point.
Fig.1

Posterior Leaf Spring (Dorsi flexion assist) AFO: A dorsi
flexion assist AFO is fabricated with from plastic and is
designed to fit inside of a shoe with little effort. It attaches to
the limb via a Velcro strap at the proximal edge and is further
stabilized with the use of a well-built shoe. It provides support
to the ankle and foot, aids in dorsi flexion (picking up the toes),
and reduces toe drop/drag when walking. This orthosis does
not limit motion of the foot and ankle but acts as a spring to help
pick up the patients toes to avoid stumbling and falling. (Fig.2)
Fig.2

Indications
Drop Foot
Neuropathy
Peroneal Palsy
Multiple Sclerosis
Charcot Marie Tooth Disease
Weak Dorsi flexors

Semi-Solid AFO: A semi-solid AFO fabricated from plastic is
designed to fit inside of a shoe with little effort. It attaches with
a Velcro strap and is stabilized by the use of a well-built shoe.
Unlike the dorsi flexion assist AFO this orthosis provides more
medial-lateral stability and limitation of motion. (Fig.2)
Fig.3

Indications
Drop Foot
Neuropathy
Minor Mediolateral Instabilities
Multiple Sclerosis
Weak Dorsi Flexors/Evertors
Spinal Cord Injuries
Myelomeningocele
Cerebral Palsy


Solid Ankle Foot Orthosis (SAFO): a Solid ankle AFO is
designed to provide maximum stability of the foot and ankle.
This orthosis limits plantar flexion (pointing toes down) and
dorsi flexion (lifting toes up), medial and lateral motions. (Fig.1)

Indications
Neuropathy
Multiple Sclerosis
Myelomeningocele
Dorsi Flexion and Plantar Flexion Muscle Weakness
J oint Instability
Spinal Cord Injuries
Muscular Dystrophy


Articulated Ankle Foot Orthosis (AAFO): This style of
orthosis is designed to provide maximum mediolateral stability
while allowing plantar flexion (pointing toes down) and dorsi flexion (lifting toes up). There are
various style of ankle joints used to allow for free, variable, and fixed range of motion. (Fig.2)
Fig.1

Indications
Fig.2
Neuropathy
Multiple Sclerosis
Myelomeningocele
Dorsi Flexion and Plantar Flexion
Muscle Weakness
J oint Instability
Cerebral Palsy
Spinal Cord Injuries














Lower Extremity Walker Boots
Lower Extremity Walker Boots: Walker boots are designed to aid in foot and ankle stability, limit range of
motion of the lower extremity.

Walker boots are designed with a solid or articulating ankle joint to accommodate for treatment of various
injuries, fractures, and pathologies. Each orthosis has a removable inner lining to protect the skin from
breakdown, malleolar (ankle) pads for additional stability and comfort, and a rocker bottom sole to provide
smooth walking pattern.

Walker Boot with Solid Ankle: This orthosis is designed to provide maximum immobilization to the foot
and ankle. (Fig.1)

Walker Boot with Articulated Ankle: This orthosis is designed to provide maximum mediolateral stability
while allowing adjustability of the ankle joint. This orthosis can be locked to eliminate motion or set to allow
various amounts of plantar flexion (pointing toes down) and dorsi flexion (lifting toes up). (Fig.2)


Walker Boot with Pneumatic Air Cells (available with solid or articulated ankle): These orthoses
incorporate the same clinical characteristics as the solid and articulated ankle walker boots with the addition
of pneumatic control Pneumatic air cells allow for circumferential compression that aid in pressure
redistribution, enhanced fit and functionality. (Fig.3)


Fig.3











Indications
Fig.1
Fig.2
Foot fractures
Post-Operative Management
Post-Cast Rehabilitation Management
Fig.4
Acute Ankle Sprains
Ligamentous Injuries
Acute posterior tibial tendon dysfunction/rupture
Achilles tendon rupture/repair

CRO Walker (Charcot Restraint Orthotic Walker): The CRO walker
was designed to provide maximum stability to the foot and ankle
complex. Its two piece or bi-valve construction aids in pressure re-
distribution, increased stability, and maximum limitation of motion.
These orthoses commonly have the addition of a soft inner boot that
can be modified to provide relief areas for skin breakdown or
abrasions and increased comfort to the patient. (Fig.4)

Indications
Diabetic neuropathy
Foot and ankle ulcerations
Charcot joint
Post-Operative Management
Acute posterior tibial tendon dysfunction/rupture










Lower Extremity (Knee) Soft Supports
and Positional Orthoses


Lower Extremity Soft Supports: Often referred to as soft goods, these orthoses include those braces that
are fabricated/manufactured from neoprene, canvas, and fabric and can be reinforced with metal/plastic
stays for additional support.



Neoprene Knee Sleeve: Neoprene knee sleeves provide limited stability to
the knee joint, compression to help control edema and for comfort, and
slightly limit range of motion to aid in rehabilitation.
Fig.1

Donut/Buttress: This is a raised area around the patella (knee cap) to aid
in additional support and proper alignment of the knee.


Side Pulls/Patellar Straps: These straps function in a similar to the
donut/buttress to provide additional support at the knee and aid in patellar
tracking. (Fig.1)

Joints: This provides increased mediolateral stability while maintaining full
range of motion n flexion and extension. (Fig.2)
Fig.2

Wrap Around Closure: This orthosis is very conducive to those patients
whose hand strength is limited. Rather than pulling up a very tight neoprene
sleeve, this option provides the patient with an anterior closure for easy
donning and doffing.

Indications
Minor knee sprains/strains
Post-reconstructive surgery/ligamentous
In conjunction with functional knee orthosis: This style of orthosis can be worn
with a functional knee orthosis to provide heat, comfort, and compression



Knee Immobilizer: Knee immobilizers are often used to stabilize and
immobilize the lower extremity post-operatively and during the acute stage
of knee injuries. They provide maximum immobilization of the knee joint
and compression. (Fig. 3)
Fig.3

Knee Immobilizer with Hinges: This option allows for
adjustability in range of motion at the knee. The orthosis can be
locked or adjusted to prescribed range of motion.

Indications
Post-operative knee surgery
Acute knee/ligamentous injuries
Rehabilitation


Functional Knee Orthosis: Functional knee orthoses are designed to aid in the stability of the knee joint
secondary to ligamentous injury, post-operative reconstruction, meniscus damage, and for prophylactic
protection. These orthoses is designed to provide maximum stability to the knee joint. Injury to the
ligaments of the knee cause unwanted motion/translation between the femur and the tibia. If left untreated
this can create significant joint laxity, lead to degenerative joint changes and put the patient at risk for further
injury and cause subsequent damage to the surrounding structures. (Fig.1)

Fig.1
Functional knee orthoses can be made to measurements or to a custom model of
the patients leg.


Indications
Anterior cruciate ligament disruption
Posterior cruciate ligament disruption
Medial/lateral collateral ligament disruption
Meniscus tears
Post-operative
Ligament reconstruction

Osteoarthritis (OA) Knee Orthosis: OA knee orthoses are designed to reduce the amount degenerative
changes of knee joint surface, pain, and joint mal-alignment that occur in patients with osteoarthritis. These
orthoses provide a corrective force at the knee to decreasing pain and joint surface degeneration. Many
incorporate an adjustable knee joint that can be changed to increase or decrease the corrective forces
applied. (Fig.2)

OA knee orthosis can be made to measurements or to a custom model of the
patients leg.

Indications

Osteoarthritis of the knee
Excessive valgus/varus
Post-operative management




Fig.2


Lower Extremity Fracture Orthoses
Distal Tibia/Fibular Fracture Orthosis: Distal tibial/fibular fractures can be treated with a walker boot or
tibial fracture orthosis. Your physician determines which style of orthosis is best indicated for your fracture
stabilization.

Fig.1
Tibial Fracture Orthosis: The tibial fracture orthosis has a posterior
component similar to a solid ankle AFO with an anterior component aiding in
compression, immobilization, and stabilization. (Fig.1)

Patellar bar: The tibial bar is an indentation that runs across the
patellar tendon (just below your knee cap) used to help reduce the
vertical load transmitted through the foot and ankle.

Foot and Ankle Component: The addition of an ankle/foot
component provides stabilization, immobilization, and aids in
suspension of the orthosis to prevent distal migration or slipping.

Indications
Distal tibial and fibular fractures
Mid-shaft tibial and fibular fractures







Proximal Tibial/Fibular Fracture Orthoses and Distal Femur Fractures: This
style of orthosis is often referred to as a KAFO or knee ankle foot fracture
orthosis. Due to the location of the fracture site, near the knee, it is necessary to
limit or prevent motion at this joint. This helps maintain reduction
or stabilization of the fracture allowing the healing process to begin. The knee
joint may be fabricated to accommodate complete immobilization, variable range
of motion, or free range of motion per the physicians prescription. (Fig.2)
Fig.2


Indications
Proximal tibial and fibular fractures
Distal femoral fractures

Proximal Femoral Fracture Orthosis: If a patient sustains a proximal
femoral fracture they are often prescribed with an orthosis that
encompasses the entire lower extremity but also utilizes a hip joint and
pelvic band. The addition of the hip joint and pelvic band provide
rotational stability and prevent excessive flexion, extension, abduction,
and adduction of the leg. Various styles of knee joints and hip joints can
be used to provide immobilization and range of motion throughout the
rehabilitation process. (Fig.1)

Indications

Proximal Femur Fractures












Fig.1





































Knee Ankle Foot Orthoses
Knee Ankle Foot Orthoses (KAFOs): KAFOs are designed to provide support,
proper joint alignment to the knee, foot and ankle, assist or substitute for muscle
weakness, and protect the foot and lower limb.

KAFO designs: Knee ankle foot orthoses can be fabricated from several types of
materials; plastic, aluminum, stainless steel, and carbon fiber laminate. The style
of fabrication is determined by the physician and practitioner relative to their
clinical presentation.


Metal or Conventional Orthoses: This style of orthosis is designed to control instability, paralysis
and weakness of the foot and ankle complex. The conventional design utilizes metal bands, bars
and metal calipers that are attached directly to shoe wear. This design has been used for many
years and is very effective for patients who experience volume fluxuations. Velcro and buckles can
be adjusted throughout the day to accommodate for swelling and or edema. (Fig.1)



Metal: Metal materials (aluminum and steel) are also used in the construct of the
sidebars and knee joints. The type of material depends upon the weight, activity, and
durability required by the patient. Steel uprights are more durable than
aluminum however are associated with increased weight. Aluminum is
often used for ease of fabrication and to reduce the overall weight of the
orthosis.
Fig.1

Plastic: Plastic orthosis are designed to fit inside a shoe and are effective
in controlling instabilities, paralysis or weakness at the knee, foot and ankle
and aid in pressure distribution. Utilization this design allows the
practitioner to apply corrective or stabilizing pressure over a large area
rather than in one specified point. (Fig.2)

Knee Joint Designs
Free Knee: This design is provides medial-lateral stability to knee joint
while allowing free motion in flexion and extension. This style of knee joint
is also utilized to prevent genu recurvatum or hyperextension of the knee.
By limiting the extension range of motion of the knee joint we can protect
and stabilize the posterior knee capsule against further injury and or
deformity.
Fig.2


Posterior Offset Knee Joint: The posterior offset
knee joint is used to aid in knee extension for those
patients who exhibit minimal quadriceps weakness.
The placement of the mechanical knee joint is just
posterior to the anatomical knee joint providing for
increased knee stability when walking. This knee
joint does not provide for stance control during the
gait cycle. The patient must have enough hip flexion
and extension strength and momentum to walk in a
safe and effective manner. (Fig.3-4)
Fig.3
Ground
reaction
force
Posterior
offset
knee joint
Fig.4






Stance Control: Stance control knee joints provide for stability during weight bearing and free
flexion (bending) during the swing phase of gait or non-weight bearing. Allowing the knee to bend
during the swing phase of gait provides for a more normal gait pattern, is more energy efficient, and
decreases the compensatory effects of a locked knee ankle foot orthosis (KAFO). There are
several varieties of knee joints; some are operated mechanically while others are operated with
computer controllers. (Fig.1-3)


















Fig.1 Fig.2 Fig.3


Locked Knee: Locked knee KAFOs are used to provide maximum stability to the patient. These
orthoses are locked during the entire gait cycle and can be unlocked for sitting. The locking
mechanism is done by a drop lock, bail or French lock, or trigger lock.


o Drop Lock: This design incorporates a ring that slides
down over the knee joint providing for a mechanical
lock. (Fig.4)







Fig.4




Fig.5
o Bail or French Lock: This style of knee joint
incorporates a loop that connects the posterior of
both knee joints. Rather than locking each knee j
individually this allows both to be unlocked via a bail
or loop design. Bail or French locks are effective for
patients wearing bilateral (two) orthoses. (Fig.5)
oint



















o Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often
uses cables and a trigger switch allowing patients to unlock the knee joint via a point at
the proximal edge of the orthosis. It is commonly used for patients with limited dexterity,
balance and for increased safety and stability. (Fig.1)







KAFO Indications
Lower extremity weakness or paralysis
Lower extremity instability
Neuropathy
Femoral nerve injury Fig.1
Spinal cord injury
Muscular dystrophy
Multiple Sclerosis
Polio and Post-Polio syndrome
Stroke (CVA: cerebrovascular accident)
Myosytosis



Reciprocating Gait Orthoses
Reciprocating Gait Orthoses (RGOs): RGOs were designed
to help patients that suffer from spinal cord injury,
Myelomeningocele, spina bifida, and other paralytic disorders
walk. Often patients who have sustained paralysis to their
lower extremities require the assistance of orthotic devices
to walk. One such device, a reciprocating gait orthosis
(RGO), is designed to provide as normal method of
movement as possible for paraplegic patients.
Reciprocating gait is defined as putting one foot in front of
the other.
The orthosis consists of two-molded plastic knee-ankle-foot
orthoses (KAFO) attached to a metal pelvic control band
and upright thoracic supports. The posterior section of the
pelvic band/thoracic component is fit with either a rocker bar
system or cable system. Both function in a similar manner; the
rocker system functions much like a seesaw. Shifting
weight from one side of the body to the other allows one
limb to be stable on the ground while advancing the contra
lateral limb. Please keep in mind that there are additional
devices that are necessary for these patients to be
stabilized. It is common for them to use crutches and/or
walkers to aid them in their movement. (Fig.1)

RGO Indications
Fig.1
Spinal Cord Injury
Myelomeningocele
Spina Bifida
Paralytic disorders



Adult Hip Abduction Orthosis
Fig.1

Hip Abduction Orthosis: Hip abduction orthoses are designed to maintain appropriate
anatomical alignment of the hip or prosthetic hip replacement. The components include a
hip/pelvic girdle, thigh cuff, and hip joint. The joints are usually adjustable and set in some
degree of flexion and abduction. This alignment positions the head of the femur in the
acetabulum allowing for the ligaments, bone, and surrounding musculature to heal. These
devices are also used to stabilize patients who suffer from chronic subluxation of the hip.
(Fig.1)

Indications
Chronic hip dislocations
Degenerative joint disease
Total hip joint replacement
Post-operative stabilization









Compression Stockings/Sequential
Compression Therapy
Compression Stockings: Compression stockings are gradient stockings that help control
edema/lymphedema and aid in venous return.

Sequential Compression Therapy: These devices are placed around the limb that operative with
intermittent compression to aid in controlling lymphedema and venous return. These are often used in
hospitals following surgery to help prevent blood clots and aid in lower extremity circulation.


Compression Stockings: These are graded in mmHg. The degree of
compression is determined by your diagnoses and physician prescription.
They range from as low as 10mmHg to as high as 40mmHg. The lower
levels are used in those patients where the edema/venous disruption are
not as severe. The higher compression is used in those patients who have
severe edema/venous disruption. These are available in pull on as well as
with zippers for ease of donning and with closed and open toe versions.
(Fig.1)

Compression Therapy Indications
Lymphedema
Varicose veins
Pitting edema
Pregnancy


Donning Compression Stockings: Invert (turn the stocking inside out)
and then slowly roll the stocking onto the limb. This is often easier than
trying to pull it on. Rubber gloves can also be very beneficial creating a
better grip when rolling them on. If you have a zipper pay close attention to the skin to ensure that you do
not pinch it when donning.
Fig.1