Orthotics and Prosthetics: Ankle Foot Orthosis Tuning
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Questions and Answers

What is an important consideration for achieving optimal knee extension during the stance phase of gait?

  • Positioning the talo-cural joint at 90°
  • Aligning the tibial and thigh shanks vertically
  • Maintaining an SVA of 10° to 12° of inclination (correct)
  • Setting the AFO at 90°

What is the purpose of extending the medial and lateral trim lines distally to cover the metatarsal phalangeal joints?

  • To reduce pressure on the metatarsal phalangeal joints
  • To block dorsiflexion at the ankle
  • To prevent tibial progression and subsequent knee collapse (correct)
  • To ensure the footplate material is sufficiently stiff and thick

What is the ideal patient profile for an AFO that uses floor reaction force through the toe aspect of the foot plate?

  • Patients with spasticity and excessive dorsiflexion
  • Patients with weakness and lack of voluntary plantarflexion (correct)
  • Patients with knee collapse and tibial progression
  • Patients with severe foot deformities

What is the myth about AFO management in CP that has been debunked?

<p>AFOs should be set at 90° (B)</p> Signup and view all the answers

What is the benefit of achieving the correct SVA angle during stance phase?

<p>It facilitates the optimum alignment of the GRF in relation to the ankle, knee, and hip joints (C)</p> Signup and view all the answers

What is the relationship between the AFO and the SVA?

<p>The AFO and SVA are independent of each other (A)</p> Signup and view all the answers

What is the primary goal of AFO management in CP?

<p>To achieve optimal knee extension during stance phase (D)</p> Signup and view all the answers

What is the significance of the Shank to Vertical Angle (SVA) in AFO management?

<p>It measures the angle of the tibial shank relative to the vertical (B)</p> Signup and view all the answers

What is AFO-FC tuning defined as?

<p>The process of fine-tuning an AFO for optimal performance during a particular activity (C)</p> Signup and view all the answers

What is the primary goal of AFO management in CP?

<p>To resist unwanted dorsiflexion and maintain GRF alignment (B)</p> Signup and view all the answers

What is the ideal alignment of the SVA during Mid-Stance and Terminal Stance?

<p>Between 10-12° (B)</p> Signup and view all the answers

What is the purpose of marking the trim line at the ankle?

<p>To allow flexion of the polypropylene (A)</p> Signup and view all the answers

What is the primary function of the Ankle-Foot Orthosis (AFO)?

<p>To maintain the foot in a plantigrade position (D)</p> Signup and view all the answers

What is the standard trim line design option?

<p>A horizontal line 2 cm below the fibula head (C)</p> Signup and view all the answers

What is the benefit of using a PLS orthosis?

<p>It allows for dorsiflexion of the ankle while preventing passive plantar flexion (A)</p> Signup and view all the answers

What is a common indication for prescribing an AFO in children?

<p>Mild hypotonia and excessive pronation (C)</p> Signup and view all the answers

What is a crucial factor in achieving optimal performance of an AFO?

<p>The design of the AFO (D)</p> Signup and view all the answers

What is a benefit of using a Supra Malleolar Ankle Foot Orthosis (SMAFO)?

<p>It provides circumferential control of the rear and forefoot (B)</p> Signup and view all the answers

What is the primary goal of orthotic treatment for gait correction?

<p>To achieve optimal alignment of the GRF (C)</p> Signup and view all the answers

What type of material is typically used to fabricate a Supra Malleolar Ankle Foot Orthosis (SMAFO)?

<p>Thin, flexible thermoplastic (A)</p> Signup and view all the answers

What is an important consideration when prescribing an AFO?

<p>Matching patient desires with functional requirements (C)</p> Signup and view all the answers

What is a potential goal of orthotic treatment using an AFO?

<p>To provide a more energy-efficient gait (D)</p> Signup and view all the answers

What is an important consideration when applying forces to an AFO?

<p>Separating swing and stance phase problems (A)</p> Signup and view all the answers

What is a characteristic of a Supra Malleolar Ankle Foot Orthosis (SMAFO)?

<p>It has a higher medial side than lateral side (C)</p> Signup and view all the answers

Flashcards

AFO Tuning

Adjusting an Ankle Foot Orthosis (AFO) for optimal performance during specific activities, like walking.

AFO Material and Design

The type and stiffness of the plastic used in an AFO and its shape influence how it affects a child's walking.

Shank to Vertical Angle (SVA)

The angle of the lower leg bone (tibia) relative to a vertical line during walking.

Optimal SVA

The ideal SVA during the middle of a walking step (midstance) is between 10° and 12°, with a range of 7° to 15°.

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SVA and Body Alignment

Correct SVA allows the thigh to tilt, helping the pelvis and torso stay upright during walking.

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AFO Primary Function

To keep the foot flat on the ground (plantigrade position) and provide a stable base for walking.

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AFO Support During Walking

The AFO helps the foot during the middle of the step (midstance) and prevents the foot from dragging during swinging leg phase.

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AFO and Energy Efficiency

AFOs make walking more energy-efficient by improving the mechanics of the leg and foot.

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Essential AFO Prescription

A comprehensive assessment is crucial for accurately prescribing an AFO.

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AFO Prescription Factors

The prescription must consider both the patient's needs and the functional requirements of the AFO.

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Dynamic AFO Needs

AFOs need to be adjusted over time as the child's needs and abilities change.

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Detailed AFO Prescription

The prescription should include details like device design, materials, joints, straps, intended function, and adjustments.

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Force System in AFO

Three points of pressure are used to effectively support the foot with an AFO.

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Static and Dynamic Analysis

Analyzing the foot and leg at rest (static) and during movement (dynamic) to identify problems.

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Organizing Force Systems

Separating problems that occur when the leg is stationary (stance) from those that occur when swinging (swing) to properly target the force system.

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Supra Malleolar Ankle Foot Orthosis (SMAFO)

A type of AFO that extends above the ankle bones and to the toes, with a higher medial side.

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SMAFO Support

The SMAFO supports the heel bone (calcaneus) and arch of the foot, providing stability and control.

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SMAFO Alignment

The SMAFO helps maintain the foot in a neutral position, keeping it aligned properly.

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SMAFO Common Indications

Often prescribed for young children with mild muscle weakness (hypotonia) and inward turning of the foot (pronation), or flexible flat feet.

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SMAFO Circumferential Control

The SMAFO provides support around the entire foot, both the back and front parts, to maintain alignment.

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Study Notes

Ankle Foot Orthosis (AFO) Management in Cerebral Palsy (CP)

  • AFO tuning is the process of fine adjustments to optimize the AFO's performance during a particular activity, such as walking.
  • The type and stiffness of the material used for the AFO, as well as its design, affect the orthosis' impact on a child's gait.

Shank to Vertical Angle (SVA)

  • SVA is defined as the angle of the tibial shank relative to the vertical in the sagittal plane.
  • The optimal SVA at mid-stance is between 10° to 12° of inclination, with a range of 7° to 15° of inclination.
  • Reaching the correct inclination of the SVA permits the thigh segment to become inclined and the pelvis and trunk to progress in a vertical position.

AFO Design and Function

  • The main function of the AFO is to maintain the foot in a plantigrade position, providing a stable base of support.
  • The AFO supports the foot in midstance and prevents drop foot during swing phase.
  • AFOs provide a more energy-efficient gait.

Orthotic Prescription Principles

  • Good assessment is key to successful prescription.
  • The prescription should match patient desires with functional requirements.
  • Orthotic needs may change over time.
  • A detailed prescription should include the design of the device, materials used, joints, straps/suspension, function, casting/anatomical angle, tibial inclination angle, wedging or tuning, and footwear & adaptations.

Force Application

  • Three-point force systems should be applied to have an effective orthosis.
  • Perform static and dynamic analysis to identify segment deviations.
  • Separate swing and stance phase problems and organize force systems.

Supra Malleolar Ankle Foot Orthosis (SMAFO)

  • SMAFO extends to just above the malleoli and to the toes.
  • The medial side is higher than the lateral, holding the calcaneus more firmly and supporting the longitudinal arch.
  • SMAFO provides circumferential control of the rear and forefoot to maintain a neutral alignment.
  • Commonly prescribed for young children with mild hypotonia and excessive pronation, or flexible pes planus (i.e., hind and midfoot instability).

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Description

Learn about the process of fine-tuning Ankle Foot Orthosis and Footwear Combination (AFO-FC) to optimize its performance during walking. Understand how to achieve the desired Subtalar Vertical Axis (SVA) and optimize the position of the Ground Reaction Force (GRF) during stance phase.

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