VMMC 20 7C 20 Notes PDF

ORTHO Upper: top - Vamp SHOES - Reinforcement: toe box — to - protection...

ORTHO Upper: top - Vamp SHOES - Reinforcement: toe box — to - protection protect - aesthetics - Quarter: - stabilization - reinforcement: Counter - tongue SHOES c modifications - throat - Attachments for orthosis - Ilets (bilog) - correction - lacestay - used for deformity (deformity is - pinaglalagyan ng ilets flexible) - goal if rigid: accommodate THROAT STYLES deformity 1. Balmoral - Accommodation ○ Tago ung loob 2. Blucher SOLE ○ nakalabas - Bottom part of the shoe ○ MC PARTS: 3. Lace to toe - Ball: widest part of the shoe ○ ”surgical boot” - metatarsal heads (corresponds) ○ gang toes ung opening - Shank: Narrowest part of the shoe Straps - reinforcement: matigas — to - elastic laces provide support (“aka shank - not adjustable piece”) - velcro - like metal piece - prob c dexteriity - dec pressure - posterior entrance - give support towards the sole - if rigid: MC used - Toe Spring: Ant portion of the shoe — not - sipper incontact c the floor - not adjustable - to facilitate toe off quarter height Heel - High cut/high shoe/boot - Breast: front - above malleoli - Curve: Pitch — angulation - Low cut/ low shoe/Oxford - heels mataas = mataas angulation - Below the malleoli - higher pitch = less stability (inverse rs) When to prescribe: - counter: - if there's problem c ankle: high shoe - Height: lowest to highest - if prob c knees stability: mag cocompensate - spring: ⅛ in high ung tuhod: use low shoe - oxford: 6/8 in - military: 10/8 in SPECIALIZED SHOES: - cuban: 12/8 in Patten-Bottom shoes:like hydraulic boot  - totally eliminate WB - lat: reverse thomas - c spring - gusto i-evert - lat. support Extra-Depth shoe - heel elevation - C place for inserts - post part of the foot - internal modification - when to use: - maluwag — di fit sa pt - if tight or ayaw pagamit si gastrochs or injured Custom molded shoe achilles - Molded by the foot of the pt - usually achilles tendon - used if c severe deformity to accommodate repair - solid ankle cushion heel SHOE MODIFICATION - counter of cushion relief INTERNAL SOLE - INSERTS rocker bar - MC - inc toe off - Mechanically? sole flare - Mas effective dahil mas malapit sa body - part na aayusin [look at deformity if ano gagamitin ] - disadvantage: pwede maging masikip sa pt - high foot — heel mod kasi maraming ilalagay - Midfoot or forefoot — sole mod EXTERNAL - Disad: mabilis masira INTERNAL MOD: heel cushion relief - counter of cushion heel Heel: External Heel wedge - cushion heel - internal - may nakalagy na pad sa heel to - may makapal at manipis help absorb impact - cushion sa inner and outer ole metatarsal pad - Heel flare: Inc base of support kung nsaan - silicone or rubber sya - c prob c metatarsal head - lateral projection on the shoe - Can be used if c pes cavus (or high arc) - if to correct: underneath - Medial: to promote eversion medial longitudinal arch support - Lateral: to promote inversion - Buong sle meron and medial part is - heel wedge: ⅛ - ¼ inch heightened - extended heel - support at MLA - medial aspect is projected anteriorly: THomas heel UCBL insert - inaangat ung center part - University of california biomechanics - dec support or laboratory arch or flat - Mold shoe base on pt foot footed - diff c custom — more on bata - MC - in toeing, out toeing, flat foot, excessive ?  - MOLDED PLASTIC SHOE - posterior/PF stop - FXN: correct the flexible flat foot - Limit PF or foot drop - to prevent complication as the - limited motion stop child ages - allow PF/DF but c limits - FOR: children - free motion ankle jt - no limits Shoe elevation: LLD - medio-lateral control only T strap ORTHOSIS - invert/evert REF: NYU - nsa filler ng shoe - if in lat: prevent inversion Orthosis - med val - promote motion - lat var - stabilization of motion UPRIGHTS AFO CALF BANDS - Types - metal SPIRAL AFO - plastic - starts at medial of the foot - Posterior lift spring - shoe insert - mc - spiral PLASTIC AFO - band - Shoe insert - correction for varus/valgus - calf shell - calf band KAFO - pretibial band (lower strap) THIGH BAND METAL AFO KNEE JT: LOCK Types - Stirrup 1. Free motion jt - kinakabit sa shank ng shoe - Not common STIRRUPS - halos walang limits - Steel stirrup - medial and lateral stab only - Rigid / di na split 2. Off-set knee jt - disad: one shoe only - - split stirrup 3. Drop ring lock* - nag-ssplit sya - - pwede mag palit palit shoe 4. Pawl lock* - caliper stirrup - bail — handle - tube - thats why unique - pwede mag palit palit shoe - Pull & bend during flexion - less stable - straight to ext knee 5. Adjustable knee lock ANKLE JT - **indicated for post-op (such as ACL and - parts: others) HKAFO - Hip into abd & ir KNEE ORTHOSIS: TORONTO SWEDISH KNEE CAGE - Hip into abd & ir - Limits knee hyperext/recurvatum SCOTTISH-RITE PALUMBO - least restrictive - no ir just abd INFRAPATELLAR STRAP PARALYSIS ON SCI: FOR PEDIA: SEVERE PARALYTIC D/O: HIGH SCI DENNIS-BROWN SPLINT - STANDING FRAME - MC - Swing through gait - Night kinakabit - correction: club foot or equinovarus - PARAPODIUM - kabit sa shank -. - fxn: - everted and pronated SCI ORTHOSIS: Parts - t1-t8 - spreader bar - KAFO + WALKER - foot plates - NO GAIT - t9-t11 A-FRAME ORTHOSIS - KAFO + WALKER - Like KAFO - swing to gait - a shape metal frame - t12 - l3 - Like dennis brown splint - KAFO + LOFT STRAND CRUTCHES - 4 pt gait TORSION SHAFT ORTHOSIS - l4 - l5 - indication: scissoring gait, cp, - AFO + LOFT STRAND CRUTCHES - - 2 pt alt gait CONGENITAL HIP DISCLOC & HIP DISPLASIA VON ROSEN SCI ORTHOSIS - most restrictive LEVEL of SCI: ORTHOSIS: CAN: ILFELD T1 - T8 PAVLIK HARNESS T9 - T11 - least restrictive T12 - L3 LCPD [LEG CAV ] TRILATERAL L4 - L5 - MC  4 types PROSTHESIS 1. Calf suspension - stabilization - MC - support - nakabalot over patella for anchor para di dumulas si patella BKP 2. Supracondylar 1. Foot ankle assembly - anterior wall mas mataas - MC:sach/solid ankle cushion heel - anchor at femoral condyles for support — - mas magaan, mas mahal, mas matibay kaya mas mataas lateral - divide: 3. suprapatellar - single axis - - one plane of motion 4. thigh corset (DF/PF) - multiaxis PRESSURE TOLERANT & PRESSURE SENSITIVE AREAS - Invert/Evert + DF/PF SENSITIVE:to look out for 1. Fibular head 2. Shank 2. tibial crest 2 major types of shank 3. tibial condyles 1. endoskeleton/pylon/modular (madali 4. antero distal part of tibia palitan components)/central support 5. hamstring tendon - ad: interchangeability of parts 2. exoskeleton — crusta TOLERANT: - disad: unchangeable 1. Gastrochs (belly) 2. patellar tendon 3. socket/butas for residual limb 3. proximal part of tibia 2 types of socket 4. tibia & fibula shafts 1. Ptb socket/ patellar tendon bearing socket - Dun lahat bearing ni pt Check @ sullivan: - MC prescribed socket long trans tibia anything than >50 >20% normal trans tibs 2. hard socket 60% - MC suspension: calf suspension normal: 35 - 60 % Short: