LOWER

EXTREMITY
ORTHOSIS
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REGIONAL CLASSIFICATION

1. Foot Orthoses (FO)

2. Ankle-Foot Orthoses (AFO)
3. Knee-Ankle Foot Orthoses (KAFO)
4. Hip-Knee-Ankle-Foot Orthoses (HKAFO)

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 ORTHOSIS SERVING SPECIALIZED FUNCTIONS

• Swedish knee cage: It is a knee orthosis that is used to control minor or

moderate genu recurvatum.

• Pediatric orthosis: Standing Frame: Used for a toddler with spina bifida
or a T12 neurosegmental level lesion or a child with cerebral palsy.

• Parapodium (Swivel Orthosis): It is used for leg length discrepancy and

has a wide abdominal support pad to assist in upright posture.
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PARAPODIUM ORTHOSIS

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SWEDISH KNEE CAGE

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• Reciprocating gait orthosis (RGO) These are bilateral hip, knee,
ankle, foot orthosis to provide contra lateral hip extension with
ipsilateral hip flexion. When one hip flexes, the contra lateral hip
extends .

• Twister: It is prescribed for lack of control of internal or external

rotation or torsion of lower limb.

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TWISTER STRAPS

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RGO

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 MATERIAL AND FABRICATION FOR LOWER LIMB
ORTHOSES

• A wide variety of materials have been used to fabricate orthotic appliances, among them metals like steel,
aluminium and alloys, rubber, leather and canvas. Some of them used more often recently are plastics and
synthetic fabrics.
• Considerations while Selecting the Material
1. Strength
2. Durability
3. Flexibility
4. Weight
5. Should accommodate a simple and inconspicuous design
6. Comfort
7. Cosmesis
8. Distribution of forces over sufficiently large surface area
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9. Material which can be accurately contoured and padded to the body.
CALIPERS

• Calipers are orthosis fitted to the lower limb. They may

be
• Foot orthosis (FO)
• Ankle Foot orthosis (AFO)
• Knee Ankle Foot orthosis (KAFO)
• Hip Knee Ankle Foot orthosis (HKAFO).
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 FOOT ORTHOSIS
• The essential difference between a shoe and a boot is
that a boot covers the malleoli, while a shoe does not.

• The foot orthoses is nothing but a boot that has

components like supports and wedges to manage
different foot symptoms and deformities.

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 ANKLE-FOOT ORTHOSIS (AFO)
Metal Ankle-foot Orthosis

• The AFO is a boot to which an ankle joint is fixed through the stirrup. There are
metal uprights (medial and lateral bars) ascending up to the calf region.

• The components are:

• Proximal calf band with leather straps

• Medial and lateral bars articulating with medial and lateral ankle joints help in
control of plantar and dorsiflexioN
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• Indications
• Ankle-foot orthosis is prescribed for,
1. Muscle weakness affecting the ankle and sub-talar joints.
2. Prevention or correction of deformities of the foot and ankle.
3. Reduction of inappropriate weight bearing forces.

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KNEE-ANKLE-FOOT ORTHOSIS (KAFO)

It provides stability to knee, ankle and foot.

• Components
1. The components are the same as those in a metal AFO.
2. In addition there are uprights extended to the knee joint and lower
thigh band.
3. Thigh bands are suspension mechanisms to which the uprights are
attached.
4. They are worn by the patient to fasten the orthoses to the leg or
thigh.
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KNEE JOINTS

• Knee joints are provided in calipers, so that the

wearer can sit down.
• During walking the joint is locked in full
extension for stability, but at the expense of a
good gait pattern because the person walks with
a stiff knee gait.
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 TYPES OF KNEE JOINT
• Straight set knee joint: allows free flexion and prevents hyperextension.
The upper segment rotates about a single transverse axis. It is used in
combination with a drop lock to give further stability. This is the joint
usually prescribed in our country. It is cheap and easy to repair.

• The polycentric knee joint uses the double axis system to simulate the
flexion/extension movements of femur and tibia at knee joint.

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• Posterior Offset Knee Joint: This is given for patients with minimal quadriceps
weakness, since it keeps the knee extended, though there is not enough stance
control.

• The criteria for prescribing a posterior offset knee joint is adequate power of
hip flexion and extension and the ability to generate enough momentum to
walk. The placement of the joint is just behind the anatomical knee joint to
increase knee stability when walking.

• If knee extensors are weak, and knee buckling into flexion occurs, a posterior
offset knee joint may be indicated.

•.
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• In the absence of knee flexion spasticity or contracture, an
offset knee joint provides a mechanical stable knee during
stance but allows knee flexion during the swing phase

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STANCE CONTROL
• The ideal joint should have stability during weight bearing and
flexion during the swing phase of gait when it is non-weight bearing.

• This is more energy efficient, and decreases the exaggerated

movements of the hip which is seen when the knee is locked.

• Some of these joints are mechanically operated while others are

powered by computerized mechanisms controllers.

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 KNEE LOCKS
• Drop lock is a wedge shaped metal piece that is placed
on the lateral upright bar. When the knee extends it
drops over the joint and locks it. This is commonly
used in our country.

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• SPRING LOADED LOCK -provides automatic
locking using a spring action rather than depending
on gravity to do it. This lock is easier for locking and
unlocking.

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• The ball lock provides an easy method of unlocking medial
and lateral knee joints. The patient can catch the ball on the
edge of the chair to release the lock mechanism to permit
sitting. This is useful

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• A dial lock may be adjusted every 6° for precise control of knee flexion.

• Plunger type lock: It is cosmetically more acceptable since it is

concealed in the knee mechanism. It is indicated in persons having hand
weakness.

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 INDICATIONS
• The biomechanical indications for the use of KAFO’S (and
HKAFO’s) are
• divided into three parts
• Muscle Weakness: Weakness of the muscles of the lower limbs,
mainly those controlling the knee and hip joint (more specifically the
quadriceps and hip extensors).
• This will most commonly result from spinal cord damage or lower
motor neuron disease such as poliomyelitis or injury to a nerve.

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• Upper Motor Neuron Lesions: Upper motor neuron lesions
impair locomotor function through loss of the normal
control of the lower limb muscles.
• There is an extensor synergy in the lower limb, which is
used by the hemiplegic to achieve stance stability.
• The orthotic device must additionally incorporate knee
joints, which limit hyperextension.
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• Loss of Structural Integrity: This is due to injuries to the main
ligaments of the knee and joint disease, either due to inflammatory
(septic arthritis) or degenerative (osteoarthritis) processes.

• Genu Varus/Valgum: Damage to the medial joint compartment with

resultant varus instability, will result in a concentration of the joint
force on the damaged condyle.

• In addition the increased knee adduction moment will result in

increased tension on the lateral collateral ligament

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• Problem in Load Bearing: This form of structural impairment may
be a consequence of either a joint or bony defect such as failure of a
hip or knee joint replacement or a delayed or non-union of a femoral
fracture.

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HKAFO

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• HKAFOs consist of the same components as described for the
standard AFOs and KAFOs, with the addition of an attached
lockable hip joint and a pelvic band to control movements at the
anatomic hip joint.

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• The suspension is with a pelvic band, which is a padded rigid steel
band extending posteriorly and laterally, which fits between iliac
crest and greater trochanter and which is used to control rotational
movement at the hip joint.

• In the front it is fastened with a soft Velcro or buckle strap fastener.

• On the lateral side it is connected by a lateral upright, or bar to a

normal KAFO and

• on the medial side the upright stops short of the ischial region
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• Movement at the hip is with an uniaxial hip joint with a drop lock,
which is locked during walking.

• In conditions where weight relief from the lower part of the body is
needed, the body weight is taken away from the foot or leg and
transmitted from ischial seat through metal uprights to the ground.

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• HKAFO provides improved posture, and balance during standing and a
better controlled forward leg swing in patients with weak hip muscles.

• However it is difficult wear and remove, and permits only limited step
length.

• There is also an increase in lumbar spine movements to compensate for

limited hip motion

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• Gait analysis affords the clinical team the opportunity to infuse the much
needed objectivity into the process of orthotic alignment assessment.

• Experienced clinicians may back their biomechanical orthotic prescription

process with the use of special quantitative and semi-quantitative assessment
methods including
• (in order of frequency of use): video recording (slow motion and instant replay)
and instrumented gait analysis (Kinematics
• [temporal and spatial measures and motion analysis]
• kinetics [force analysis], dynamic electromyography.

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