ORTHOTICS

Definition: Orthosis is an orthopaedic appliance or apparatus used to support, align, prevent, or

correct deformities or to improve function of movable parts of the body.
Purpose:
1. To lend stability to a weak joint
2. Correct or maintain alignment.
3. Correct skeletal deformities, etc
Principle

Principles in designing orthosis

 Three-point pressure.
 Total contact
 Partial weight relieving

Three point pressure:

The sum of the forces and the bending moments created is equal to zero A single force is placed at
the area of deformity; two additional counter forces act in the opposing direction. During "quiet"
standing, line of gravity (weight line) passes through posterior to hip joint anterior to knee joint and
anterior to ankle joint

Total contact:
"Pressure is equal to the total force per unit area. The greater the area of a pad of an orthosis, the less
force will be placed on the skin.
P=force/Area of application

Partial weight relieving:

1. "The farther the point of force from the joint, the greater the moment arm and the smaller the
magnitude of force required to produce a given torque at the joint."
2. The greater the length of the supporting orthotic structure, the greater the
moment or torque that can be placed on the joint or unstable segment
Types

Types of orthosis
1. Upper limb orthosis
2. Lower limb orthosis.

Lower limb orthosis

Purpose: For supporting lower limbs
Materials used:
 Plastic (recently in demand): e.g. polypropylene, polyethylene
 Metal: aluminum (lightweight), stainless steel, etc.
Types of lower limb orthosis:
1. Ankle foot orthosis (AFO)
2. Knee ankle foot orthosis (KAFO)
3. Knee orthosis (KO)
4. Hip knee ankle foot orthosis (HKAFO)
5. Hip orthosis (HO)

AFO: Ankle-foot orthosis is a brace, usually plastic, worn on the lower leg and foot to support the
ankle, hold the foot and ankle in the correct position, and correct foot drop.
Purpose:
 To control alignment and motion of the joints of foot and ankle
 For patients affected with muscular dystrophy, cerebral palsy, etc.
Construction:
 Consists of a shoe attachment, ankle control, uprights, and a proximal leg band.
Parts:
 Calf bands
 Metal uprights
 Ankle joint
 Shoe attachments
 Stirrup

Types of AFO:
 1. Dorsiflexion assist AFO: In case of moderate foot drop
2. Plantar flexion assist AFO:
3. Posterior leaf spring AFO:
4. Patellar tendon bearing AFO:
5. Spiral AFO:
6. Solid AFO: In case of severe foot drop.

KAFO: A KAFO is a long-leg orthosis that spans the knee, the ankle, and the foot in an effort to
stabilize the joints and assist the muscles of the leg.
Material for fabrication: metals, plastics, fabrics, and leather.
Parts:
 Hip joints and locks
 Controls for abduction, adduction and rotation.
 Controls for hip flexion when locked
 2 position hip locks are also available
 Pelvic band: To stabilize the hip joint. There are two types unilateral pelvic band and
bilateral pelvic band.
 It adds weight and increases overall energy expenditure during ambulation.

Types of KAFO:

1. Supracondylar plastic orthosis

2. Scott-Craig orthosis.

Knee orthosis: A knee orthosis (KO) extends above and below the knee joint. Designed to control
the ligament deficiencies around the knee. Provide functional support and rehabilitation after injury
& surgery of the knee.
Parts:
 Double uprights
 Free or adjustable knee joint
 Thigh and calf cuffs

Types of knee orthosis:

 1. Dynamic patellar orthosis: It consists of an elastic sleeve with patellar cutout. Its purpose is
to prevent the dislocation of the patella.
2. Traditional knee orthosis: It consists of leather thigh, calf cuffs, and metal sidebars. Pressure
pad may be applied to generate medial or lateral forces.
3. Swedish knee cage: It is used in the management of knee hyperextension. Two anterior pads
and adjustable posterior pressure pad at the attachment to the upright.

Types of knee joints:

1. Free motion knee joint: allows unrestricted flexion & extension.

2. Off-set knee joint: the hinge is located posterior to the knee joint stabilize knee during stance
HKAFO: Hip joint and pelvic band attached to the lateral upright of a KAFO converts it to a
HKAFO.

Purpose:
 Hip flexion/extension instability
 Hip adduction/abduction weakness
 Hip internal rotation/external rotation instability
Parts:
 Soleplate extending to the metatarsal heads with a crossbar added to the metatarsal heads
area for mediolateral stabilization.
 Ankle joint set at 10% of dorsiflexion
 Anterior rigid tibial band (patellar tendon strap)
 Offset

Proximal Posterior Thigh Band Purpose:

The Proximal Posterior Thigh Band is a component of Hip-Knee-Ankle-Foot Orthosis (HKAFO)
used to provide stability and support to the hip joint and prevent hip flexion contractures.
Parts: It is a band that is placed around the proximal (upper) part of the posterior (back) thigh. It is
made of durable and supportive material such as leather or neoprene.
Other Types of HKAFO: Apart from Reciprocal Gait Orthosis (RGO) and Hip Orthosis, there are
other types of HKAFOs that are used for different conditions such as Paraplegia, Quadriplegia, and
Cerebral Palsy. These include:
 Knee-Ankle-Foot Orthosis (KAFO)
  Hip Guidance Orthosis (HGO)
 Ischial weight-bearing Orthosis (IWO)
Indications:
 To support or stabilize a joint or body part
 To correct or prevent deformities
 To provide assistance with movement or mobility
 To relieve pain or discomfort
Contraindications:
 Open wounds or skin irritation in the area of application
 Allergies to materials used in the orthotic device
 Acute inflammation or infection in the area of application
 Severe vascular or neurological problems
 Uncontrolled muscle spasms or contractures
Applications:
 Orthotics can be used for various conditions such as plantar fasciitis, Achilles tendonitis,
ankle sprains, knee osteoarthritis, scoliosis, and cerebral palsy.
 The application of orthotics should be done by a trained professional, such as an orthotist or
physical therapist, to ensure proper fit and function.
 Orthotics may be custom-made or off-the-shelf and may require adjustments over time.
 Patients using orthotics should be monitored regularly to ensure proper use and to identify
any issues that may arise.
 SPLINT

A splint is a rigid support made from metal, plaster, or plastic. It's used to protect support, or
immobilize an injured or inflamed part of the body.

Purpose
Splints have various purposes. Including:
• Immobilization
• Support to Promote Healing
• Positioning or supporting during function
• Pain Relief
• Substitute for Weak Muscles
• Prevention and Correction of Contracture & Deformity
• Restoration or Maintenance of Range of Motion
• Edema Control

Region Type of Splint

Upper Extremity
Ulnar Side of Hand Ulnar Gutter Splint
Thumb, First Metacarpal, and Carpal Thumb Spica Splint
Finger injury Buddy Taping
Aluminium U-shaped Splint
Dorsal Extension-block Splint
Mallet Finger Splint
Wrist / Hand Volar/Dorsal Forearm Splint
Short Arm Cast
Forearm Single Sugar-tong Splint

Elbow, proximal forearm, and skeletally immature wrist injuries Long Arm Posterior Splint
Long Arm Cast
Double Sugar-tong Splint
Lower Limb
Ankle Posterior Ankle Splint
Stirrup Splint
Lower Leg, Ankle and Foot Short Leg Cast
Knee and Lower Leg Posterior Knee Splint

Foot Short Leg Cast with Toe Plate Extension

Indications of Splinting:

 Temporary stabilization of acute fractures, sprains, strains, or nerve injuries before further
evaluation or definitive operative management.
  Immobilization of a suspected occult fracture (such as a scaphoid fracture).
 Severe soft tissue injuries requiring immobilization and protection from further injury.
 Definitive management of specific stable fracture patterns.
 Peripheral neuropathy requiring extremity protection.
 Partial immobilization for minor soft tissue injuries.
 Treatment of joint instability, including dislocation.

Contraindications of Splinting:

 Injuries that violate the skin or open wounds.

 Injuries that result in sensory or neurological deficits.
 Injuries to the vasculature.
 Patients with peripheral vascular disease.

Advantages of Splinting:

 Splints are faster and easier to apply.

 They may be static (i.e., prevent motion) or dynamic (i.e., functional; assist with controlled
motion).
 Splints are non-circumferential, allowing for natural swelling that occurs during the initial
inflammatory phase of the injury.
 A splint may be removed more easily than a cast, allowing for regular inspection of the
injury site.

Disadvantages of Splinting:

 Poor patient compliance.

 Excessive motion at the injury site.
 Limitations in their usage, as in unstable or potentially unstable fractures.

Complications of Splinting:

 Compartment Syndrome.
 Ischemia.
 Heat Injury.
 Pressure sores and skin breakdown.
 Edema.
 Infection.
 Dermatitis.
 Joint stiffness.
 Altered range of motion.
 Decreased strength.
 Altered sensation.
 Neurological injury.

Considerations for Effective Splinting:

 Creases provide landmarks in splint fabrication.
 Bony prominences may cause pressure.
 Ensure three points of pressure.
 Custom-made splints to fit the contours of the body rather than ready-made splints.
  Patient education for better compliance.

PROTHOTICS
A prosthesis is an artificial device used to replace a missing body part or enhance the function of an
existing body part. Prostheses are designed to improve the quality of life of individuals who have
lost or impaired a body part due to injury, disease, or birth defects.
Principles of prosthesis design:

Prosthesis design is based on several principles including biomechanics, material science and patient
comfort.

Below are some of the most important principles of prosthesis design.

1. Biomechanics:
The prosthesis should be designed to provide the support and functionality the patient needs to carry
out their daily activities. These include considerations such as weight distribution, range of motion,
and joint stability.
2. Materials Science:
Materials used for prostheses must be carefully selected to ensure durability, strength, and
compatibility with the patient's body. The material should also be lightweight to avoid fatigue and
stress on the remaining limbs. 3. Patient comfort:
The prosthesis should be comfortable to wear, fit snugly, and not move or rub against the skin.
Patient comfort is important to ensure long-term prosthesis wear without discomfort or irritation.

Type of prosthesis:

Different types of prostheses are available depending on the location and extent of the amputation or
loss of function. Below are some of the most common types of prostheses.

1. Upper limb prosthesis:

These are used to replace lost arms and hands. Upper limb prostheses are either passive or active.
Passive prostheses are decorative in nature and designed to match the appearance of the rest of the
limb. Active prostheses, on the other hand, are designed to provide function and mimic natural limb
movements. may contain electronic components that
2. Lower limb prosthesis:
These are used to replace lost legs or feet. Lower extremity prostheses are typically designed to
mimic the natural movements of the leg or foot to provide stability and support while walking or
standing. They may include hydraulic or pneumatic systems to control movement and absorb shocks.
3. Eye prosthesis:
They are used to replace eyes that have been lost due to injury, disease, or congenital abnormalities.
Eye prostheses are designed to match the appearance of the rest of your eye and provide a natural
look.
4. Dentures:
They are used to replace teeth lost due to injury, disease, or tooth decay. Dentures are removable or
fixable and are designed to provide a natural appearance and improve oral function.
Five. Breast prosthesis:
These are used to replace breasts lost due to mastectomy or other surgical procedures. Breast
prostheses, either external or implanted, are intended to provide a natural appearance and improve
body image.

Indications and uses of the prosthesis:

1. Cutting:
The main indication for prostheses is limb amputation due to injury or disease such as cancer or
diabetes. Prostheses help individuals regain mobility and independence. 2. Congenital
malformations:
Prostheses can also be used by people born with missing limbs or incomplete congenital
malformations.
3. Trauma:
Injuries that have resulted in the loss of limbs, such as in car accidents or military combat, are also
potential indications for prosthetic limbs.
Four. Osteosarcoma:
Prostheses are also used to treat osteosarcoma.
5. Cosmetic Enhancement:
Prostheses can also be used cosmetically to improve the appearance of existing limbs or to replace
limbs lost for cosmetic reasons.

Contraindications of Prosthesis:

1. Poor Wound Healing: If the amputation site is not healing well or is at risk of infection, it
may not be appropriate to fit a prosthesis.
2. Severe Edema: If the residual limb is swollen and edematous, it may be difficult to fit a
prosthesis properly.
3. Inadequate Bone or Soft Tissue Coverage: If there is not enough soft tissue or bone to
properly support the prosthesis, it may not be feasible to fit a prosthesis.
4. Severe Arthritis: Severe arthritis may limit the range of motion in the residual limb, making it
difficult to properly use a prosthesis.
5. Neurological Impairment: If the individual has a severe neurological impairment that affects
their ability to control or feel their residual limb, it may not be appropriate to fit a prosthesis.

Uses of Specific Types of Prostheses:

1. Lower Limb Prostheses: Lower limb prostheses can help individuals with amputations or
congenital deformities to regain their mobility and independence. They can also help
individuals with conditions such as osteoarthritis or polio to improve their gait and balance.
2. Upper Limb Prostheses: Upper limb prostheses can help individuals with amputations or
congenital deformities to regain the use of their hands or arms. They can also be used for
cosmetic enhancement purposes.
3. Knee Prostheses: Knee prostheses are used to replace the knee joint in individuals with
severe arthritis or injury. They can help to improve mobility and reduce pain.
4. Hip Prostheses: Hip prostheses are used to replace the hip joint in individuals with severe
arthritis or injury. They can help to improve mobility and reduce pain.

Fitting and Assessment

The fitting and assessment process of a prosthesis is a collaborative effort between the prosthetist
and the individual. It requires careful evaluation and consideration of the individual's physical
condition, goals, and needs, as well as ongoing monitoring and adjustment of the prosthesis to
optimize function and comfort. With proper fitting and assessment, a prosthesis can provide
significant benefits to individuals with limb loss or other conditions that affect mobility or function.

REFERENCES
1. Academy of Orthopaedic Surgeons. (2017). Orthotics and Prosthetics. Retrieved from
https://orthoinfo.aaos.org/en/treatment/orthotics-and-prosthetics/

2. Kusumaningtyas, M. D., Jusuf, A. A., & Tarigan, R. (2021). The use of custom-made splints
in the management of acute hand and wrist injuries: a systematic review

3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2018). Orthotics and
Prosthetics Research. Retrieved from https://www.niams.nih.gov/health-topics/orthotics-and-
prosthetics-research

4. Ossur. (2021). Orthotics and Prosthetics Products. Retrieved from https://www.ossur.com/en-

us/products/orthotics-and-prosthetics

5. Pedretti, L. W., & Hsu, J. D. (2017). Splinting the Hand and Upper Extremity: Principles and
Process. Lippincott Williams & Wilkins.

6. World Health Organization. (2020). Assistive Technology.