Summary Orthotics are lower extremity supportive apparel that provide soft tissue protection, bone/joint stability and control of body segment motion. Orthotics play an important role in the nonoperative treatment of foot and ankle pathology. The type of orthotic needs to be specific for the underlying bony or ligamentous pathology in order to provide appropriate functional support. Overview Uses off-load areas of high pressure and decrease shear forces cushion vulnerable soft tissue sites (ex. diabetics) correct flexible deformities and accomdate rigid deformities (ex. pes planovalgus) eliminate painful motion (ex. hallux rigidus) replace lost motion, improve gait and ambulation (ex. ankle fusion) Options type of stabilization static: rigid device, supports body segment in fixed position dynamic: mobile device, permits body segment motion combination material metal, plastic, leather, synthetic fabric body region named for joints controlled (ankle and foot = "ankle-foot-orthosis" or AFO) Principles patient-related soft tissue login to view 2 more bullets functional level of patient login to view 1 more bullet pathology being addressed login to view 4 more bullets orthotic-related three-point pressure control system should be aligned at the approximate anatomic joint design should be login to view 4 more bullets Foot Orthoses Shoes shoes are a type of orthosis can be modified to correct or accommodate deformity, minimize painful motion and optimize gait mechanics shoe selection extra depth shoe login to view 1 more bullet stiff, supportive shoe login to view 1 more bullet soft, accommodating shoe with shock-absorbing sole (running shoe) login to view 1 more bullet custom shoe login to view 1 more bullet shoe modifications can be internal (placed inside the shoe) or external (built up outside the shoe) login to view 2 more bullets can modify heel, sole or both adjustable closures login to view 3 more bullets sole excavation and padding login to view 3 more bullets cushioned heel login to view 2 more bullets flares login to view 5 more bullets wedges login to view 6 more bullets heel lift login to view 1 more bullet rocker soles login to view 26 more bullets extended shank login to view 4 more bullets Foot orthoses (inserts/inlays) Heel cup rigid plastic insert covers plantar surface of the heel and extends posteriorly, medially and laterally useful to prevent lateral calcaneal shift in flexible pes planovalgus University of California Biomechanics Laboratory (UCBL) orthosis constructed with rigid plastic over a cast of the foot held in maximum manual correction includes the heel and midfoot, with rigid medial, lateral and posterior walls holds the heel in a vertical neutral position designed for flexible pes planovalgus login to view 1 more bullet Longitudinal arch support can be applied medially or laterally prevents depression of subtalar joint and corrects for pes planus metatarsal pads or bars can be used for symptomatic metatarsalgia transfers the load of the foot from the metatarsal heads to the more proximal forefoot Ankle Orthoses Arizona brace combination of a UCBL and lace-up ankle support useful for flexible pes planovalgus provides more rigid hindfoot support Ankle foot orthosis (AFO) construction composed of a footplate, calf support and a calf band can be made of plastic, metal and leather indications correct or prevent ankle deformity by assisting in muscular weakness or overactivity involving ankle dorsiflexion, plantarflexion, inversion or eversion ankle position indirectly affects knee stability with ankle plantarflexion providing a knee extension dorce and ankle dorsiflexion providing a knee flexion force types divided broadly into non-articulating and articulating non-articulating login to view 6 more bullets articulating login to view 9 more bullets specific designs posterior leaf spring (PLS) AFO login to view 5 more bullets solid AFO login to view 2 more bullets hinged AFO login to view 3 more bullets ground reaction AFO login to view 3 more bullets patellar tendon bearing AFO login to view 2 more bullets immobilization AFO (ex. CAM walker) login to view 3 more bullets free motion ankle joint login to view 5 more bullets plantarflexion ankle joint stop login to view 4 more bullets dorsiflexion ankle joint stop login to view 4 more bullets limited motion ankle joint stop login to view 2 more bullets dorsiflexion assist spring joint login to view 3 more bullets varus-valgus correction straps (T-straps) login to view 2 more bullets supramalleolar orthosis (SMO) login to view 3 more bullets Knee Orthoses Knee ankle foot orthosis (KAFO) construction consist of an AFO with medial uprights, a mechanical knee joint and two thigh bands can be made of metal, plastic and leather quadrilateral or ischial containment brim limits the weight bearing of the thigh, leg and foot indications quadriceps weakness or paralysis, to maintain knee stability flexible genu varum or valgum more difficult to place and remove than AFOs not recommended for patients with moderate to severe cognitive dysfunction specific designs double upright metal KAFO login to view 3 more bullets Scott Craig orthosis login to view 6 more bullets