HANGER PROSTHETICS AND ORTHOTICS, INC.

Lower Extremity Foot Orthotics

Foot Orthotics (Shoe Inserts): Foot orthotics are designed to evenly distribute the pressure over the entire plantar surface of the foot, alleviate areas that may be sensitive or painful, accommodate/correct for deformities, and improve the overall alignment of the foot, ankle complex and lower limb.

Foot Orthoses Designs:

• Accommodative: An accommodative foot orthoses is used to accommodate rather than correct a deformity of the foot. These orthoses can be used to prevent or heal skin abrasions or breakdowns, ulcerations, or aid in preventing further deformity from occurring. (Fig.1)
  
  Indications
  Rigid deformities
  Diabetic patients
  Charcot joint
  Some cavus foot deformities
  

• Corrective: A corrective foot orthosis is fabricated to correct a current deformity or mal-alignment of the lower extremity. (Fig.2)
  
  Indications
  Flexible foot deformities i.e. pes planus, metatarsalgia
  
  
  

Foot Orthoses

• Rigid Orthoses: Rigid orthoses are fabricated from materials that are stiff, strong, and durable. They are effective in transferring weight, limiting motion and stabilizing flexible deformities. (Fig.1)
  
  Indications
  Joint laxity
  Over-use syndromes
  Sesamoiditis
  Morton’s neuroma
  
  

• Semi-rigid Orthoses: Semi-rigid orthoses usually refer to a hybrid orthosis manufactured with a combination of rigid, semi-rigid, and soft materials. They are effective in stabilizing and supporting certain areas of the foot while the softer materials allow for increased comfort and shock absorption. (Fig. 2-3)

Indications
Athletes with flexible foot deformities
Metatarsalgia
Planar fasciitis

Lower Extremity Ankle Supports

Lower Extremity Ankle Supports: These orthoses are designed primarily to aid in ankle stability and for chronic ankle sprains/strains.

• University California Berkley Laboratory Orthosis (UCBL): A UCB orthosis is designed to control the heel, mid foot, and longitudinal and transverse arches. It provides additional medial and lateral support of the foot complex. (Fig.1)
  
  Indications
  Excessive inversion or eversion
  Excessive pronation or supination
  Posterior tibial tendon dysfunction/rupture
  

• Semi-rigid / Rigid Ankle Orthosis: This orthosis is designed to provide medial and lateral ankle stability. It can be fabricated to allow for free motion, limited or fixed range of motion. (Fig. 1&2)
  
  Indications
  Ligamentous Instabilities
  Ankle Instabilities (secondary to chronic sprains/strains)
  Tendonitis
  Posterior tibial tendon dysfunction or rupture
  Inversion/eversion (medial/lateral) instabilities
  Chronic sprains/strains
  Posterior tibial tendon dysfunction/rupture
  

• Custom Ankle Orthosis: This orthosis is designed from the cast or scan of the patient’s foot and ankle. This type of orthosis can be fabricated with a solid (static) or articulated ankle (Fig.1)
  
  Indications
  Severe pes planus (flat foot)
  Posterior tibial tendon dysfunction/rupture
  Medial/Lateral Instabilities
  Neuropathic involvement (i.e. drop foot secondary to neurological pathology)
  Osteoarthritis
  Post-operative stabilization
  

• Gel/Air Ankle Support: These orthose are designed to provide medial-lateral stability and compression. Some are available with hot/cold gel packs for therapy regimens.  (Fig. 1 &2)
  
  Indications
  Acute sprains or strains
  Chronic ankle instability with associated swelling/edema
  Tendonitis
  

• Plantar Fasciitis Orthosis: These orthoses are designed to provide a passive stretch on the foot and ankle at night and during non-weightbearing. They have adjustable range of motion to accommodate for various positions (Fig.3)
  
  Indications
  Plantar Fasciitis
  Slight Ankle Contractures/Tightness
  
  

Ankle Foot Orthoses (AFOs)

Ankle Foot Orthoses (AFOs): AFOs are designed to provide support, proper joint alignment to the foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb.

AFO designs: AFOs can be fabricated from plastic or in a conventional manner from metal and leather components.

• Metal or Conventional Orthoses: Metal orthoses are designed to control instability, paralysis and weakness of the foot and ankle complex. The conventional design utilizes metal bands, bars and metal calipers that are attached directly to shoe wear. These designs have been used for many years and are very effective for patients who experience volume fluxuations and swelling. The adjustable straps and buckles can accommodate for volume changes throughout the day. This style is also used in areas where the temperature is very high; the open construction allows the skin to breathe. (Fig.1)
  
• Plastic: Plastic orthosis are designed to fit inside a shoe and are effective in controlling instabilities, paralysis or weakness at the foot and ankle and aid in pressure distribution. Utilizing this design allows the practitioner to apply corrective or stabilizing pressure over a large area rather than in one specified point.
  

• Posterior Leaf Spring (Dorsi flexion assist) AFO: A dorsi flexion assist AFO is fabricated from plastic and is designed to fit inside of a shoe with little effort. It attaches to the limb via a Velcro strap at the proximal edge and is further stabilized with the use of a well-built shoe. It provides support to the ankle and foot, aids in dorsi flexion (picking up the toes), and reduces toe drop/drag when walking. This orthosis does not limit motion of the foot and ankle but acts as a spring to help pick up the patient’s toes to avoid stumbling and falling. (Fig.1)
  
  Indications
  Drop Foot
  Neuropathy
  Peroneal Palsy
  Multiple Sclerosis
  Charcot Marie Tooth Disease
  Weak Dorsi flexors
  

• Semi-Solid AFO: A semi-solid AFO fabricated from plastic is designed to fit inside of a shoe with little effort. It attaches with a Velcro strap and is stabilized by the use of a well-built shoe. Unlike the dorsi flexion assist AFO this orthosis provides more medial-lateral stability and limitation of motion. (Fig.2)
  
  Indications
  Drop Foot
  Neuropathy
  Minor Mediolateral Instabilities
  Multiple Sclerosis
  Weak Dorsi Flexors/Evertors
  Spinal Cord Injuries
  Myelomeningocele
  Cerebral Palsy
  

• Solid Ankle Foot Orthosis (SAFO): a Solid ankle AFO is designed to provide maximum stability of the foot and ankle. This orthosis limits plantar flexion (pointing toes down) and dorsi flexion (lifting toes up), medial and lateral motions. (Fig.1)
  
  Indications
  Neuropathy
  Multiple Sclerosis
  Myelomeningocele
  Dorsi Flexion and Plantar Flexion Muscle Weakness
  Joint Instability
  Spinal Cord Injuries
  Muscular Dystrophy
  

• Articulated Ankle Foot Orthosis (AAFO): This style of orthosis is designed to provide maximum mediolateral stability while allowing plantar flexion (pointing toes down) and dorsi flexion (lifting toes up). There are various style of ankle joints used to allow for free, variable, and fixed range of motion. (Fig.2)
  
  Indications
  Neuropathy
  Multiple Sclerosis
  Myelomeningocele
  Dorsi Flexion and Plantar Flexion
  Muscle Weakness
  Joint Instability
  Cerebral Palsy
  Spinal Cord Injuries
  
  

Lower Extremity Walker Boots

Lower Extremity Walker Boots: Walker boots are designed to aid in foot and ankle stability, limit range of motion of the lower extremity.

Walker boots are designed with a solid or articulating ankle joint to accommodate for treatment of various injuries, fractures, and pathologies. Each orthosis has a removable inner lining to protect the skin from breakdown, malleolar (ankle) pads for additional stability and comfort, and a rocker bottom sole to provide smooth walking pattern.

• Walker Boot with Solid Ankle: This orthosis is designed to provide maximum immobilization to the foot and ankle. (Fig.1)
• Walker Boot with Articulated Ankle: This orthosis is designed to provide maximum mediolateral stability while allowing adjustability of the ankle joint. This orthosis can be locked to eliminate motion or set to allow various amounts of plantar flexion (pointing toes down) and dorsi flexion (lifting toes up). (Fig.2)
• Walker Boot with Pneumatic Air Cells (available with solid or articulated ankle): These orthoses incorporate the same clinical characteristics as the solid and articulated ankle walker boots with the addition of pneumatic control Pneumatic air cells allow for circumferential compression that aid in pressure redistribution, enhanced fit and functionality. (Fig.3)

CRO Walker (Charcot Restraint Orthotic Walker): The CRO walker was designed to provide maximum stability to the foot and ankle complex. Its two piece or bi-valve construction aids in pressure re-distribution, increased stability, and maximum limitation of motion. These orthoses commonly have the addition of a soft inner boot that can be modified to provide relief areas for skin breakdown or abrasions and increased comfort to the patient. (Fig.4)

              Indications
              Diabetic neuropathy
              Foot and ankle ulcerations
             Charcot joint
             Post-Operative Management
            Acute posterior tibial tendon dysfunction/rupture

Lower Extremity (Knee) Soft Supports and Positional Orthoses

Lower Extremity Soft Supports: Often referred to as soft goods, these orthoses include those braces that are fabricated/manufactured from neoprene, canvas, and fabric and can be reinforced with metal/plastic stays for additional support.

• Neoprene Knee Sleeve: Neoprene knee sleeves provide limited stability to the knee joint, compression to help control edema and for comfort, and slightly limit range of motion to aid in rehabilitation.
• Donut/Buttress: This is a raised area around the patella (knee cap) to aid in additional support and proper alignment of the knee.
• Side Pulls/Patellar Straps: These straps function in a similar to the donut/buttress to provide additional support at the knee and aid in patellar tracking. (Fig.1)
  Joints: This provides increased mediolateral stability while maintaining full range of motion n flexion and extension. (Fig.2)
• Wrap Around Closure: This orthosis is very conducive to those patients whose hand strength is limited. Rather than pulling up a very tight neoprene sleeve, this option provides the patient with an anterior closure for easy donning and doffing.
  
  Indications
  Minor knee sprains/strains
  Post-reconstructive surgery/ligamentous
  In conjunction with functional knee orthosis: This style of orthosis can be worn with a functional knee orthosis to provide heat, comfort, and compression
  

• Knee Immobilizer with Hinges: This option allows for adjustability in range of motion at the knee. The orthosis can be locked or adjusted to prescribed range of motion.
  
  Indications
  Post-operative knee surgery
  Acute knee/ligamentous injuries
  Rehabilitation
  

Functional Knee Orthosis: Functional knee orthoses are designed to aid in the stability of the knee joint secondary to ligamentous injury, post-operative reconstruction, meniscus damage, and for prophylactic protection. These orthoses is designed to provide maximum stability to the knee joint. Injury to the ligaments of the knee cause unwanted motion/translation between the femur and the tibia. If left untreated this can create significant joint laxity, lead to degenerative joint changes and put the patient at risk for further injury and cause subsequent damage to the surrounding structures. (Fig.1)

Functional knee orthoses can be made to measurements or to a custom model of the patient’s leg.

Indications
Anterior cruciate ligament disruption
Posterior cruciate ligament disruption
Medial/lateral collateral ligament disruption
Meniscus tears
Post-operative
Ligament reconstruction

Osteoarthritis(OA) Knee Orthosis: OA knee orthoses are designed to reduce the amount degenerative changes of knee joint surface, pain, and joint mal-alignment that occur in patients with osteoarthritis. These orthoses provide a corrective force at the knee to decreasing pain and joint surface degeneration. Many incorporate an adjustable knee joint that can be changed to increase or decrease the corrective forces applied. (Fig.2)

OA knee orthosis can be made to measurements or to a custom model of the patient’s leg.

Indications
Osteoarthritis of the knee
Excessive valgus/varus
Post-operative management

Lower Extremity Fracture Orthoses

Distal Tibia/Fibular Fracture Orthosis: Distal tibial/fibular fractures can be treated with a walker boot or tibial fracture orthosis. Your physician determines which style of orthosis is best indicated for your fracture stabilization.

• Patellar bar: The tibial bar is an indentation that runs across the patellar tendon (just below your knee cap) used to help reduce the vertical load transmitted through the foot and ankle.
  
• Foot and Ankle Component: The addition of an ankle/foot component provides stabilization, immobilization, and aids in suspension of the orthosis to prevent distal migration or slipping.
  
  Indications
  Distal tibial and fibular fractures
  Mid-shaft tibial and fibular fractures
  

Proximal Tibial/Fibular Fracture Orthoses and Distal Femur Fractures: This style of orthosis is often referred to as a KAFO or knee ankle foot fracture orthosis. Due to the location of the fracture site, near the knee, it is necessary to limit or prevent motion at this joint. This helps maintain reduction
or stabilization of the fracture allowing the healing process to begin. The knee joint may be fabricated to accommodate complete immobilization, variable range of motion, or free range of motion per the physician’s prescription. (Fig.2)

Indications
Proximal tibial and fibular fractures
Distal femoral fractures

Indications
Proximal Femur Fractures

Knee Ankle Foot Orthoses

Knee Ankle Foot Orthoses (KAFOs): KAFOs are designed to provide support, proper joint alignment to the knee, foot and ankle, assist or substitute for muscle weakness, and protect the foot and lower limb.

KAFO designs: Knee ankle foot orthoses can be fabricated from several types of materials; plastic, aluminum, stainless steel, and carbon fiber laminate. The style of fabrication is determined by the physician and practitioner relative to their clinical presentation.

• Metal or Conventional Orthoses: This style of orthosis is designed to control instability, paralysis and weakness of the foot and ankle complex. The conventional design utilizes metal bands, bars and metal calipers that are attached directly to shoe wear. This design has been used for many years and is very effective for patients who experience volume fluxuations. Velcro and buckles can be adjusted throughout the day to accommodate for swelling and or edema. (Fig.1)
  
• Metal: Metal materials (aluminum and steel) are also used in the construct of the sidebars and knee joints. The type of material depends upon the weight, activity, and durability required by the patient. Steel uprights are more durable than aluminum however are associated with increased weight. Aluminum is often used for ease of fabrication and to reduce the overall weight of the orthosis.
  

• Plastic: Plastic orthosis are designed to fit inside a shoe and are effective in controlling instabilities, paralysis or weakness at the knee, foot and ankle and aid in pressure distribution. Utilization this design allows the practitioner to apply corrective or stabilizing pressure over a large area rather than in one specified point. (Fig.2)
  
  

Knee Joint Designs

• Free Knee: This design is provides medial-lateral stability to knee joint while allowing free motion in flexion and extension. This style of knee joint is also utilized to prevent genu recurvatum or hyperextension of the knee. By limiting the extension range of motion of the knee joint we can protect and stabilize the posterior knee capsule against further injury and or deformity.
  
  

• Posterior Offset Knee Joint: The posterior offset knee joint is used to aid in knee extension for those patients who exhibit minimal quadriceps weakness. The placement of the mechanical knee joint is just posterior to the anatomical knee joint providing for increased knee stability when walking. This knee joint does not provide for stance control during the gait cycle. The patient must have enough hip flexion and extension strength and momentum to walk in a safe and effective manner. (Fig.3-4)
  
  
  
• Stance Control: Stance control knee joints provide for stability during weight bearing and free flexion (bending) during the swing phase of gait or non-weight bearing. Allowing the knee to bend during the swing phase of gait provides for a more normal gait pattern, is more energy efficient, and decreases the compensatory effects of a locked knee ankle foot orthosis (KAFO). There are several varieties of knee joints; some are operated mechanically while others are operated with computer controllers. (Fig.1-3)

• Locked Knee: Locked knee KAFOs are used to provide maximum stability to the patient. These orthoses are locked during the entire gait cycle and can be unlocked for sitting. The locking mechanism is done by a drop lock, bail or French lock, or trigger lock.
  

• Drop Lock: This design incorporates a ring that slides down over the knee joint providing for a mechanical lock. (Fig.4)
  

• Bail or French Lock: This style of knee joint incorporates a loop that connects the posterior of both knee joints. Rather than locking each knee joint individually this allows both to be unlocked via a bail or loop design. Bail or French locks are effective for patients wearing bilateral (two) orthoses. (Fig.5)
  

• Trigger Lock: A trigger lock design is similar to the bail or French lock. This design often uses cables and a trigger switch allowing patients to unlock the knee joint via a point at the proximal edge of the orthosis. It is commonly used for patients with limited dexterity, balance and for increased safety and stability. (Fig.1)
  
  KAFO Indications
  Lower extremity weakness or paralysis
  Lower extremity instability
  Neuropathy
  Femoral nerve injury
  Spinal cord injury
  Muscular dystrophy
  Multiple Sclerosis
  Polio and Post-Polio syndrome
  Stroke (CVA: cerebrovascular accident)
  Myosytosis
  
  

Reciprocating Gait Orthoses (RGO’s): RGO’s were designed to help patients that suffer from spinal cord injury, Myelomeningocele, spina bifida, and other paralytic disorders walk. Often patients who have sustained paralysis to their lower extremities require the assistance of orthotic devices to walk. One such device, a reciprocating gait orthosis (RGO), is designed to provide as normal method of movement as possible for paraplegic patients. Reciprocating gait is defined as putting one foot in front of the other.

The orthosis consists of two-molded plastic knee-ankle-foot orthoses (KAFO) attached to a metal pelvic control band and upright thoracic supports. The posterior section of the pelvic band/thoracic component is fit with either a rocker bar system or cable system. Both function in a similar manner; the rocker system functions much like a seesaw. Shifting weight from one side of the body to the other allows one limb to be stable on the ground while advancing the contra lateral limb. Please keep in mind that there are additional devices that are necessary for these patients to be stabilized. It is common for them to use crutches and/or walkers to aid them in their movement. (Fig.1)

RGO Indications
Spinal Cord Injury
Myelomeningocele
Spina Bifida
Paralytic disorders

 

Adult Hip Abduction Orthosis

Indications
Chronic hip dislocations
Degenerative joint disease
Total hip joint replacement
Post-operative stabilization

Compression Stockings/Sequential Compression Therapy

Compression Stockings: Compression stockings are gradient stockings that help control edema/lymphedema and aid in venous return.

Sequential Compression Therapy: These devices are placed around the limb that operative with intermittent compression to aid in controlling lymphedema and venous return. These are often used in hospitals following surgery to help prevent blood clots and aid in lower extremity circulation.

Compression Stockings: These are graded in mmHg. The degree of compression is determined by your diagnoses and physician prescription. They range from as low as 10mmHg to as high as 40mmHg. The lower levels are used in those patients where the edema/venous disruption are not as severe. The higher compression is used in those patients who have severe edema/venous disruption. These are available in pull on as well as with zippers for ease of donning and with closed and open toe versions. (Fig.1)

Compression Therapy Indications
Lymphedema
Varicose veins
Pitting edema
Pregnancy

Donning Compression Stockings: Invert (turn the stocking inside out) and then slowly roll the stocking onto the limb. This is often easier than trying to pull it on. Rubber gloves can also be very beneficial creating a better grip when rolling them on. If you have a zipper pay close attention to the skin to ensure that you do not pinch it when donning.