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Lee, Winson CC, Toshiki Kobayashi, Barton TS Choy, and Aaron KL Leung. "Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements." Prosthetics and Orthotics International 36, no. 2 (February 21, 2012): 190–95. http://dx.doi.org/10.1177/0309364611435500.
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Background: A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. Objectives: To test the above hypothesis by comparing it to three other available orthoses. Study Design: Repeated measures. Methods: Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. Results: The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact ( p = 0.006) and the peak inversion angle ( p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. Conclusions: The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Clinical relevance Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.
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Abbasi, Faezeh, Mahmood bahramizadeh, and Mohammad Hadadi. "Comparison of the effect of foot orthoses on Star Excursion Balance Test performance in patients with chronic ankle instability." Prosthetics and Orthotics International 43, no. 1 (August 13, 2018): 6–11. http://dx.doi.org/10.1177/0309364618792718.
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Background: Chronic ankle instability as a prevalent consequence of ankle sprain causes various impairments such as balance and postural control deficits. Foot orthoses are one of the common interventions for rehabilitation of patients with chronic ankle instability. Objectives: To investigate the effect of custom-molded foot orthoses with textured surfaces on dynamic balance of chronic ankle instability patients and to compare their effects with other types of foot orthoses. Study design: This is a repeated measure design. Methods: A total of 30 participants were recruited based on the guideline introduced by the International Ankle Consortium. The effect of prefabricated, custom-molded, and custom-molded with textured surface foot orthoses was evaluated on dynamic balance by the Star Excursion Balance Test. Normalized reach distances in anteromedial, medial, and posteromedial directions of the test were computed to be used for statistical analysis. Results: The foot orthoses increased reach distances compared to the no-orthosis conditions in all three directions. The custom-molded with textured surface foot orthosis has significant differences compared with prefabricated foot orthosis ( p = 0.001) in all measured directions and with custom-molded foot orthosis ( p < 0.01) in medial and posteromedial directions. Conclusion: Foot orthoses improve reach distances in patients with chronic ankle instability. Custom-molded with textured surface foot orthosis has a more pronounced effect compared with other foot orthoses. Clinical relevance The custom-molded foot orthosis with textured surface could be an effective device to improve dynamic balance in chronic ankle instability (CAI) patients. It may be considered as an efficient intervention to reduce ankle sprain recurrence in these individuals, although further research should be conducted.
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Balsdon, Megan, Colin Dombroski, Kristen Bushey, and Thomas R. Jenkyn. "Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: A biplane fluoroscopy study." Prosthetics and Orthotics International 43, no. 3 (February 14, 2019): 331–38. http://dx.doi.org/10.1177/0309364619825607.
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Background: Foot orthoses have proven to be effective for conservative management of various pathologies. Pathologies of the lower limb can be caused by abnormal biomechanics such as irregular foot structure and alignment, leading to inadequate support. Objectives: To compare biomechanical effects of different foot orthoses on the medial longitudinal arch during dynamic gait using skeletal kinematics. Study design: This study follows a prospective, cross-sectional study design. Methods: The medial longitudinal arch angle was measured for 12 participants among three groups: pes planus, pes cavus and normal arch. Five conditions were compared: three orthotic devices (hard custom foot orthosis, soft custom foot orthosis and off-the-shelf Barefoot Science©), barefoot and shod. An innovative method, markerless fluoroscopic radiostereometric analysis, was used to measure the medial longitudinal arch angle. Results: Mean medial longitudinal arch angles for both custom foot orthosis conditions were significantly different from the barefoot and shod conditions ( p < 0.05). There was no significant difference between the off-the-shelf device and the barefoot or shod conditions ( p > 0.05). In addition, the differences between hard and soft custom foot orthoses were not statistically significant. All foot types showed a medial longitudinal arch angle decrease with both the hard and soft custom foot orthoses. Conclusion: These results suggest that custom foot orthoses can reduce motion of the medial longitudinal arch for a range of foot types during dynamic gait. Level of evidence: Therapeutic study, Level 2. Clinical relevance Custom foot orthoses support and alter the position of the foot during weightbearing. The goal is to eliminate compensation of the foot for a structural deformity or malalignment and redistribute abnormal plantar pressures. By optimizing the position of the foot, the medial longitudinal arch (MLA) will also change and quantifying this change is of interest to clinicians.
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Raijmakers, Bart, Roelofine A. Berendsen-de Gooijer, Hilde E. Ploeger, Fieke S. Koopman, Frans Nollet, and Merel-Anne Brehm. "Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey." Journal of Rehabilitation Medicine 54 (February 14, 2022): jrm00261. http://dx.doi.org/10.2340/jrm.v53.1122.
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Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.Design: Cross-sectional survey study.Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors. LAY ABSTRACTKnee-ankle-foot orthoses for knee instability are commonly prescribed in polio survivors to enhance safe ambulation. This survey investigated the use of knee-ankle-foot orthoses in daily life and differences in factors of usability between users and discontinued users. Seventy-six percent of polio survivors used their custom-made knee-ankle-foot orthosis in daily life. Important usability factors that were related to continued use of knee-ankle-foot orthoses were low perceived walking ability status without orthosis, previous orthosis experience, high perceived effectiveness and satisfaction when standing and walking with a knee-ankle-foot orthoses. When prescribing a custom-made knee-ankle-foot orthoses it is important to consider these factors and discuss goals of use and expected benefits of the knee-ankle-foot orthoses with the patient, especially in relation to perceived walking limitations and activities in daily life.
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Mlakar, Maja, Nerrolyn Ramstrand, Helena Burger, and Gaj Vidmar. "Effect of custom-made and prefabricated orthoses on grip strength in persons with carpal tunnel syndrome." Prosthetics and Orthotics International 38, no. 3 (June 24, 2013): 193–98. http://dx.doi.org/10.1177/0309364613490440.
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Background: Based on the literature, patients with carpal tunnel syndrome are suggested to wear a custom-made wrist orthosis immobilizing the wrist in a neutral position. Many prefabricated orthoses are available on the market, but the majority of those do not assure neutral wrist position. Objectives: We hypothesized that the use of orthosis affects grip strength in persons with carpal tunnel syndrome in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses. Study design: Experimental. Methods: Comparisons of grip strength for three types of grips (cylindrical, lateral, and pinch) were made across orthosis types (custom-made, prefabricated with wrist in 20° of flexion, and none) on the affected side immediately after fitting, as well as between affected side without orthosis and nonaffected side. Results: Orthosis type did not significantly affect grip strength ( p = 0.661). Cylindrical grip was by far the strongest, followed by lateral and pinch grips ( p < 0.050). The grips of the affected side were weaker than those of the nonaffected side ( p = 0.002). Conclusions: In persons with carpal tunnel syndrome, neither prefabricated orthoses with 20° wrist extension nor custom-made wrist orthoses with neutral wrist position influenced grip strength of the affected hand. Compared to the nonaffected side, the grips of the affected side were weaker. Clinical relevance The findings from this study can be used to guide application of orthoses to patients with carpal tunnel syndrome.
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Pataradool, Kawee, and Chayanin Lertmahandpueti. "A proximal interphalangeal joint custom-made orthosis in trigger finger: Functional outcome." Hand Therapy 26, no. 3 (May 22, 2021): 85–90. http://dx.doi.org/10.1177/17589983211018717.
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Introduction Trigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger. Methods This study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at the dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis. Results There were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference −29.0 (95%CI −34.5 to −23.4); p < 0.001), SST (mean difference −1.4 (95%CI −1.8 to −1.0); p < 0.001) and VAS (mean difference −3.4 (95%CI −4.3 to −2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Conclusions Despite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.
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Young, Joshua, and Sally Jackson. "Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination: A case report." Prosthetics and Orthotics International 43, no. 4 (June 4, 2019): 453–58. http://dx.doi.org/10.1177/0309364619852239.
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Background: Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis–footwear combination on the acquisition of walking in a single subject with cerebral palsy. Case Description and Methods: This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. Findings and Outcomes: The subject developed the ability to stand and walk using an ankle-foot orthosis–footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis–footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. Conclusion: An ankle-foot orthosis–footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Clinical relevance Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.
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Ghoseiri, Kamiar, Galavij Ghoseiri, Ahlam Bavi, and Rojin Ghoseiri. "Face-protective orthosis in sport-related injuries." Prosthetics and Orthotics International 37, no. 4 (November 9, 2012): 329–31. http://dx.doi.org/10.1177/0309364612463929.
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Background and aim: Sport is associated with risk of injury and re-injury. A rehabilitative sport-related orthosis could protect the injured site and help in the earlier return of athlete to the match. This technical note aims to describe a potential high-prescribed face orthosis to protect/prevent a sport-related injury. Technique: Face-protective orthosis should be custom molded from negative impression of the injured athlete’s face. It is lightweight and structured as a one-piece rigid plastic shell that is secured in place with three elastic straps. Due to the diverse patterns of craniomaxillofacial injuries, the shape, length, trimline, and characteristics of face-protective orthoses could be different. Discussion: Face-protective orthoses could have prophylactic or rehabilitative roles according to task and prescription reason. Although the main action of the facial orthoses should be protection, the design of the face-protective orthosis should be improved both functionality and aesthetically to promote its use by athletes. Clinical relevance The craniomaxillofacial injuries have potential to be treated by custom-molded face-protective orthoses. These orthoses could have prophylactic or rehabilitative roles based on their prescription purpose. These orthoses could cause earlier return of athletes to sports matches.
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Lee, Justin J., Siraj Z. Shaikh, and Alice Chu. "398 The Feasibility of Designing and Using a 3-D Printed Dynamic Upper Extremity Orthosis (DUEO) with Children with Cerebral Palsy and Severe Upper Extremity Involvement." Journal of Clinical and Translational Science 6, s1 (April 2022): 75. http://dx.doi.org/10.1017/cts.2022.226.
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OBJECTIVES/GOALS: To evaluate whether a low cost, functional dynamic 3-D printed upper extremity (UE) orthosis could be designed, fabricated and used by children with cerebral palsy (CP) with severe unilateral UE involvement and the ability of common standardized instruments to assess its effectiveness. METHODS/STUDY POPULATION: Five patients, ages 13-17 years, with CP and unilateral UE involvement, MACS levels III-IV, were enrolled. Custom forearm thumb opponens orthosis and dynamic upper extremity orthosis (DUEO) were designed and fabricated by a multidisciplinary team for use during 8 one-hour occupational therapy sessions targeting bimanual UE training. Pre- and post-assessments included Assisting Hand Assessment(AHA), Melbourne-2(MA-2), Pediatric Motor Activity Log-Revised(PMAL-R), and PedsQL Measurement Model for the Pediatric Quality of Life Inventory: CP Module(Peds-QL). RESULTS/ANTICIPATED RESULTS: The 3D printed orthotic device is custom fit to the patient based on scans of their arm and is designed with a tensioning system that allows for functional usage of the arm. It incorporates a rigid polymer to provide support and flexible material for comfort where appropriate. Overall, higher post-treatment scores were found for the majority of participants using the custom orthotic. Four made minimal clinically important differences (MCID) in the AHA. Three met MCID scores in subtests of MA-2 (two positive and one negative). Patient-reported outcome improvements were found for PMAL-R for four, but only one met MCID and at least three reported improvements in more than one domain of PedsQL. DISCUSSION/SIGNIFICANCE: Children with CP may often present with UE impairment, yet current therapeutic orthoses only target the progression of contractures and are still limited by cost and discomfort. Our team designed and fabricated a functional, low cost, 3D printed orthosis that showed significant gains in UE function.
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Williamson, Patrick, Aron Lechtig, Philip Hanna, Stephen Okajima, Peter Biggane, Michael Nasr, David Zurakowski, Naven Duggal, and Ara Nazarian. "Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses." Foot & Ankle International 39, no. 8 (April 26, 2018): 994–1000. http://dx.doi.org/10.1177/1071100718770659.
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Background: Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Methods: Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. Results: The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. Conclusion: The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. Clinical Relevance: The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.
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Spooner, Simon K., David K. Smith, and Kevin A. Kirby. "In-Shoe Pressure Measurement and Foot Orthosis Research." Journal of the American Podiatric Medical Association 100, no. 6 (November 1, 2010): 518–29. http://dx.doi.org/10.7547/1000518.
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Foot orthoses are believed to exert their therapeutic effect on the human locomotor apparatus by altering the location, magnitude, and temporal patterns of ground reaction forces acting on the plantar foot during weightbearing activities. In-shoe pressure-measurement systems are increasingly being used by clinicians and researchers to assess kinetic changes at the foot-orthosis interface to better understand the function of foot orthoses and to derive more efficacious treatments for many painful foot and lower-extremity abnormalities. This article explores how the inherent three-dimensional surface topography and load-deformation characteristics of foot orthoses may challenge the validity, reliability, and clinical usefulness of the data obtained from in-shoe pressure-measurement systems in the context of foot orthotic therapy and research. The inability of in-shoe pressure-measurement systems to measure shearing forces beneath the foot, the required bending of the flat two-dimensional sensor insole to fit the pressure insole to the three-dimensional curves of the orthosis, the subsequent unbending of the sensor insole to display it on a computer monitor, and variations in the load-deformation characteristics of orthoses are all sources of potential error in examination of the kinetic effects of foot orthoses. Consequently, caution is required when interpreting the results of orthotic research that has used in-shoe pressure insole technology. The limitations of the technology should also be given due respect when in-shoe pressure measurement is used to make clinical decisions and prescribe custom foot orthoses for patients. (J Am Podiatr Med Assoc 100(6): 518–529, 2010)
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Carse, Bruce, Roy Bowers, Barry C. Meadows, and Philip Rowe. "The immediate effects of fitting and tuning solid ankle–foot orthoses in early stroke rehabilitation." Prosthetics and Orthotics International 39, no. 6 (June 17, 2014): 454–62. http://dx.doi.org/10.1177/0309364614538090.
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Background: Ankle-foot orthoses are known to have a generally positive effect on gait in stroke, however the specifc type of AFO and the time point at which it is provided are highly variable in the currently available literature. Objective: The objective was to determine the immediate spatiotemporal and kinematic effect of custom-made solid ankle–foot orthoses in early stroke rehabilitation, compared to shod walking. Methods: Five male and three female participants were recruited to the study ( n = 8), with a mean age of 57 (16) years who were 3.5 (3) weeks post-stroke. Each received a custom-made solid ankle–foot orthosis to a predefined set of design criteria and tuned using heel wedges to control the shank inclination angle during shod walking. Repeated spatiotemporal and three-dimensional gait measures were taken pre- and immediately post-intervention. Study design: A pre–post-test experimental study. Results: With the solid ankle–foot orthosis, walking velocity increased from 0.22 (0.2) to 0.36 (0.3) m/s ( p < 0.05), overall average step length increased from 0.28 (0.1) to 0.37 (0.1) m ( p < 0.05), cadence increased from 45 (19) to 56 (19) steps/min ( p < 0.05) and step length symmetry ratio increased from 0.65 (0.2) to 0.74 (0.2) (not significant). No clear changes were observed in the joint kinematics of the hip and knee. Conclusion: In our small group of early stroke patients who were fitted with a solid ankle–foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only. Clinical relevance This study provides evidence about the immediate effects of custom solid ankle–foot orthoses on gait of early stroke survivors. Ankle–foot orthosis design specifications are fully described for replication. This study suggests that observing global segment orientation may be more useful than joint angles when fitting and tuning ankle–foot orthoses for optimal ankle–foot orthosis/footwear alignment.
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Sletto, Larissa A., Yeongchi Wu, and Christopher Robinson. "Dilatancy-based impression and fabrication technique for custom foot orthoses." Prosthetics and Orthotics International 40, no. 3 (March 11, 2015): 409–13. http://dx.doi.org/10.1177/0309364615574162.
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Background and aim: Current methods used to take impressions for custom foot orthoses include plaster bandage, foam box, fiberglass, and laser-optical scanner. Impressions are converted to positive plaster or foam models. These methods create waste and may not be feasible in resource-limited areas. This technical note presents an alternative, greener impression and fabrication technique for foot orthoses that utilizes the dilatancy principle. Technique: Steps of the dilatancy (vacuum-based) procedure include taking an impression of the foot, converting the negative mold to a positive sand model, modifying the positive sand model, and thermoforming the foot orthosis. Discussion: This plaster-less system is inexpensive to set up and maintain, is reusable thereby minimizing cost and waste, and is clean to use. It enables a practitioner to quickly take an impression for fabricating a foot orthosis in a short period of time during a single clinic visit by the patient. Clinical relevance The dilatancy casting system could potentially be a cheaper, faster, and greener alternative procedure for fabricating custom foot orthoses in both developing and developed countries.
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Martinez, Andria, Renee Warthman, Derek Murray, Kristin Hazak, and Kevin N. Foster. "104 A Quality Improvement Project to Reduce Orthoses Complications." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S70—S71. http://dx.doi.org/10.1093/jbcr/irab032.108.
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Abstract Introduction Anatomical structures of the hand are complex and delicate making hand burns particularly challenging to manage. Orthoses are a cornerstone treatment modality and unsuccessful therapeutic interventions can result in hand contracture and deformities, which can result in up to 95% impairment in upper extremity function. Therapists at our burn center have varying degrees of education and credentials, and we had noticed increased incidence of orthotic induced complications in the hand. The purpose of this QI project was to implement a formal protocol that provided guidelines around fabricating and fitting hand orthoses. Methods The protocol mandated that custom fabricated resting hand orthoses should be fabricated by a single CHT or co-fabricated by two (non-CHT) therapists. Orthoses were fabricated as indicated. Orthosis modifications and orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) were documented. For the purposes of our study, breakdown was limited to the index finger. These modifications and complication totals were compared to pre-implementation data. Any patient with missing data points was excluded. Results Seventy-seven patient hands were examined from 2016–2019. Prior to implementation of the protocol, erythema occurred with 23.4% (n=18) of orthoses and orthosis induced partial thickness injury was found in 11.7% (n=9) of cases. Post protocol implementation involved examination of 51 hands. Erythema occurred in just 2.0% of cases (n=1) and partial thickness injury in 3.9% of cases (n=2) This represents a decrease of 94.4% and 77.7%, respectively. Number of modifications was reduced by 40.9%, from 22 to 13. Conclusions Orthosis fabrication is a specialized therapy skill, requiring hands-on training and advanced anatomical knowledge. While orthotic fabrication is part of general therapy education, the depth and breadth of this education is limited by the clinical opportunities presented to each therapist. CHT’s have undergone rigorous study and testing to make them experts in orthosis management and can bolster skills in a burn therapy department. For therapists without this specialty certification, co-fabrication can also lead to improved outcomes, through real time peer review. Data from this QI project showed a statistically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses.
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Gijon-Nogueron, Gabriel, Encarnacion Cortes-Jeronimo, Jose Antonio Cervera-Marin, Esther Diaz-Mohedo, Eva Lopezosa-Reca, Manuel Fernandez-Sanchez, and Alejandro Luque-Suarez. "The effects of custom-made foot orthosis using the Central Stabilizer Element on foot pain." Prosthetics and Orthotics International 39, no. 4 (May 8, 2014): 293–99. http://dx.doi.org/10.1177/0309364614531012.
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Background: Foot orthoses have been applied for the management of lower limb disorders, mainly for those who develop foot pain. The Central Stabilizer Element (CSE) is a new element that contains the midfoot laterally when a plantar insole is manufactured. Objectives: To determine the effect on foot pain of adding the Central Stabilizer Element during the manufacturing process of foot orthosis, and to describe the proportions of Central Stabilizer Element in terms of width and length of this element. Study design: A clinical study. Methods: A sample comprising 130 patients (57 males and 73 females) with foot pain was recruited for this study, with the patients having supinated, neutral, pronated and overpronated feet. All the patients received a custom-made foot orthosis with the Central Stabilizer Element. The Central Stabilizer Element was made of resins of polyvinyl chloride, and is a device insert in foot orthosis that contains the midfoot laterally to control pronation and supination movements. Perceived patient’s foot pain was collected using a Visual Analog Scale at baseline, 15, 60 and 90 days after treatment. Results: A statistically significant decrease was found after foot orthosis application at all times in all foot types. There was a statistically significant correlation between all the ratio proportions according to foot posture (Foot Posture Index scores), except for heel length proportion. Conclusions: The Central Stabilizer Element, applied at midfoot level of a custom-made foot orthoses through a directly mould technique, can reduce foot pain, when a previous foot posture status is considered. Clinical relevance The Central Stabilizer Element can be of interest for those professionals who are involved in the manufacturing process of foot orthosis, throughout the control of an excesive pronated or a supinated foot condition that is provoking foot pain.
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Brinckmann, Paul, Burkhard Drerup, Thomas Kretschmer, Daniel Schulze-Frenking, Andre Wohlatz, and Hans Henning Wetz. "Locating the Axis of Rotation when Fitting an Elbow Orthosis: A Comparison of Measurement and Palpation." Prosthetics and Orthotics International 31, no. 1 (March 2007): 36–44. http://dx.doi.org/10.1080/03093640600982354.
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No other previously published studies consider the relative motion of orthotic components positioned on the upper arm and the forearm. This study therefore measured the location and direction of the axis of rotation of an orthotic component fixed to the forearm in relation to an orthotic component fixed to the upper arm, and compared the results with those obtained by palpation. A plane flexion or extension motion of the forearm component in relation to the component on the upper arm can be described as a pure rotation about a fixed centre. However, activation of the biceps or triceps shifts that centre by around 2 cm, due to a displacement of the humerus within the orthotic component on the upper arm. Within a range of approximately 1 cm, the location of the axis of rotation was similar to that obtained by palpation. Neither custom-made plastic/foam orthoses with their hinges aligned to the measured axis, nor orthoses with their hinges aligned to the palpated axis, exhibited any difference in the wearer's comfort. It is concluded that the best choice for the location of the axis of a hinge-type orthosis for the elbow constitutes a compromise between the axes for active flexion and active extension. In view of the large influence that muscle activation has on axis location, errors in the order of 1 cm seem to be negligible when adjusting the hinge of an orthosis in individual cases.
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Damiao, John, Natalie Calianese, Daniel Cartwright, Cynthia Cherian, Erica Lee, and Danielle Mucek. "Comparison of 3D Printing and Traditional Hand Orthosis Fabrication." Global Journal of Health Science 15, no. 2 (January 31, 2023): 42. http://dx.doi.org/10.5539/gjhs.v15n2p42.
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Traditional methods of custom orthosis fabrication are prone to challenges and limitations. Three-dimensional (3D) printing has been piloted with lower extremity orthotics and worthy of exploration with upper extremities. The aim of this study was to compare three-dimensionally printed wrist immobilization splints to conventionally made orthoses in terms of fabrication, comfort, and functionality. Three healthy participants with no history of wrist or hand conditions were recruited to be fitted for conventional and 3D-printed wrist immobilization splints. A sequential mixed-methods study design was conducted to explore comfort, fabrication, and functionality. An ethnographic study was conducted afterward to further understand the fabrication process of 3D-printed orthotics. The Quebec User Evaluation of Satisfaction with Assistive Technology and a Splint Analysis form was used to assess comfort. The function was assessed using the Jebsen-Taylor Hand Function Test. A five-point satisfaction Likert scale was used to evaluate fabrication. Although the results were not statistically significant due to the small sample size, 3D-printed orthotics appear to provide some benefits over traditional methods.
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Engen, T. "Lightweight modular orthosis." Prosthetics and Orthotics International 13, no. 3 (December 1989): 125–29. http://dx.doi.org/10.3109/03093648909079419.
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Background and highlights are presented concerning the development of a new orthotic system judged to be “the most outstanding innovation in prosthetics and/or orthotics practice” during the 1986-1989 period. The first Brian Blatchford Prize was awarded at the Sixth World Congress of ISPO held in Kobe, Japan, November 12-17, 1989. The new development selected as most deserving of this award consists of a system utilizing inexpensive, lightweight, modular components which can be quickly assembled with a few hand tools to provide custom-fitted knee-ankle-foot orthoses for persons with paraplegia and quadriplegia. These leg frames support standing and permit the patient to begin receiving the physical and psychological benefits of weightbearing as soon as medically feasible after injury. Later, if desired, specially designed knee-joints, with a variety of possible locking features, can be installed on the existing leg frames at a reasonable cost.
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Arvin, Mina, Mojtaba Kamyab, Vahideh Moradi, Behnam Hajiaghaei, and Nader Maroufi. "Influence of modified solid ankle-foot orthosis to be used with and without shoe on dynamic balance and gait characteristic in asymptomatic people." Prosthetics and Orthotics International 37, no. 2 (August 20, 2012): 145–51. http://dx.doi.org/10.1177/0309364612454159.
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Background: Ankle-foot orthoses are usually used in combination with footwear. Shoe design can have a significant effect on kinematics of the lower limb joints and line of action of the ground reaction force during walking. But, ankle-foot orthosis–footwear combination is not appropriate for indoor barefoot walking in some Asian cultures. In this study, we have modified a solid ankle-foot orthosis in order to set it in the same position as a solid ankle-foot orthosis–footwear combination. Objective: To investigate the effect of a modified solid ankle-foot orthosis; a solid ankle-foot orthosis which can be locked in different positions on gait and balance performance in comparison with a conventional solid ankle-foot orthosis, a common solid ankle-foot orthosis–shoe combination in asymptomatic adults. Study Design: Cross sectional. Methods: Two standard solid ankle-foot orthoses were manufactured with the ankle joint in neutral position. Then, one of these solid ankle-foot orthoses was modified in order to allow locking in a different alignment. Walk across, limit of stability, and sit-to-stand tests of the balance master system were performed while participants wore the modified solid ankle-foot orthosis aligned in 5°–7° anterior inclination without a shoe and a conventional solid ankle-foot orthosis–shoe combination. Results: There was no significant change in walking speed, step length, and step width with the conventional and modified solid ankle-foot orthoses. In addition, movement velocity and maximum excursion of the center of gravity during the limit of stability test were not different, although the maximal forward excursion of the center of gravity was longer when wearing the modified solid ankle-foot orthosis compared to the conventional solid ankle-foot orthosis–shoe combination ( P = 0.000). Sway velocity of the center of gravity did not change during the sit-to-stand test. Conclusion: The results demonstrated that the modified solid ankle-foot orthosis had the same effects as the conventional solid ankle-foot orthosis–shoe combination on the gait and balance performance of asymptomatic adults. Clinical relevance The findings of the present study can be used as the basis for further investigations on the efficacy of the modified solid ankle-foot orthoses in different neuromuscular populations in order to help people who do not wear shoes at home, as is the custom in some Asian cultures.
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Ibuki, Aileen, Timothy Bach, Douglas Rogers, and Julie Bernhardt. "The Effect of Tone-Reducing Orthotic Devices on Soleus Muscle Reflex Excitability while Standing in Patients with Spasticity Following Stroke." Prosthetics and Orthotics International 34, no. 1 (March 2010): 46–57. http://dx.doi.org/10.3109/03093640903476802.
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Orthoses are commonly prescribed for the management of spasticity but their neurophysiologic effect on spasticity remains unsubstantiated. The purpose of this study was to investigate the effect of three tone-reducing devices (dynamic foot orthosis, muscle stretch, and orthokinetic compression garment) on soleus muscle reflex excitability while standing in patients with spasticity following stroke. A repeated-measures intervention study was conducted on 13 patients with stroke selected from a sample of convenience. A custom-made dynamic foot orthosis, a range of motion walker to stretch the soleus muscle and class 1 and class 2 orthokinetic compression garments were assessed using the ratio of maximum Hoffmann reflex amplitude to maximum M-response amplitude (Hmax:Mmax) to determine their effect on soleus muscle reflex excitability. Only 10 subjects were able to complete the testing. There were no significant treatment effects for the interventions (F = 1.208, df = 3.232, p = 0.328); however, when analyzed subject-by-subject, two subjects responded to the dynamic foot orthosis and one of those two subjects also responded to the class 1 orthokinetic compression garment. Overall, the results demonstrated that the tone-reducing devices had no significant effect on soleus reflex excitability suggesting that these tone-reducing orthotic devices have no significant neurophysiologic effect on spasticity.
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Christophersen, Christy, Sean Zeller, Alicia M. Gotcsik, Gabriel A. Ramirez, Caroline Thirukumaran, and Judith F. Baumhauer. "Do Custom Orthotics Help Improve Pain and Function in Patients with Progressive Collapsing Foot Deformity." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0014. http://dx.doi.org/10.1177/2473011421s00145.
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Category: Hindfoot Introduction/Purpose: Progressive collapsing foot deformity presents with pain, deformity and functional limitations affecting quality of life. The prevalence of this condition ranges from 3-10% depending on the age and sex of the patient. Sixty percent of patients have concurrent medical problems that may delay or limit the ability to undergo surgical intervention. Non-operative treatments such as ankle bracing or custom orthotics are costly and their value to improve pain and function has not been examined with validated patient-centered instruments, specifically patient reported outcome measures. The purpose of this study was to assess if use of a modified UCBL orthosis improved PROMIS pain interference (PI) and physical function (PF) in patients with progressive collapsing foot deformity (PCFD). Methods: Prospective PROMIS data (PF, PI) was obtained from 2015 to 2020 for all patients who obtained a modified UCBL orthosis for PCFD. Patients with PROMIS data pre- and post-obtaining an orthotic with a minimal follow up of 90 days were included. Patients who elected to pursue operative treatment after receiving the orthotic were noted using CPT codes. Patients without complete evaluations were excluded (Figure 1). The primary outcome was PROMIS Scores (PF and PI) before and after orthotic usage. Covariate analysis included patient demographics including age, gender, marital status, race and ethnicity, and orthotic laterality. We estimated separate mixed effects linear regression models with patient random effects for each PROMIS outcome. Results: There were 282 patients included in our cohort with an average age of 57 years. 61% were female and 87.8% were White. Patients had an average follow-up of 467 days +/- 366. Multivariate analysis indicates that there was a 0.94 decrease in PROMIS PF t-score relative to orthotic usage at final follow up (p = 0.035 +/- 7.47) with an increase of 0.76 PROMIS PI t-score (p value = 0.085 +/- 7.40). Despite limited measureable impact on PROMIS outcomes using custom orthotics, only eleven patients subsequently pursued surgery and underwent operative fixation at an average of 461 days after initial evaluation. There were no differences in regard to race, ethnicity or orthotic laterality and PROMIS scores. Conclusion: Publications have focused on outcomes of operative treatment for FCFD, with few examining orthotics. Our study demonstrates a lack of pain and functional improvement with a modified UCBL questioning the potential value of this costly item. However, despite this only 3.9% of patients subsequently underwent surgery. This work raises additional questions: 'What does the patient hope to improve with treatment?' 'What is the role of risk assessment in patients considering treatment choices?' Patient reported outcomes can be used in shared decision making, not only to align expectations, but also when allocating healthcare dollars to durable medical goods.
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Arazpour, Mokhtar, Ahmad Chitsazan, Monireh Ahmadi Bani, Gholamreza Rouhi, Farhad Tabatabai Ghomshe, and Stephen W. Hutchins. "The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis." Prosthetics and Orthotics International 37, no. 5 (January 17, 2013): 411–14. http://dx.doi.org/10.1177/0309364612469140.
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Background: The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. Case description and methods: A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Findings and outcomes: Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. Conclusion: The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person. Clinical relevance The powered stance control knee ankle foot orthosis has the potential to improve knee joint kinematics in persons with poliomyelitis when ambulating.
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Sahinoğlu, Dilek, Gürsoy Coskun, and Nilgün Bek. "Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy." Prosthetics and Orthotics International 41, no. 1 (July 9, 2016): 85–94. http://dx.doi.org/10.1177/0309364616637490.
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Background:Adaptive seating supports for cerebral palsy are recommended to develop and maintain optimum posture, and functional use of upper extremities.Objectives:To compare the effectiveness of different seating adaptations regarding postural alignment and related functions and to investigate the effects of these seating adaptations on different motor levels.Study design:Prospective study.Methods:A total of 20 children with spastic cerebral palsy (Gross Motor Function Classification System 3–5) were included. Postural control and function (Seated Postural Control Measure, Sitting Assessment Scale) were measured in three different systems: standard chair, adjustable seating system and custom-made orthosis.Results:In results of all participants ungrouped, there was a significant difference in most parameters of both measurement tools in favor of custom-made orthosis and adjustable seating system when compared to standard chair ( p < 0.0017). There was a difference among interventions in most of the Seated Postural Control Measure results in Level 4 when subjects were grouped according to Gross Motor Function Classification System levels. A difference was observed between standard chair and adjustable seating system in foot control, arm control, and total Sitting Assessment Scale scores; and between standard chair and custom-made orthosis in trunk control, arm control, and total Sitting Assessment Scale score in Level 4. There was no difference in adjustable seating system and custom-made orthosis in Sitting Assessment Scale in this group of children ( p < 0.017).Conclusion:Although custom-made orthosis fabrication is time consuming, it is still recommended since it is custom made, easy to use, and low-cost. On the other hand, the adjustable seating system can be modified according to a patient’s height and weight.Clinical relevanceIt was found that Gross Motor Function Classification System Level 4 children benefitted most from the seating support systems. It was presented that standard chair is sufficient in providing postural alignment. Both custom-made orthosis and adjustable seating system have pros and cons and the best solution for each will be dependent on a number of factors.
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Cobb, Stephen C., Laurie L. Tis, Jeffrey T. Johnson, Yong “Tai” Wang, and Mark D. Geil. "Custom-Molded Foot-Orthosis Intervention and Multisegment Medial Foot Kinematics During Walking." Journal of Athletic Training 46, no. 4 (July 1, 2011): 358–65. http://dx.doi.org/10.4085/1062-6050-46.4.358.
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Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Intervention(s): After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dys-functional kinematic patterns associated with low-mobile foot postures.
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Short, Nathan. "Multimodal custom orthosis to promote hook fist." Journal of Hand Therapy 32, no. 3 (July 2019): 399–402. http://dx.doi.org/10.1016/j.jht.2017.10.014.
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Hadadi, Mohammad, and Faezeh Abbasi. "Comparison of the Effect of the Combined Mechanism Ankle Support on Static and Dynamic Postural Control of Chronic Ankle Instability Patients." Foot & Ankle International 40, no. 6 (February 27, 2019): 702–9. http://dx.doi.org/10.1177/1071100719833993.
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Background: Chronic ankle instability (CAI) is associated with postural control impairment. Orthotic devices are routinely used to improve postural control of CAI patients and prevent recurrence of ankle sprain. This study aimed to evaluate and compare the effect of combined mechanism ankle support (CMAS) with soft ankle support (SAS) and custom-molded foot orthosis (CFO) on static and dynamic postural control in patients with CAI. Methods: Twenty-two patients with CAI and 22 matched healthy subjects were recruited. The participants were evaluated in four orthotic conditions (without orthosis and with the CMAS, SAS, and CFO). Static balance was investigated in single-limb stance on the force platform, and dynamic balance was assessed using the Star Excursion Balance Test (SEBT). Results: Statistically significant differences were found for the main effects of the groups in all center of pressure (COP) parameters and reach distances in medial (M), anteromedial (AM), and posteromedial (PM) directions of the SEBT ( P < .05). The main effect of the orthotics for all evaluated parameters, except reach distance in the PM direction, was statistically different. All COP parameters were significantly lower with the CMAS compared with other orthotic conditions in CAI patients. Also, the higher reach distances with the CMAS were obtained in the AM and M directions of the SEBT. Conclusion: The CMAS improved impaired postural control in static and dynamic stability tests, but no similar effect was found for SAS and CFO. This result may have implications for the best bracing for CAI. Level of Evidence: Level II, comparative study.
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Erel, Suat, İbrahim Engin Şimşek, Çiğdem Ayhan, Nilgün Bek, Yavuz Yakut, and Fatma Uygur. "An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study." Prosthetics and Orthotics International 32, no. 2 (January 2008): 129–35. http://dx.doi.org/10.1080/03093640802015755.
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Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 – 100° abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.
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Johnson, Jeffrey E., Jonas R. Rudzki, Erick Janisse, Dennis J. Janisse, Ray R. Valdez, Douglas P. Hanel, and John S. Gould. "Hindfoot Containment Orthosis for Management of Bone and Soft-Tissue Defects of the Heel." Foot & Ankle International 26, no. 3 (March 2005): 198–203. http://dx.doi.org/10.1177/107110070502600303.
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Background: Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Methods: Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Results: Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. Conclusions: The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.
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Castro-Méndez, Aurora, Pedro V. Munuera, and Manuel Albornoz-Cabello. "The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: A randomized, double-blinded, clinical trial." Prosthetics and Orthotics International 37, no. 5 (January 17, 2013): 384–90. http://dx.doi.org/10.1177/0309364612471370.
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Study design: randomized, double-blinded, clinical trial. Background: Low back pain is one of the commonest disorders affecting the back. The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain, and how the problem can evolve for the better with the use of compensating foot orthoses. Objectives: The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain. Material and methods: In a sample of 51 participants with excessive subtalar pronation and chronic low back pain (43 women and 8 men), the effect of custom-made foot orthoses in low back pain was studied. The study design was a randomized, double-blinded, clinical trial with two groups: experimental, treated with the custom-made foot orthoses, and control, treated with a placebo. Low back pain was evaluated by a visual analog scale for pain and Oswestry’s Disability Index Questionnaire for lower back pain at two moments—on the day of inclusion in the study and after 4 weeks of treatment. Results: The evolution of the low back pain showed significant differences in the experimental group, showing a significant reduction of pain and disability ( p < 0.001, visual analog scale; p < 0.001, Oswestry’s Index). Conclusions: In the sample studied, the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain. Clinical relevance If subtalar joint hyperpronation plays a fundamental role in the pathomechanics of lower limb, and this can facilitate the development of low back pain, then controlling the abnormal mobility of subtalar joint by means of foot orthoses should improve this symptom. This article could help solve this controversy.
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Mohanty, Rajesh K., Abhishek Tripathi, Prasanna Lenka, Ameed Equebal, and Ratnesh Kumar. "The effect of a spinal orthosis on posture and cardio-respiratory functions in progressive myopathic scoliosis." Prosthetics and Orthotics International 36, no. 4 (May 2012): 450–55. http://dx.doi.org/10.1177/0309364612442678.
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Background: Historically, the orthotic treatment in progressive myopathic scoliosis has not been as effective as expected. The purpose of this study was to investigate the effect of a spinal orthosis on scoliotic curve correction, alignment of altered posture and cardio-respiratory functions. Case Description and Methods: An 11 year-old girl diagnosed with myopathy was fitted with a custom molded thoraco-lumbo-sacral orthosis to enhance the sitting ability. The cardio-respiratory tests were performed by a COSMED K4 b2; metabolic analyzer. The anterior posterior radiographs were analyzed for measuring Cobb angle and Ferguson angle. A plumb line test was used to assess the postural improvements. Findings and Outcomes: No significant difference was observed for variables such as O2 consumption level, PaO2, tidal volume, heart rate and energy expenditure/min. The improved posture was evident by shifting of the plumb line 18 mm towards the mid line with the use of orthosis. Very minor improvements in both angles were observed with the use of the brace. Conclusion: The brace treatment cannot be expected to have a lasting corrective effect although it can be used as a sitting support and for maintaining posture Clinical relevance This case study provides an objective prescription of thoraco-lumbo-sacral orthosis as a sitting support and for improving posture in progressive myopathic scoliosis if suitably designed and properly fitted.
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Rubin, Russel, and Hylton B. Menz. "Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis." Journal of the American Podiatric Medical Association 95, no. 4 (July 1, 2005): 347–52. http://dx.doi.org/10.7547/0950347.
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Osteoarthritis of the knee is a common condition that can cause considerable pain and disability. Various forms of lateral wedging may be effective in the treatment of medial compartment osteoarthritis, but it is not known whether incorporating a lateral wedge into a custom-molded foot orthosis will achieve similar results. Therefore, 30 subjects (21 men and 9 women) aged 29 to 77 years (mean ± SD, 58.1 ± 11.6 years) with radiographically confirmed medial compartment knee osteoarthritis were issued custom-molded foot orthoses with a 5° lateral heel wedge. Pain levels were recorded using a 100-mm visual analog pain scale on the date of issue of the orthoses (baseline) and again 3 and 6 weeks later. Mean ± SD pain levels were significantly reduced at 3 weeks (34 ± 22 mm) and 6 weeks (23 ± 22 mm) versus baseline (69 ± 19 mm) (F2 = 39.57). The degree of pain reduction was greater in patients with less severe osteoarthritis. At 6 weeks, all subjects had achieved at least some reduction in pain, and 28 reported that their orthoses were comfortable. This preliminary study indicates that laterally wedged foot orthoses may be beneficial in the treatment of mild-to-moderate osteoarthritis of the medial compartment of the knee. Further investigations using a larger sample, longer follow-up, and a no-treatment control group seem warranted. (J Am Podiatr Med Assoc 95(4): 347–352, 2005)
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Eldeeb, Hesham, Shihab Asfour, and Nourredine Boubekri. "CT/MR imaging: a design tool for custom orthosis." Disability and Rehabilitation 22, no. 13-14 (January 2000): 583–90. http://dx.doi.org/10.1080/09638280050138250.
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Kelly, Adam, and Justin Stanek. "The Impact of a Foot-Toe Orthosis on Dynamic Balance: An Exploratory Randomized Control Trial." Journal of Sport Rehabilitation 29, no. 7 (September 1, 2020): 871–78. http://dx.doi.org/10.1123/jsr.2017-0321.
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Context: The influence of custom and over-the-counter foot orthoses on dynamic balance has been investigated in the past. However, there has not been an exploration of the use of a foot-toe orthosis for improving balance. The ability of clinicians to influence balance could have important implications for injury prevention and rehabilitation. Objective: To determine the impact of a foot-toe orthosis on dynamic balance in healthy, young adults. Design: Randomized control trial. Setting: Athletic training laboratory. Participants: In total, 64 healthy, recreationally active participants aged 18–29 years were randomly allocated to one of the following groups: the foot-toe orthosis and laboratory-issued shoe group, the laboratory-issued shoe only (SO) group, or the control group. Interventions: Subjects in the intervention group wore the foot-toe orthosis and laboratory-issued shoe with activities of daily living for 4 weeks. Subjects in the SO intervention group wore the laboratory-issued shoe with activities of daily living for 4 weeks. Participants in the control group did not receive any intervention. Main Outcome Measures: The instrumented version of the Star Excursion Balance Test, known as the Lower Quarter Y-Balance Test, was used to quantify the dynamic balance at baseline and follow-up. Reaches were normalized for leg length. Results: There were statistically significant differences in postintervention scores on the Lower Quarter Y-Balance Test for both the dominant (P = .03, effect size = 0.84; 95% confidence interval, 0.25 to 1.43) and nondominant (P = .002, effect size = 0.74; 95% confidence interval, 0.15 to 1.32) legs when comparing dynamic balance scores of the foot-toe orthosis and laboratory-issued shoe group with the SO and control groups. No significant differences were observed when comparing dynamic balance between the SO and control groups. Conclusions: A 4-week intervention with a foot-toe orthosis and laboratory-issued shoe resulted in improved dynamic balance in a healthy young adult population. These findings suggest a novel intervention for increasing balance.
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ALAM, MORSHED, IMTIAZ AHMED CHOUDHURY, AZUDDIN BIN MAMAT, and SAJJAD HUSSAIN. "COMPUTER AIDED DESIGN AND FABRICATION OF A CUSTOM ARTICULATED ANKLE FOOT ORTHOSIS." Journal of Mechanics in Medicine and Biology 15, no. 04 (August 2015): 1550058. http://dx.doi.org/10.1142/s021951941550058x.
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Traditional design and manufacturing methods of ankle foot orthosis (AFO) involve manual techniques e.g., casting and molding of the limbs and often depend on trial and error. Three-dimensional scanning allows computer aided design (CAD) tools to be incorporated, however, both approaches rely on the external model of the limb. To design AFO with articulated joint, precise alignment of mechanical and anatomical joint axes is imperative. It is difficult to infer joint axis from external model as it is partially specified by the skeletal structure. In this article, a computer integrated design approach of an articulated AFO has been demonstrated. CAD model of the AFO was developed for a healthy subject's left leg based on the 3D models of skeleton and soft tissue of the limb. Components of the AFO were fabricated by rapid prototyping and CNC machining. The design approach is faster than the traditional techniques and also facilitates exact positioning of articulated ankle joint. The gait analysis indicates that the subject's ankle had to overcome lesser resistance with the custom made AFO compared to a pre-fabricated AFO. Simultaneous viewing of exterior and skeletal geometry might help the clinicians modify the design to enhance performance of the orthotic.
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Ricotta, V., R. I. Campbell, T. Ingrassia, and V. Nigrelli. "A new design approach for customised medical devices realized by additive manufacturing." International Journal on Interactive Design and Manufacturing (IJIDeM) 14, no. 4 (September 7, 2020): 1171–78. http://dx.doi.org/10.1007/s12008-020-00705-5.
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AbstractThe aim of this work is the design of a new customised elbow orthosis completely realized by Additive Manufacturing and the development of generative algorithms for parametric modelling and creation of 3D patterns to be adapted to the CAD model. This work describes a method to perfect the design of a custom elbow orthosis. A reverse engineering approach has been used to digitalize the patient’s arm and the subsequent CAD modelling of the structure of the custom elbow orthosis has been performed. In particular, two algorithms have been implemented for the creation of 3D patterns and Voronoi tessellations. Subsequently, FEM analyses have been carried out to validate the design. Finally, a prototype of the elbow orthosis with Voronoi tessellation has been realized by means of the SLS technology. The results obtained have demonstrated that the implemented algorithm solved the problems found during CAD modelling with conventional software. Furthermore, the results of FEM analyses have validated the design choices. All this allowed realizing the prototype by AM technologies without problems. Moreover, the new proposed modelling approaches allows creating, in an interactive way, patterns on complex surfaces. The results of this research activity present innovative elements of originality in the CAD modelling sector, which can contribute to solving problems related to the modelling for Additive Manufacturing. Furthermore, another innovative characteristic of the device is the use of torsion springs that simulate the action of physiotherapists during exercises for patient rehabilitation.
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de Sèze, Mathieu-Panchoa, Clément Bonhomme, Jean-Christophe Daviet, Emmanuel Burguete, Hugues Machat, Marc Rousseaux, and Jean Michel Mazaux. "Effect of early compensation of distal motor deficiency by the Chignon ankle-foot orthosis on gait in hemiplegic patients: a randomized pilot study." Clinical Rehabilitation 25, no. 11 (July 12, 2011): 989–98. http://dx.doi.org/10.1177/0269215511410730.
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Objective: To compare the effect of the Chignon ankle-foot orthosis on gait versus a standard ankle-foot orthosis. Method: A multicentre randomized study was conducted in seven rehabilitation centres. Hemiplegic patients were recruited after unilateral stroke lasting less than six months. Exclusion criteria were: impossibility to stand for 10 seconds; ankle passive dorsiflexion <5 degrees with knee flexed to 90 degrees; triceps spasticity ≥3/4 on the Ashworth modified scale; diseases that might impair active participation in the study. Thirteen patients were randomized to the Chignon group and 15 to the control group. Included patients were given a standard ankle-foot orthosis or Chignon ankle-foot orthosis. The Chignon ankle-foot orthosis is an articulated double-stopped custom-made orthosis with elements to assist dorsiflexion and plantar flexion. Gait speed improvement (ten-metre test), kinematic assessment, and functional scales were assessed. Results: Gain ratio of walking speed with the orthosis increased significantly more in the Chignon group than in the control group at day 0 (27.2 ± 36% versus −0.8 ± 17%; P = 0.006), day 30 (39.9 ± 19% versus 7.5 ± 17%; P = 0.0004) and day 90 (44.6 ± 27% versus 17.1 ± 0.3%; P = 0.04). There was also a significant improvement in kinematic parameters and spasticity in the Chignon group. Conclusion: Early compensation of distal motor deficiency by the Chignon ankle-foot orthosis improves the immediate gait of hemiplegics more than the standard ankle-foot orthosis and seems to modify motor recovery processes in the legs after stroke.
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Younger, Alastair. "Custom Energy-Storing Carbon Fiber Orthosis for Lower-Limb Trauma." Journal of Bone and Joint Surgery 100, no. 20 (October 2018): e136. http://dx.doi.org/10.2106/jbjs.18.00871.
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Trujillo, Leonard G., and Debbie Amini. "Creating a custom fabricated neoprene orthosis for optimal thumb positioning." Journal of Hand Therapy 26, no. 4 (October 2013): 365–68. http://dx.doi.org/10.1016/j.jht.2013.05.008.
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Uğurlu, Ümit, Mehmed Özkan, and Huri Özdoğan. "The Development of a New Orthosis (Neuro-Orthosis) for Patients with Carpal Tunnel Syndrome: Its Effect on the Function and Strength of the Hand." Prosthetics and Orthotics International 32, no. 4 (January 2008): 403–21. http://dx.doi.org/10.1080/03093640802366166.
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Static wrist orthoses (SWOs) are used in the treatment of carpal tunnel syndrome (CTS) with some drawbacks. As an alternate approach to SWOs, an active closed-loop wrist control strategy based on the principles of functional electrical stimulation was proposed to limit wrist movements. The purpose of the study was to determine whether the proposed ‘neuro-orthosis’ (NeO) system resulted in less restriction in the hand compared to clinically accepted custom-made SWOs while limiting the wrist movements. A case-control study was designed to determine the specific effects of the system on patients with CTS. A total of 24 right-handed female volunteers (12: CTS, 12: healthy) participated in the study. Function, dexterity, and strengths were measured under three different testing conditions: without orthosis, with SWO, and with the NeO system. Maximum angles in one subtest while the NeO system was on and off and general discomfort levels in SWO and NeO test conditions were recorded. The NeO system resulted in less restriction with respect to SWO and provided considerable angular limitation compared to placebo. It was concluded that the proposed prototype control system can be a good candidate to limit the wrist movements in place of SWOs with a better degree of freedom in patients with CTS.
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LePage, Lisa. "836 Custom Fabricated Open Anterior Ankle Foot Orthosis to Promote Early Mobility with Lower Extremity Grafts." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S256—S257. http://dx.doi.org/10.1093/jbcr/iraa024.409.
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Abstract Introduction Distal lower extremity STSG’s present a challenge with the balance of early mobility and immobilization of the ankle. Traditional commercially available ambulation boots or pre-fabricated orthotics may impose circumferential compression endangering graft integrity. Custom fabricated posterior AFO’s comprised of thermoplastic, scotch cast or fiberglass materials are not recommended for weight-bearing of the lower extremity during mobility/ambulation. What may also hinder promotion of early mobility is having a multitude of injuries or advanced age with decreased ability to adhere to a LE NWB status. An anterior approach to immobilization of the ankle was thought of to free the plantar surface of the foot for weight-bearing. The open concept of the orthosis itself minimizes direct contact with the involved LE graft. This promotes graft integrity during mobility with ankle immobilization. Methods Materials: Thermoplastic material, scissors, strapping, dense adhesive foam, adhesive Velcro and a heat gun. Fabrication: Measure the point of distance between where the desired proximal end of the orthosis would be to the patient’s metatarsal heads on the dorsal aspect of the foot; double it to calculate the amount of material needed. The width of the material should be approx. 3 to 4 inches. Warm material and tri-fold it together reducing width to approx. 1 ½ to 2 inches to increase stability. Shape the folded material into a continuous oval and place on the patient’s distal LE. As the material cools, shape the oval away from the medial/ lateral aspects of the distal LE restricting the points of contact to the anterior most proximal and distal aspect of the desired splint parameters. Remove once cooled and add dense adhesive foam to the 2 points of contact that will rest against the patient. This will allow for a slight area of “give” against the patient during weight-bearing of the LE/foot. Velcro and straps are added to the proximal/distal ends of the oval; heating the adhesive side will imbed the Velcro allowing increased durability with repeated donning/doffing. Results The open construction of this orthosis allows different degrees of weight-bearing eliminating contact with the distal LE STSG. The forefoot and heel are available to weight bear safely within the confines of the open anterior ankle foot orthosis. Conclusions Patients have been trialed with/without an AD with success in the achievement of ankle immobilization with mobility. Weight-bearing instructions that accompany this splint wear is foot placement rather than a normal heel strike cadence to avoid undue pressure at the proximal aspect of the splint on the lower extremity. Applicability of Research to Practice This splint has been successfully utilized for immobilization without compromise to STSG integrity due to the anterior open support it offers the ankle. Perhaps this concept could be applied to other joints to avoid direct contact of the splint with STSG during the initial stages of healing.
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Ahmadi Bani, Monireh, Mokhtar Arazpour, Stephen William Hutchins, Fereydoun Layeghi, Mahmood Bahramizadeh, and Mohammad Ali Mardani. "A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis." Prosthetics and Orthotics International 38, no. 1 (May 17, 2013): 79–82. http://dx.doi.org/10.1177/0309364613488621.
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Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.
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Pandey, Richa, and Rahul Singh. "Experimental Analysis of Various Materials on Custom-Fit Ankle Foot Orthosis." Journal of Physics: Conference Series 1950, no. 1 (August 1, 2021): 012028. http://dx.doi.org/10.1088/1742-6596/1950/1/012028.
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Wapner, Keith L., and Peter F. Sharkey. "The Use of Night Splints for Treatment of Recalcitrant Plantar Fasciitis." Foot & Ankle 12, no. 3 (December 1991): 135–37. http://dx.doi.org/10.1177/107110079101200301.
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This study reports the results of the use of molded ankle foot orthosis night splints for the treatment of recalcitrant plantar fasciitis on 14 patients with a total of 18 symptomatic feet. All patients had symptoms for greater than 1 year and had previously undergone treatment with nonsteroidal anti-inflammatory medicines, cortisone injections, shoe modifications, and physical therapy without resolution. All patients were provided with custom-molded polypropylene ankle foot orthoses in 5° of dorsiflexion to be used as a night splint. With continued use of nonsteroidal anti-inflammatory medication, Tuli heel cups, Spenco liners, and general stretching exercises, successful resolution occurred in 11 patients in less than 4 months. There were three failures. It is felt that the use of night splints provides a useful, cost-effective adjunct to current therapeutic regimens of plantar fasciitis.
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Febri Anggriani, Atika, Agus Kristiyanto, and Setyo Sri Rahardjo. "The Effect of Foot Orthosis Use in Reducing Pain in Patients with Plantar Fasciitis: A Meta-Analysis." Journal Epidemiology and Public Health 5, no. 3 (2020): 309–19. http://dx.doi.org/10.26911/jepublichealth.2020.05.03.05.
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Background: Plantar fasciitis is an inflammatory problem that occurs in the foot area that causes pain. Its prevalence rates range from 4% to 7% in the elderly population, 8% in athletes and up to 25% in runners. One of the treatments used to reduce the degree of pain is the use of foot orthosis. A number of related articles stated that the use of foot orthosis can reduce the degree of pain in plantar fasciitis patients. The purpose of this study was to estimate the magnitude of the effect of using foot orthosis on pain reduction in plantar fasciitis patients by conducting a meta-analysis on the same number of articles. Subjects and Method: The meta-analysis was carried out by systematically reviewing the same number of articles from PubMed, Science Direct, and Google Scholar. By using the search keywords "foot orthosis" OR "FO" AND "custom foot orthosis" AND "foot pain" AND "plantar fasciitis" AND "plantar fasciopathy" AND "effect foot orthosis for plantar fasciitis" AND "treatment for plantar fasciitis" A "randomized controlled trial". The intervention given was the use of a foot orthosis with a comparison without using a foot orthosis with the study subject of plantar fasciitis patients. The study outcome was pain reduction. The article used is a full text article with a randomized controlled trial design that reports the value of the effect size (mean and standard deviations). Articles were collected using the PRISMA flow chart and analyzed using the Review Manager 5.3 application with random effect models. Results: A meta-analysis of 7 randomized controlled trial studies from Brazil, Virginia, Turkey, Germany, China, and Australia suggested that the use of foot orthosis was -0.54 times better at reducing pain in plantar fasciitis patients compared to those without foot orthosis (ES= -0.54; 95% CI -1.11 to 0.03; p= 0.06). Heterogeneity I2= 82%. Conclusion: Foot orthosis reduces pain in plantar fasciitis patients compared to those without foot orthosis Keywords: Plantar fasciitis, pain, foot orthosis Correspondence: Atika Febri Anggriani, Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: atikaanggriani07@gmail.com. Mobile : 085728794960
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Wynne, James H., and Lauren R. Houle. "Short-Term Outcomes of the Boston Brace 3D Program Based on SRS and SOSORT Criteria: A Retrospective Study." Children 9, no. 6 (June 7, 2022): 842. http://dx.doi.org/10.3390/children9060842.
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Background: Adolescent idiopathic scoliosis (AIS) is characterized by a lateral curvature of the spine with a Cobb angle greater than 10 degrees, accompanied by rotation of the vertebral body. Bracing has been shown to be effective in halting the progression of at-risk curves, and, in some cases, even improving the Cobb angle by 6° or more. The Boston Brace 3D is part of the Boston Orthotics and Prosthetics standardized scoliosis program. The orthosis is custom-fabricated from scans, computer-aided design (CAD), and computer-aided manufactured (CAM) thoracolumbosacral orthosis used in the non-operative management of AIS. Aim: To evaluate the outcomes of a scoliosis program utilizing the Boston Brace 3D orthosis for patients with AIS, based on SRS and SOSORT criteria. Design: Retrospective study. Methods: An electronic medical records search was conducted to identify first-time brace wearers fitted between 1 January 2018, and 30 June 2019, at Boston Orthotics and Prosthetics Boston area clinics that met the SRS/SOSORT research guidelines. The initial out-of-brace, in-brace, and last follow-up X-rays (taken at least 12 months after fitting) were compared. Results: 84% of patients presenting with a single curve and 69% of patients with a double curve saw their curves improve (reduced 6° or more) or remain unchanged (±5°). Thirty-one patients started with a single curve between 25° and 30°, and thirty-two presented at 30° or below. Fifty-nine patients started with a double curve between 25° and 30°, and 59 patients presented at 30° or below. In general, the patients who wore their brace for more hours per day saw improved results. Conclusion: The Boston Brace 3D program is effective in controlling (and in some cases improving) curve progression in the non-operative management of adolescent idiopathic scoliosis. The approach is a repeatable system, as shown in this cohort of thirteen clinicians across six area clinics following the Boston Brace 3D clinical guidelines.
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Quick, Charles D., Adam M. Meyer, Jill M. Cancio, William S. Dewey, Cindy M. Ridge, James K. Brown, Tiffany T. Pittman, and Leopoldo C. Cancio. "645 Adjustable Dynamic Ankle Foot Orthosis for Recovery of Functional Mobility." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S179—S180. http://dx.doi.org/10.1093/jbcr/irab032.295.
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Abstract Introduction We present a case of a 23-year-old woman with primary-onset peroneal nerve impairment following diagnosis of purpura fulminans involving 30% total body surface area, who was treated in our burn center. Medical complexity required a unique rehabilitation intervention. The purpose of this case study is to demonstrate the effectiveness of a dynamic ankle-foot orthosis (AFO) to recover functional ambulation. Methods Upon initial evaluation and during weekly re-evaluations, a physical therapist (PT) and an occupational therapist (OT) measured active range of motion (AROM), passive range of motion (PROM), and strength. Absent to trace common peroneal nerve function was identified bilaterally 8 days after admission. The patient underwent 41 surgeries and spent 231 days in the burn intensive care unit. Medical complications included 3 episodes of acute respiratory distress syndrome and septic shock, acute renal failure requiring 150 days of continuous renal replacement therapy, and 51 ventilator days. Due to post-operative restrictions and/or medical complications, lower-extremity ROM was restricted for 63 days and supine position was restricted for 49 days. Rehabilitation interventions included PROM, AROM and continuous passive motion. Weight-bearing activities included a tilt table, Moveo™, standing frame, transfer and gait training with a rolling walker (RW). Positional interventions were sitting in a Total Lift Chair, serial casting, and custom AFO fabrication. Results On hospital day 215 the patient ambulated 15 feet using a platform walker and required assistance of 4 staff to support the ankle and foot. On hospital day 229, static custom AFOs were implemented and the patient ambulated 325 feet with contact guard assist (CGA). The static AFOs required frequent re-fabrication due to daily ROM progress. Adjustable dynamic AFOs were fabricated to decrease resource burden. With the dynamic AFOs, the patient progressed to 745 feet CGA on hospital day 258. The patient discharged to an acute rehabilitation center on hospital day 260. Conclusions Extensive medical, surgical and positional restrictions required innovative interventions by a multidisciplinary team. This resulted in the fabrication of dynamic custom AFOs for gait training. Utilization of these AFOs significantly increased activity tolerance and ambulation distance, and enabled eventual discharge to a rehabilitation center.
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Lee, Seunghwan, Yong Min Lee, Kyeong Eun Uhm, and Jongmin Lee. "Adult-Onset Primary Focal Foot Dystonia Improved with Custom Made Ankle-Foot Orthosis." Clinical Pain 19, no. 1 (June 30, 2020): 40–44. http://dx.doi.org/10.35827/cp.2020.19.1.40.
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Aldridge Whitehead, Jennifer M., Elizabeth Russell Esposito, and Jason M. Wilken. "Stair ascent and descent biomechanical adaptations while using a custom ankle–foot orthosis." Journal of Biomechanics 49, no. 13 (September 2016): 2899–908. http://dx.doi.org/10.1016/j.jbiomech.2016.06.035.
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Ikeda, Andrea J., John R. Fergason, and Jason M. Wilken. "Effects of altering heel wedge properties on gait with the Intrepid Dynamic Exoskeletal Orthosis." Prosthetics and Orthotics International 42, no. 3 (September 4, 2017): 265–74. http://dx.doi.org/10.1177/0309364617728116.
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Background: The Intrepid Dynamic Exoskeletal Orthosis is a custom-made dynamic response carbon fiber device. A heel wedge, which sits in the shoe, is an integral part of the orthosis-heel wedge-shoe system. Because the device restricts ankle movement, the system must compensate to simulate plantarflexion and allow smooth forward progression during gait. Objectives: To determine the influence of wedge height and durometer on the walking gait of individuals using the Intrepid Dynamic Exoskeletal Orthosis. Study design: Repeated measures. Methods: Twelve individuals walked over level ground with their Intrepid Dynamic Exoskeletal Orthosis and six different heel wedges of soft or firm durometer and 1, 2, or 3 cm height. Center of pressure velocity, joint moments, and roll-over shape were calculated for each wedge. Results: Height and durometer significantly affected time to peak center of pressure velocity, time to peak internal dorsiflexion and knee extension moments, time to ankle moment zero crossing, and roll-over shape center of curvature anterior-posterior position. Wedge height had a significant influence on peak center of pressure velocity, peak dorsiflexion moment, time to peak knee extension moment, and roll-over shape radius and vertical center of curvature. Conclusion: Changes in wedge height and durometer systematically affected foot loading. Participants preferred wedges which produced ankle moment zero crossing timing, peak internal knee extension moment timing, and roll-over shape center of curvature anterior-posterior position close to that of able-bodied individuals. Clinical relevance Adjusting the heel wedge is a simple, straightforward way to adjust the orthosis-heel wedge-shoe system. Changing wedge height and durometer significantly alters loading of the foot and has great potential to improve an individual’s gait.
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Arazpour, Mokhtar, Monireh Ahmadi Bani, Stephen William Hutchins, Richard Keith Jones, and Monireh Habibi Babadi. "Frontal plane corrective ability of a new unloader orthosis for medial compartment of the knee." Prosthetics and Orthotics International 37, no. 6 (March 7, 2013): 481–88. http://dx.doi.org/10.1177/0309364613478964.
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Background: Patients with medial compartment osteoarthritis of the knee suffer from pain and stiffness. However, current unloader braces are not being used for extended periods by knee osteoarthritis patients due to interface problems, so compliance is an issue. The aim of this study was to design a new bespoke orthosis that could be comfortable to wear while also providing the required correction to reduce medial compartment loading. Case Description and Methods: A new knee orthosis design was initially tested for its frontal plane correction of knee varus using a surrogate knee model. It was then assessed by a volunteer subject with grade 2 medial compartment knee osteoarthritis using a static standing radiograph. Findings and Outcomes: When fitted to the surrogate knee model, the brace corrected the knee from 10° of varus to neutral alignment in the frontal plane. When worn in situ during static stance on the affected leg of the volunteer patient, it corrected the knee by 6° to a less varus position. Conclusion: The orthosis provided frontal plane correction of the knee during static standing. It could therefore prove to be suitable for use by knee osteoarthritis patients. Clinical relevance This new custom unloader knee orthosis produced a more valgus knee alignment by adjusting the pneumatic components attached to the thigh and leg shells. During static stance, it corrected frontal plane varus knee rotation by 6° in a single subject with knee osteoarthritis.