1. Lower Limb OrthosesLower Limb Orthoses

2. DefinitionDefinition
An orthosis is defined as a deviceAn orthosis is defined as a device
attached or applied to the externalattached or applied to the external
surface of the body to improvesurface of the body to improve
function, restrict or enforcefunction, restrict or enforce
motion, or support a bodymotion, or support a body
segment.segment.

3. Indications
• Assist gaitAssist gait
• Reduce painReduce pain
• Decrease weight bearingDecrease weight bearing
• Control MovementControl Movement
• Minimize progression of aMinimize progression of a
deformitydeformity

4. Lower Limb Orthoses assistLower Limb Orthoses assist
nonambulatory patients withnonambulatory patients with
transfer and mobility skills andtransfer and mobility skills and
help ambulatory patients inhelp ambulatory patients in
becoming safe walkers.becoming safe walkers.

5. PrinciplesPrinciples
• Use only as indicated and for as long asUse only as indicated and for as long as
necessary.necessary.
• Allow joint movement wherever possibleAllow joint movement wherever possible
and appropriate.and appropriate.
• Orthoses should be functional during allOrthoses should be functional during all
phases of gait.phases of gait.
• The orthotic ankle joint should be centredThe orthotic ankle joint should be centred
over the tip of the medial malleolus.over the tip of the medial malleolus.

6. Principles…Principles…
• The orthotic knee joint should be centredThe orthotic knee joint should be centred
over the prominence of the medial femoralover the prominence of the medial femoral
condyle.condyle.
• The orthotic hip joint should be in aThe orthotic hip joint should be in a
position that allows the patient to sitposition that allows the patient to sit
upright at 90 degrees.upright at 90 degrees.
• Patient compliance will be enhanced if thePatient compliance will be enhanced if the
orthosis is comfortable, cosmetic andorthosis is comfortable, cosmetic and
functional.functional.

7. Principles…Principles…
• Most orthoses utilize a three-point systemMost orthoses utilize a three-point system
to ensure proper positioning of the limbto ensure proper positioning of the limb
within the orthosis.within the orthosis.
• For e.g.., a knee that has a tendency forFor e.g.., a knee that has a tendency for
hyperextension can be treated with a kneehyperextension can be treated with a knee
orthosis that applies force posterior to theorthosis that applies force posterior to the
knee but also applies forces anteriorlyknee but also applies forces anteriorly
along the leg and thigh.along the leg and thigh.

9. Foot Orthoses (FOs)Foot Orthoses (FOs)
• FOs affect the ground reactive
forces acting on the joints of the
lower limb.
• They also have an effect over
rotational components of gait.

10. FOs in Pes Planus…FOs in Pes Planus…
• Symptomatic control of pain can be obtained bySymptomatic control of pain can be obtained by
controlling excess pronation of the foot.controlling excess pronation of the foot.
• Pronation of the foot can be defined as a rotationPronation of the foot can be defined as a rotation
of the foot in the longitudinal axis resulting in aof the foot in the longitudinal axis resulting in a
lowering of the medial aspect of the foot.lowering of the medial aspect of the foot.
• It is also referred to as inrolling.It is also referred to as inrolling.
• Eversion involves pronation and abduction at theEversion involves pronation and abduction at the
subtalar joint and dorsiflexion at the ankle joint.subtalar joint and dorsiflexion at the ankle joint.

11. FOs in Pes Planus…FOs in Pes Planus…
• The key to controlling excess pronation isThe key to controlling excess pronation is
controlling the calcaneus to keep the subtalarcontrolling the calcaneus to keep the subtalar
joint in a neutral position.joint in a neutral position.
• A custom-made foot orthosis designed to preventA custom-made foot orthosis designed to prevent
hyperpronation is also referred to as a UCBLhyperpronation is also referred to as a UCBL
orthosis denoting the University of Californiaorthosis denoting the University of California
Biomchanics Laboratory where original workBiomchanics Laboratory where original work
regarding this type of orthosis was performed inregarding this type of orthosis was performed in
the 1940s.the 1940s.

12. FOs in Pes Planus…FOs in Pes Planus…
• Cases of pes planus due to ligamentous laxityCases of pes planus due to ligamentous laxity
may be treated with a medial longitudinal archmay be treated with a medial longitudinal arch
support for alleviating pain.support for alleviating pain.
• A Thomas heel extension can also offer medialA Thomas heel extension can also offer medial
support particularly for heavier individuals.support particularly for heavier individuals.
• For runners who have pronated feet, a firmFor runners who have pronated feet, a firm
medial heel counter and a wide last at the shankmedial heel counter and a wide last at the shank
can help prevent pronation at the subtalar joint.can help prevent pronation at the subtalar joint.

13. Thomas Heel & Reverse ThomasThomas Heel & Reverse Thomas
HeelHeel

14. FOs in Pes Cavus…FOs in Pes Cavus…
• A typical problem with pes cavus is excessA typical problem with pes cavus is excess
pressure along the heel and metatarsal headpressure along the heel and metatarsal head
areas, which can lead to pain.areas, which can lead to pain.
• This can be prevented by making the height ofThis can be prevented by making the height of
the longitudinal support just high enough to fillthe longitudinal support just high enough to fill
in the space between the shank of the shoe andin the space between the shank of the shoe and
the arch of the foot to distribute weight morethe arch of the foot to distribute weight more
effectively.effectively.
• The lift is extended just to the metatarsal headThe lift is extended just to the metatarsal head
area to help distribute and alleviate pressure overarea to help distribute and alleviate pressure over
the metatarsal weight-bearing area.the metatarsal weight-bearing area.

15. Pes Cavus Orthosis…Pes Cavus Orthosis…

16. Metatarsalgia (Forefoot Pain)Metatarsalgia (Forefoot Pain)
• Relief of pain in the forefoot is accomplished byRelief of pain in the forefoot is accomplished by
distributing the weight-bearing forces to an areadistributing the weight-bearing forces to an area
proximal to the metatarsal heads.proximal to the metatarsal heads.
• This can be achieved by either internal orThis can be achieved by either internal or
external modification.external modification.
• A metatarsal pad also referred to as a ‘cookie’A metatarsal pad also referred to as a ‘cookie’
can be placed inside the shoe just posterior to thecan be placed inside the shoe just posterior to the
second, third and fourth metatarsal heads.second, third and fourth metatarsal heads.

17. ““Cookie”Cookie”

18. Metatarsalgia (Forefoot Pain)…Metatarsalgia (Forefoot Pain)…
• A metatarsal bar is an external modification andA metatarsal bar is an external modification and
is indicated in metatarsalgia in cases in whichis indicated in metatarsalgia in cases in which
the foot is too sensitive to tolerate a pad insidethe foot is too sensitive to tolerate a pad inside
the shoe.the shoe.
• The metarsal bar is typically ¼ inch thick andThe metarsal bar is typically ¼ inch thick and
tapers distally.tapers distally.
• The distal edge should be proximal to theThe distal edge should be proximal to the
metatarsal heads.metatarsal heads.
• The bar can also be used for forefoot painThe bar can also be used for forefoot pain
associated with pes cavus.associated with pes cavus.

19. Metatarsal BarMetatarsal Bar

20. FOs in Heel PainFOs in Heel Pain
• Rubber heel pads inside the shoe can offerRubber heel pads inside the shoe can offer
relief in minor discomfort.relief in minor discomfort.
• A calcaneal bar is recommended for casesA calcaneal bar is recommended for cases
in which the foot is too sensitive to toleratein which the foot is too sensitive to tolerate
a pad inside the shoe and the heel pain isa pad inside the shoe and the heel pain is
associated with a chronic condition.associated with a chronic condition.
• The calcaneal bar is placed distal to theThe calcaneal bar is placed distal to the
painful area to prevent the calcaneus frompainful area to prevent the calcaneus from
assuming full weightbearing status.assuming full weightbearing status.

21. FOs in Heel Pain…FOs in Heel Pain…
• A common cause of heel pain along theA common cause of heel pain along the
anteromedial calcaneus is plantar fasciitis.anteromedial calcaneus is plantar fasciitis.
• It is common in people who hyperpronate theirIt is common in people who hyperpronate their
feet, thereby placing excess stress on the medialfeet, thereby placing excess stress on the medial
longitudinal arch.longitudinal arch.
• Conservative treatment should include a pair ofConservative treatment should include a pair of
shoes wih a firm medial heel counter and a wideshoes wih a firm medial heel counter and a wide
shank.shank.
• In cases in which conservative management hasIn cases in which conservative management has
failed, custom-made shoes such as the UCBL isfailed, custom-made shoes such as the UCBL is
indicated.indicated.

22. FOs in Heel Pain…FOs in Heel Pain…
• Plantar fasciitis is also common in patientsPlantar fasciitis is also common in patients
with high arches.with high arches.
• The medial longitudinal arch undergoesThe medial longitudinal arch undergoes
marked stress during weight bearing.marked stress during weight bearing.
• This can be treated with either an elevatedThis can be treated with either an elevated
arch support or a heel well that helpsarch support or a heel well that helps
distribute pressure along the medialdistribute pressure along the medial
longitudinal arch.longitudinal arch.

23. FOs in Heel Pain…FOs in Heel Pain…
Heel liftsHeel lifts are of help inare of help in
• Achilles enthesitis where it decreases theAchilles enthesitis where it decreases the
amount of stretch placed on th Achillesamount of stretch placed on th Achilles
tendon by keeping the ankle joint plantartendon by keeping the ankle joint plantar
flexed, and inflexed, and in
• treating plantar flexor spasticity ortreating plantar flexor spasticity or
contracture by increasing the total heelcontracture by increasing the total heel
height to help ensure that the patient has aheight to help ensure that the patient has a
heel strike prior to toe touch during gait.heel strike prior to toe touch during gait.

24. FOs in Osteoarthritis of the KneeFOs in Osteoarthritis of the Knee
• Lateral heel wedgesLateral heel wedges can be used forcan be used for
conservative treatment of Osteoarthritisconservative treatment of Osteoarthritis
when the medial compartment narrowingwhen the medial compartment narrowing
results in genu varum.results in genu varum.
• The heel wedges used are ¼ inch thickThe heel wedges used are ¼ inch thick
along the lateral border and taperalong the lateral border and taper
mediallymedially..

26. Ankle-Foot Orthoses (AFOs)Ankle-Foot Orthoses (AFOs)
• AFOs were formerly called short leg braces.AFOs were formerly called short leg braces.
• Metal or plastic AFOs can be used effectively toMetal or plastic AFOs can be used effectively to
control ankle motion.control ankle motion.
• AFOS should provide mediolateral stability as aAFOS should provide mediolateral stability as a
safety feature.safety feature.
• It should be remembered thatIt should be remembered that plantar flexionplantar flexion
creates a knee extension moment andcreates a knee extension moment and
dorsiflexion a knee flexion moment.dorsiflexion a knee flexion moment.

27. Metal AFOsMetal AFOs
• The metal AFO consists of a proximal calf band,The metal AFO consists of a proximal calf band,
two uprights, ankle joints and an attachment totwo uprights, ankle joints and an attachment to
the shoe to anchor the AFO.the shoe to anchor the AFO.
• The posterior metal portion of the calf bandThe posterior metal portion of the calf band
should be 1.5 to 3 inches wide in order to evenlyshould be 1.5 to 3 inches wide in order to evenly
distribute pressure.distribute pressure.
• The calf band should be 1 inch below the fibularThe calf band should be 1 inch below the fibular
neck to prevent a compressive common peronealneck to prevent a compressive common peroneal
nerve palsy.nerve palsy.

28. Metal AFOs…Metal AFOs…
• Ankle joint motion is controlled by pins orAnkle joint motion is controlled by pins or
springs inserted into channels.springs inserted into channels.
• The pins are adjusted with a screw driver to setThe pins are adjusted with a screw driver to set
the desired amount of plantar flexion andthe desired amount of plantar flexion and
dorsiflexion.dorsiflexion.
• The spring is also adjusted with a screw driver toThe spring is also adjusted with a screw driver to
provide the proper amount of tension necessaryprovide the proper amount of tension necessary
to aid motion at the ankle joint.to aid motion at the ankle joint.

29. Metal AFOs…Metal AFOs…
• AA solid stirrupsolid stirrup is a U shaped metal pieceis a U shaped metal piece
permanently attached to the shoe.permanently attached to the shoe.
• Its two ends are bent upward to articulate withIts two ends are bent upward to articulate with
the medial and lateral ankle joints. The proximalthe medial and lateral ankle joints. The proximal
stirrup attachment sites are shaped to enforce thestirrup attachment sites are shaped to enforce the
desired movements at the ankle joint.desired movements at the ankle joint.
• The sole plate can be extended beyond theThe sole plate can be extended beyond the
metatarsal head area for conditions requiring ametatarsal head area for conditions requiring a
longer lever arm for better control of plantarlonger lever arm for better control of plantar
flexion such as in plantar flexor spasticity.flexion such as in plantar flexor spasticity.

30. Double-action Metal Ankle Joint
with Solid Stirrup

31. Metal AFOs…Metal AFOs…
• A split stirrup can be used instead of aA split stirrup can be used instead of a
solid stirrup.solid stirrup.
• It has a sole plate with two flat channelsIt has a sole plate with two flat channels
for insertion of the uprights.for insertion of the uprights.
• The uprights are now called calipers asThe uprights are now called calipers as
they can open and close distally to allowthey can open and close distally to allow
donning and doffing of the AFO.donning and doffing of the AFO.
• A split stirrup allows removal of theA split stirrup allows removal of the
uprights from the shoes so that the AFOsuprights from the shoes so that the AFOs
can be worn with other shoes.can be worn with other shoes.

32. Ankle Stops and Assists in MetalAnkle Stops and Assists in Metal
AFOsAFOs
• Plantar Stop (Posterior Stop)Plantar Stop (Posterior Stop)
• Dorsiflexion Stop (Anterior Stop)Dorsiflexion Stop (Anterior Stop)
• Dorsiflexion Assist ( PosteriorDorsiflexion Assist ( Posterior
Spring)Spring)

33. Plantar Stop ( Posterior Stop)Plantar Stop ( Posterior Stop)
• The plantar stop is used to control plantarThe plantar stop is used to control plantar
flexor spasticity or help incrementallyflexor spasticity or help incrementally
stretch plantar contractures.stretch plantar contractures.
• The plantar stop is most commonly set atThe plantar stop is most commonly set at
90 degrees.90 degrees.
• An AFO with a plantar stop at 90 degreesAn AFO with a plantar stop at 90 degrees
produces a flexion moment at the kneeproduces a flexion moment at the knee
during heel strike.during heel strike.

34. Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…
• Since the dorsiflexors cannot
eccentrically activate to permit contact
with the ground, the ground reactive
force remains posterior to the knee
after heel strike, which creates a
flexion moment at the knee and
possibly an unstable gait.

35. Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…
• The proximal portion of the AFO also
has an effect on knee stability.
• The posterior portion of the proximal
AFO exerts a forward push on the
proximal leg to increase the knee
flexion moment after heel strike.
• The opposite occurs at toe-off , with
an extension moment at the knee.

36. Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…
• The greater the plantar flexion
resistance, the greater the flexion
moment at the knee at heel strike, and
the greater the need for active hip
extensors to prevent the body from
collapsing forward on a buckling
knee.

37. Plantar Stop ( Posterior Stop)…Plantar Stop ( Posterior Stop)…
• The posterior stop should be set at the minimal
amount of plantar flexion required to clear the
foot during swing-through.
• Remember, the plantar flexion creates a knee
extension moment at the knee after heel strike.
• This creates a more stable gait than when the
ankle plantar stops are set in any degree of
dorsiflexion.

38. Dorsiflexion Stop ( Anterior Stop)Dorsiflexion Stop ( Anterior Stop)
• An anterior stop is used to compensate for theAn anterior stop is used to compensate for the
function of the gastrocnemius /soleus complex.function of the gastrocnemius /soleus complex.
• It is used in conditions with weak calf muscles orIt is used in conditions with weak calf muscles or
weak quadriceps (because of its effect on theweak quadriceps (because of its effect on the
knee).knee).
• Weak calf muscles allow the ankle to enterWeak calf muscles allow the ankle to enter
dorsiflexion.dorsiflexion.
• The anterior stop set at 5 degrees of dorsiflexionThe anterior stop set at 5 degrees of dorsiflexion
best substitutes for gastrocnemius/ soleusbest substitutes for gastrocnemius/ soleus
function.function.

39. Dorsiflexion Stop ( Anterior Stop)Dorsiflexion Stop ( Anterior Stop)
• The anterior stop assists with push-offassists with push-off and assists the
knee joint into extension. It should be used in
combination with a stirrup with a sole extension to the
metatarsal heads to simulate the action of the calf
muscles.
• The dorsiflexion stop simulates the gastrocnemius /
soleus function by causing the heel to rise during the
latter part of stance rather than remaining flat on the
ground.
• The shoe pivots over the metatarsal heads creating an
extension moment at the knee that helps stabilize the
knee from midstance to toe-off.

40. Dorsiflexion Assist (PosteriorDorsiflexion Assist (Posterior
Spring)Spring)
The posterior spring serves two purposes.
• It substitutes for concentric contraction of
dorsiflexors to prevent flaccid foot drop after toe-
off.
• It also substitutes inadequately for the eccentric
activation of the dorsiflexors after heel strike.
• The metal dorsiflexion assist ankle joint is also
known as a Klenzak ankle joint.

41. Metal Dorsiflexion Assist Ankle JointMetal Dorsiflexion Assist Ankle Joint
(Klenzak Ankle Joint)(Klenzak Ankle Joint)

42. Metal AFO Varus /Valgus ControlMetal AFO Varus /Valgus Control
• Valgus and varus deformities are associated with
rotation of the subtalar joint.
• A T strapT strap is attached along the side of the shoe
distal to the subtalar joint to help minimize this
deformity.
• T straps are either medial or lateral.
• A medial T strap is used to control a valgus
deformity.
• The medial T strap is sown to the medial aspect
of the shoe and the belt is cinched around the
lateral upright.

43. Metal AFO Varus /Valgus ControlMetal AFO Varus /Valgus Control
• The medial T strapmedial T strap helps create a force
directing the subtalar joint inward which
counteracts the pronation and abduction
tendency at the subtalar joint.
• The opposite is true for a lateral T straplateral T strap
used to control or minimize the tendency
for varus at the subtalar joint.

45. Plastic AFOsPlastic AFOs
• Advantages include cosmesis, light weight,
interchangeability with shoes, ability to
control varus and valgus deformities,
provision of better foot support with the
customized foot portion and ability to
achieve what is offered by the metal AFO.
• Energy consumption is equal with a plastic
solid AFO or a metal double upright AFO.

46. Plastic AFOs…Plastic AFOs…
• The weight of the orthoses is not as important as
the influence of the ground reactive force created
by the presence of the orthosis.
• The same orthotic principles apply for plastic
and metal orthoses.
• The plastic AFO prescribed for toe clearance
should be just rigid enough to provide resistance
for toe clearance. Excessive resistance to plantar
flexion can make the knee unstable after heel
strike and create a knee flexion moment.

47. Custom Plastic Solid AFO with PosteriorCustom Plastic Solid AFO with Posterior
Trimline to Allow Some Flexibility withTrimline to Allow Some Flexibility with
Plantar FlexionPlantar Flexion..

48. Plastic AFO ComponentsPlastic AFO Components
• The foot component of the AFO
should extend beyond the metatarsal
heads.
• The foot plate can be extended beyond
the toes to reduce the spasticity
aggravated by toe flexion..

49. Plastic AFO Components…Plastic AFO Components…
• Plastic AFOs can be hinged at the ankle.
• Ankle hinges allow full or partial ankle motion,
which can permit a more natural gait.
• Plastic ankle joints can be a good choice for
children and metal ankle joints for adults
particularly heavy adults.
• Newer designs have a single midline posterior
rod/spring mechanism which functions like the
more traditional medial and lateral dual
posterior spring assist mechanism.

50. (Plastic AFO Components)(Plastic AFO Components)
Elite Midline Posterior Stop ArticulatedElite Midline Posterior Stop Articulated
AFOAFO

51. The Solid Plastic AFOThe Solid Plastic AFO
• The term solid refers to an AFO that is made of a
single piece of plastic and does not have ankle
joints.
• Solid AFOs set at 90 degrees are commonly used
for foot drop. Solid AFOs are also used to treat
conditions of the knee.
• It should be remembered that plantar flexion
creates knee extension and dorsiflexion knee
flexion at heel strike.

52. The Solid Plastic AFO…The Solid Plastic AFO…
• The AFO can be fixed in a few degrees of plantar flexion
to provide stability at the knee during the stance phase of
gait.
• Genu recurvatum can also be treated with a solid AFO.
• The more rigid the AFO, the greater the flexion moment
at the knee at heel strike which helps reverse the
extension moment at the knee associated with genu
recurvatum.
• The flexion moment of the knee also becomes greater if
the ankle is placed in a few degrees of dorsiflexion.

53. Plastic AFO Varus /Valgus ControlPlastic AFO Varus /Valgus Control
• An equinovarus or inversion deformity is
controlled by applying forces medially at the
metatarsal head area and calcaneus.
• The next force is applied more proximally at the
lateral aspect of the fibula. This helps prevent
inversion at the subtalar and ankle joints.
• A more proximal medial tibial force is applied to
provide stabilization of the leg portion of the
plastic AFO by applying an opposing force to the
fibular area.

54. Plastic AFO Varus/Valgus ControlPlastic AFO Varus/Valgus Control
• A three point system also exists at the
foot level to help prevent supination of
the foot related to the equinovarus
deformity.
• A three point system is again applied
to control plantar flexion deformity
associated with equinovarus.

55. Patellar Tendon-Bearing AFOs
• A PTB AFO uses the patellar tendon and the
tibial condyles to partially relieve weight bearing
stress on skeletal structures distally, with more
weight bearing distributed along the medial tibial
condyle.
• It is often prescribed for diabetic ulcerations of
the foot, tibial fractures, relief of the weight –
bearing surface in painful heel conditions such
as calcaneal fractures, postoperative ankle
fusions and avascular necrosis of the foot or
ankle.

56. Patellar Tendon-Bearing AFOs
• The orthoses are bivalved and fit snugly
with the use of Velcro straps or buckles.
• A custom-moulded PTB AFO can reduce
weight bearing in the affected foot by 50%.

57. Prefabricated Bivalved PTB AFO

59. Knee Ankle Foot OrthosisKnee Ankle Foot Orthosis
• KAFOs were formerly referred to as long leg
braces.
• In addition to the components of an AFO, the
KAFO also includes knee joints, thigh uprights
and a proximal thigh band.
• KAFOs are used in patients with severe knee
extensor and hamstring weakness, structural
knee instability and knee flexion spasticity.
• The purpose of the KAFO is to provide stability
at the knee, ankle and subtalar joints during
ambulation.

60. Knee Ankle Foot Orthosis…Knee Ankle Foot Orthosis…
• They are most commonly prescribed bilaterally
for patients with spinal cord injuries and
unilaterally for patients with polio.
• Good trunk control and upper body strength are
needed in order to ambulate with KAFOs
because these devices are used in combination
with ambulation aids, such as walkers and
Lofstrand forearm crutches.

61. Ground Reaction or FloorGround Reaction or Floor
Reaction OrthosisReaction Orthosis
• Some paraplegic patients such as those
with lower lumbar lesions with some knee
extensor strength are able to ambulate
without KAFOs. Ambulation in these
patients can often be accomplished with
the use of bilateral plastic ground reactionground reaction
AFOAFOs with the ankles fixed in 10 to 15
degrees of plantar flexion.

62. Ground Reaction Orthosis…Ground Reaction Orthosis…
• The plantar flexion provides an
extension momentextension moment at the knee during
gait for stability with ambulation.
• The proximal anterior tibial shell
closing provides further stability at
the knee from midstance to toe-off.

63. Ground Reaction OrthosisGround Reaction Orthosis

64. Knee JointsKnee Joints
Three types
• Straight set knee joint
• Polycentric knee joint
• Posterior offset knee joint

65. Straight Set Knee JointStraight Set Knee Joint
• Provides rotation about a single axis
• Allows free flexion
• Prevents hyperextension
• Often used in combination with a drop
lock
• The lock keeps the knee in extension
through all the phases of the gait cycle.

66. Straight Set Knee JointStraight Set Knee Joint

67. Polycentric Knee JointPolycentric Knee Joint
• Uses a double axis system to simulate
the flexion-extension movements of
the femur and the tibia at the knee
joint
• Adds bulk to the orthosis
• Most frequently used in sport knee
orthosis

68. Polycentric Knee JointPolycentric Knee Joint

69. Posterior Offset Knee JointPosterior Offset Knee Joint
• Prescribed for patients with weak knee
extensors and some hip extensor strength
• Allows free flexion and extension of the
knee during the swing phase of gait
• Helps keep the orthotic ground reaction
force in front of the knee axis for stability
during stance

70. Knee OrthosesKnee Orthoses
Swedish Knee CageSwedish Knee Cage
• Used to control minor to moderateUsed to control minor to moderate genugenu
recurvatumrecurvatum due to ligamentous or capsulardue to ligamentous or capsular
laxity.laxity.
• The articulated version of the orthosis allows fullThe articulated version of the orthosis allows full
knee flexion and prevents hyperextension.knee flexion and prevents hyperextension.
• It uses a three point system with two bandsIt uses a three point system with two bands
placed anterior to the knee axis (one above andplaced anterior to the knee axis (one above and
one below the knee) and a third band posterior toone below the knee) and a third band posterior to
the knee joint in the popliteal area.the knee joint in the popliteal area.
• It also has a thigh band with longer uprights toIt also has a thigh band with longer uprights to
obtain better leverage at the knee joint.obtain better leverage at the knee joint.

71. Swedish Knee CageSwedish Knee Cage

72. Osteoarthritis Knee OrthosisOsteoarthritis Knee Orthosis
Uses the same orthotic three
point principle
The three point system
distribution is achieved by a
strap that is applied across the
knee joint.
The limiting factor regarding
this orthotic prescription is the
patient’s weight and obesity.

73. Sport Knee OrthosisSport Knee Orthosis
Sport KOs can be divided into
three types
• Prophylactic
• Rehabilitative
• Functional

74. Sport Knee OrthosisSport Knee Orthosis
ProphylacticProphylactic
• Prophylactic knee bracing attempts to
prevent or reduce the severity of knee
injuries.
• No evidence to support their use
• Associated with increased energy
consumption which can impair
athletic performance

75. Sport Knee OrthosisSport Knee Orthosis
RehabilitativeRehabilitative
• Used to allow protected motion
within defined limits
• Useful for postoperative and
conservative management of knee
injuries

76. Sport Knee Orthosis-Sport Knee Orthosis-
FunctionalFunctional
• Designed to assist or provide stability forDesigned to assist or provide stability for
the unstable kneethe unstable knee
• Most commonly used to stabilize a laterallyMost commonly used to stabilize a laterally
subluxating patella or an anterior cruciatesubluxating patella or an anterior cruciate
ligament-deficient kneeligament-deficient knee
• Use has been shown to be effective only atUse has been shown to be effective only at
loads much lower than those placed on theloads much lower than those placed on the
knee during athletic participationknee during athletic participation

77. Sport Knee Orthosis-FunctionalSport Knee Orthosis-Functional
Lenox Hill Spectralite Knee OrthosisLenox Hill Spectralite Knee Orthosis

78. Reciprocating Gait Orthosis (RGO)Reciprocating Gait Orthosis (RGO)
• Formerly known as the Hip-guided orthosisFormerly known as the Hip-guided orthosis
(HGO)(HGO)
• Its purpose is to provide contralateral hipIts purpose is to provide contralateral hip
extension with ipsilateral hip flexion.extension with ipsilateral hip flexion.
• The RGO is appropriate for children who haveThe RGO is appropriate for children who have
used the standing frame, developed good trunkused the standing frame, developed good trunk
control and coordination, can safely stand andcontrol and coordination, can safely stand and
are mentally prepared for ambulation.are mentally prepared for ambulation.
• Good upper limb strength, trunk balance andGood upper limb strength, trunk balance and
active hip flexion are important positiveactive hip flexion are important positive
variables.variables.

79. Reciprocating Gait Orthosis (RGO)Reciprocating Gait Orthosis (RGO)
• Obesity, advanced age, lack of patient motivationObesity, advanced age, lack of patient motivation
scoliosis, spasticity and contractures arescoliosis, spasticity and contractures are
significant negative factors.significant negative factors.
• Gait is initiated with active unilateral hip flexionGait is initiated with active unilateral hip flexion
and can be assisted by swaying the trunk whenand can be assisted by swaying the trunk when
hip flexion is inadequate.hip flexion is inadequate.
• Contralateral hip extension occurs passively withContralateral hip extension occurs passively with
each step employing either cables or the ‘teeter-each step employing either cables or the ‘teeter-
totter’ concept.totter’ concept.
• Crutches are used with the RGO to provide aCrutches are used with the RGO to provide a
control mechanism.control mechanism.

80. Isocentric Reciprocating GaitIsocentric Reciprocating Gait
Orthosis (RGO)Orthosis (RGO)