Mr Simon B Dickinson MSc (Hons) MBAPO SRpros/orth
Orthotic Clinical Lead & Clinical Specialist-Nottingham University Hospi...
   Orthotists are
    registered healthcare
    professionals who
    specialise in the
    assessment of the
    whole b...
   An orthosis is an
    externally applied device.
    It may also be called a
    „brace‟, „splint‟ or
    „orthotic‟....
 Centre of Excellence
 In-house service
 On site
  manufacturing
 3 sites
 3rd Largest Orthotics
  department in
  En...
   Neurologist
   Orthopaedic Surgeon
   Orthotist
   Physiotherapist
   Podiatrist?
   Named in 1886
   Common inherited
    Neurological disorder
   Affects 1:2500 people
   Affects peripheral
    sens...
   Impaired Balance
   Recurrent Ankle
    Sprains/fractures
   Changing foot shape
    (high arch, flat foot
   Drop-...
   Motor nerve
    degeneration
   Typically weakening
    Peroneal muscles
    (ankle evertors)
    causing muscle
    ...
   Weakness in Peroneal
    Muscles
   Initially ankle feels
    unstable
   Made worse on
    uneven ground
   Freque...
   Weakness of pre-tibial
    muscles
   Initially causes
    increased tripping
   Foot Slap
   Compensation by
    b...
Patient History/Diagnosis

                   Biomechanical Assessment
                   Gait/Pressure/Force Analysis

  ...
This must include:

Weight Bearing and Non-Weight Bearing Exam

Static and Dynamic Assessment

Proprioception

Physical Ex...
For every patient and EVERY Joint

   Ask about discomfort/pain in segment
   R.O.M (Range of Motion)
   Muscle Strengt...
“Neutral”



Supination               Pronation
   Protect against
    excessive ankle
    inversion
   Function is to
    evert ankle and
    forefoot
M
                                                          m



      d                          D



For Rotation Equili...
MF




            2D   D




      GRF

GRF x 2D = MF x
   Improve Balance
   Improve Stability
   Improve Walking
    Pattern
   Prevent deformity
   Reduce Pain
   Supple...
   Every patient is different
   Every Patient should be thoroughly assessed
   Orthosis designed in conjunction with p...
   Insoles (foot orthoses)
   Ankle Braces
   Supra Malleolar
    Orthoses (SMO‟s)
   Ankle Foot Orthoses
    (AFO‟s)
...
   Orthopaedic footwear controls foot deformities
   Insoles (foot orthoses) correct feet to neutral
    and make them w...
   Aim to improve
    stability and reduce
    pain
   Rarely pre-made
   “Gold standard” is
    custom made
   Wedges...
DESIGN ESSENTIALS

   Should conform to shape
    of foot
   Fairly rigid
   Durable materials
   Wedges to replace
  ...
FUNCTION

   Reduce heel inversion
   Improve ankle stability
   Can assist very mild
    drop foot

Caution
 Ankle br...
   Correct drop foot
   Increase ankle
    stability
   Improve balance
   Prevent contractures
   Can be bulky and
 ...
   Should conform to
    shape of leg and foot
   Should correct poor foot
    alignment
   Accommodate fixed
    defor...
   Highly cosmetic
   Appropriate for very mild
    instability and easily
    correctable drop foot
   Difficult to ap...
   Required to
    accomodate fixed
    deformities
   Must have custom
    made insole inside
    boot/shoe
   Can be ...
   Used to provide
    increased forces
   Must be used in
    conjunction with
    appropriate
    footwear
   Must be...
   Orthotic treatment for patients must be
    designed to meet their individual needs
   Orthoses must be appropriately...
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
Orthotic Management of Charcot Marie Tooth
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Orthotic Management of Charcot Marie Tooth

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Orthotic Management of Charcot Marie Tooth

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Orthotic Management of Charcot Marie Tooth

  1. 1. Mr Simon B Dickinson MSc (Hons) MBAPO SRpros/orth Orthotic Clinical Lead & Clinical Specialist-Nottingham University Hospitals Professional Affairs Chairman- British Association Of Prosthetists and Orthotists (BAPO)
  2. 2.  Orthotists are registered healthcare professionals who specialise in the assessment of the whole body for biomechanical problems and if appropriate may prescribe, measure, fit, or review, an orthosis.
  3. 3.  An orthosis is an externally applied device.  It may also be called a „brace‟, „splint‟ or „orthotic‟.  The purpose and design of an orthosis may change over time along with the changing needs of the patient.  An orthosis can: improve function, reduce pain, prevent deformity.
  4. 4.  Centre of Excellence  In-house service  On site manufacturing  3 sites  3rd Largest Orthotics department in England The Team  7 Orthotists  6 Administrators  4 Technicians
  5. 5.  Neurologist  Orthopaedic Surgeon  Orthotist  Physiotherapist  Podiatrist?
  6. 6.  Named in 1886  Common inherited Neurological disorder  Affects 1:2500 people  Affects peripheral sensory and motor nerves  Mainly affects feet and hands  Slowly Progressive
  7. 7.  Impaired Balance  Recurrent Ankle Sprains/fractures  Changing foot shape (high arch, flat foot  Drop-Foot  Reduced hand function
  8. 8.  Motor nerve degeneration  Typically weakening Peroneal muscles (ankle evertors) causing muscle imbalance  Repeated sprains weaken lateral ankle structures
  9. 9.  Weakness in Peroneal Muscles  Initially ankle feels unstable  Made worse on uneven ground  Frequency of sprains increases
  10. 10.  Weakness of pre-tibial muscles  Initially causes increased tripping  Foot Slap  Compensation by bending knee and hip excessively to help swing leg through
  11. 11. Patient History/Diagnosis Biomechanical Assessment Gait/Pressure/Force Analysis Establish Biomechanical Deficit/Objective Design Orthosis Measurement/Casting Manufacture Fitting Stage Is Biomechanical Objective Being Achieved? Yes No Follow Up Return To Beginning Review
  12. 12. This must include: Weight Bearing and Non-Weight Bearing Exam Static and Dynamic Assessment Proprioception Physical Examination
  13. 13. For every patient and EVERY Joint  Ask about discomfort/pain in segment  R.O.M (Range of Motion)  Muscle Strength  Limitations/compensations  Soft tissue
  14. 14. “Neutral” Supination Pronation
  15. 15.  Protect against excessive ankle inversion  Function is to evert ankle and forefoot
  16. 16. M m d D For Rotation Equilibrium to occur the net turning moment must be zero M x d= m x D
  17. 17. MF 2D D GRF GRF x 2D = MF x
  18. 18.  Improve Balance  Improve Stability  Improve Walking Pattern  Prevent deformity  Reduce Pain  Supplement function of weakened muscles  Reduce need for Surgery
  19. 19.  Every patient is different  Every Patient should be thoroughly assessed  Orthosis designed in conjunction with patient and clinical team  Orthosis should be designed to meet patients needs  Orthosis should be as comfortable and cosmetic as possible
  20. 20.  Insoles (foot orthoses)  Ankle Braces  Supra Malleolar Orthoses (SMO‟s)  Ankle Foot Orthoses (AFO‟s)  Silicon Ankle Foot Orthoses (SAFO‟s)  Footwear and footwear adaptions  Conventional calipers  Surgery?
  21. 21.  Orthopaedic footwear controls foot deformities  Insoles (foot orthoses) correct feet to neutral and make them work normally  All AFO‟s should be at 90 degrees  The hindfoot and forefoot should be held neutral in an AFO
  22. 22.  Aim to improve stability and reduce pain  Rarely pre-made  “Gold standard” is custom made  Wedges added to improve alignment and stability
  23. 23. DESIGN ESSENTIALS  Should conform to shape of foot  Fairly rigid  Durable materials  Wedges to replace function of weakened peroneal muscles-lateral forefoot wedges  Accommodate fixed deformities  Should be comfortable
  24. 24. FUNCTION  Reduce heel inversion  Improve ankle stability  Can assist very mild drop foot Caution  Ankle braces can improve stability but can make ankles weaker Push Aequi. when brace removed
  25. 25.  Correct drop foot  Increase ankle stability  Improve balance  Prevent contractures  Can be bulky and cause problems with footwear  Should be comfortable  Strong durable devices
  26. 26.  Should conform to shape of leg and foot  Should correct poor foot alignment  Accommodate fixed deformities  Wedges to replace function of weakened peroneal muscles-lateral forefoot wedges  Ankle straps to control ankle position
  27. 27.  Highly cosmetic  Appropriate for very mild instability and easily correctable drop foot  Difficult to apply/remove  Tolerance?  Unsuitable for moderate to severe ankle instability  Unsuitable for any patient with reduced ankle movements
  28. 28.  Required to accomodate fixed deformities  Must have custom made insole inside boot/shoe  Can be reinforced for increased support  Footwear adaption: Heel raises, wedges, floats/flares
  29. 29.  Used to provide increased forces  Must be used in conjunction with appropriate footwear  Must be used in conjunction with foot orthosis
  30. 30.  Orthotic treatment for patients must be designed to meet their individual needs  Orthoses must be appropriately designed and made  All patients must be regularly reviewed  More investment must be made to improve orthotic treatment options to meet the needs of patients
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