This document discusses orthotics for abnormalities in the coronal, sagittal, and transverse planes of the foot. It focuses on pronated and supinated foot types, describing their key features. Different types of ankle-foot orthoses are outlined, including conventional metal/leather designs, thermoplastic designs, and different variations for posterior, anterior, and PTB styles. Conventional AFO designs are described in more detail, explaining how they use straps on the shoe to provide varus or valgus control and different types of ankle joints for motion restriction or assistance. Complications of bracing are also listed.

1. ORTHOTICS SCIENCE
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2. Abnormalities in 3 planes
Coronal (frontal) plane
• Rearfoot/hindfoot varus & valgus
• Forefoot varus & valgus
Sagittal plane
• Ankle equinus & calcaneus
• 1st Ray plantarflexion or elevation
Transverse plane
• Forefoot/Metatarsus adductus
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3. Images
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4. WHOLE FOOT PRONATED/ TALIPES
VALGUS
Overview of pronation
disorders
• This section deals with
conditions that can be
grouped as the whole foot:
'pronated'.
• 'Flat foot' is also commonly
used.
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5. Key features of a pronated foot
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• Flattened medial longitudinal arch,
• Abducted forefoot; indicated in standing by most toes
being visible lateral to the calcaneus in the posterior
view
• Valgus calcaneus; theoretically, when a foot with a
rearfoot valgus deformity is weightbearing, the
Achilles tendon is displaced laterally from its usual
line of action through the centre of the subtalar
joint. This mean that, when gastrosoleus contracts, it
generates an eversion moment about the subtalar
joint, which can perpetuate the valgus deformity
• Occasional weight bearing directly through the
navicular

6. WHOLE FOOT SUPINATED/ TALIPES
VARUS
Overview of Supination
disorders
• This section deals with
conditions that can be
grouped as the whole
foot: ‘supinated'.
• ‘Hollow foot' is also
commonly used.
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7. Key features of a supinated foot
• High medial longitudinal arch
• Adducted forefoot; indicated in standing by most toes
being visible medial to the calcaneus in the posterior
view
• Varus calcaneus; theoretically, when a foot with a
rearfoot varus deformity is weightbearing, the Achilles
tendon is displaced medially from its usual line of
action through the centre of the subtalar joint. This
mean that, when gastrosoleus contracts, it generates
an inversion moment about the subtalar joint, which
can perpetuate the varus deformity
• Occasional weight bearing at the lateral border of the
foot ORTHOTICS SCIENCE 7

8. SUPRA MALLEOLAR ORTHOSIS
• FO/ Dynamic Ankle
Foot Orthosis is made
to apply pressure over
the malleoli to offer
greater control of the
M-L deviation of the
hind foot.
• SMO allows
dorsiflexion and
plantarflexion
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9. 9
ANKLE FOOT ORTHOSIS
• There are various types of AFO’s that differ
not only in design but in functional controls on
the ankle as well.
• Before deciding on what type of AFO to
prescribe, the Orthotist must conduct a
detailed subjective and objective examination
of the patient.
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Ankle Foot Orthoses
• AFOs are manufactured from a wide variety of
materials and have several designs, to achieve
various functions
• Many causes of disability that require orthotic
devices come from problems with nervous system
• A strong understanding is needed on nervous system
pathologies and how it works
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Ankle Foot Orthoses
When prescribing AFO’s, it is really important to;
• Understand the pathology of the patient and what
are the deficits; Muscle strength tests, range of
motion tests and some special tests like Silfverskoild
test and others.
• It is also important to make some biomechanical
goals. Thus, is my AFO going to;
a. To block a movement
b. To limit a movement
c. To enhance or assist in a movement
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12. Bracing Complications:
• Pressure sores
• Bulky
• Hot
• Heavy
• Stiffness (limits motion)
• Muscle atrophy
• Frequent Maintenance needed
• Poor cosmesis
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13. DIFFERENT AFO DESIGNS
Conventional AFO
• Made up of mainly
metals and leather
Thermoplastic AFO
• Mainly made out of plastic.
• Varying thickness and trimline will
change function
TYPES
• Posterior Shell AFO
– Rigid design
– Flexible design (Leaf Spring)
– Jointed
• Anterior Shell AFO
– Rigid design
– Jointed
• PTB AFO
• GRAFO
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14. CONVENTIONAL AFO
• Made from Metal and
Leather
• Shoe is part of control
system
• Can be used with only 1
shoe
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15. • Reduced Cosmesis
• Less contact area- Increased
Pressure
• Control or correction of varus
or valgus is done by applying
straps to the shoe that apply
pressure around the malleoli,
then strapped to the upright
in a particular direction
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16. Ankle Control System
Varus Control
• T strap pulls ankle
towards medial side bar
M L
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17. Valgus Control
• Y strap pulls ankle
towards lateral side bar
M L
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18. Ankle Joints For Conventional AFO
Design
Double Action Ankle Joint
• Ankle Joint can be
locked in any position
• Or free motion through
a range
• Spring can be used to
assist motion
• Pin is used to block or
restrict motion
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19. Free Motion
• Allows both plantarflexion and
dorsiflexion
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20. Plantarflexion Stop
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21. Dorsiflexion Stop
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22. Dorsiflexion Assist
(Klenzak)
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23. Dorsiflexion/ Plantarflexion
assist
(Double Klenzak)
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24. Fixed ankle Joint
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25. Stirrup And Dorsiflexion Assist
Ankle Joint
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26. • Attaching the side bars to the shoe
• Solid Stirrup / Split Stirrup
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