Lower Limb

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Lower Limb
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• Crural muscles
• Muscles of the leg
• Responsible for foot movement
• 3 groups of crural muscles
• Muscles in each group share the same nerve, blood
  supply, same general function), and posterior
• Anterior-extensor
• Lateral- fibular or peroneal
• Posterior- flexor

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Anterior Crural Muscles

• Responsible for dorsiflexion of the ankle joint
  and extension of the toes.
• Supplied by the deep fibular nerve- branch of
  sciatic

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Lateral Crural Muscles

• Peroneus longus
• Peroneus brevis
• These two muscles are synergistic in flexion and
  eversion of the foot.
• Eversion-turning sole of foot outwards

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Posterior Crural Muscles

• Superficial group
• These muscles act together in plantarflexing the
  foot at the ankle joint. They raise the heel
  against the weight of the body

• Deep group
• popliteus acts on the knee joint the other
  muscles aid in movement of the ankle and foot
  joint

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Foot Structure

• Similar nomenclature to hand musculature
• 26 bones
• Provide weight support and leverage during
  walking
• Weakening of the ligaments and tendons of the
  foot can cause flat feet

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Need for Orthotics and Prosthetics

• Talipes-Clubfoot
• Diabetes-use lightweight plastics and pressure
  relieving foam
• Foot Drop-Paralysis of the tibialis anterior
  muscle
• Shin Splits
• Fractures
• Pes Planus-flatfoot

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Manual Muscle Test Scale

• Grade 5 Patient can hold the position against
  maximum resistance and through complete range of
  motion.
• Grade 4 Patient can hold the position against
  strong to moderate resistance, has full range of
  motion.
• Grade 3 Patient can tolerate no resistance but
  can perform the movement through the full range
  of motion.
• Grade 2 Patient has all or partial range of
  motion in the gravity eliminated position.
• Grade 1 The muscle/muscles can be palpated
  while the patient is performing the action in the
  gravity eliminated position.
• Grade 0 No contractile activity can be felt in
  the gravity eliminated position.

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Progression of AFOs

• Basic Ankle Foot Orthosis
• Keeps foot stationary
• Requires adjustment in gait
• Used after ankle fracture

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Progression of AFOs

• Advanced Ankle Foot Orthosis
• Allow for joint movement
• Different types
• Free motion
• Assisted
• Stopping

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Types of Devices

• Free motion
• Dorsiflexion assist
• Plantarflexion stop
• Dorsiflexion stop
• Fixed ankle

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Manufacturers

• Orthomerica
• Custom semi-custom orthoses
• Bauerfeind
• AFO supports
• AFO stabilizers

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Support

• Orthosis manufacturer
• Most devices are custom fit with follow ups
• Podiatrists/physical therapists
• Support organizations
• Children Hemiplegia and Stroke Association

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Schools

• University of Michigan
• UMOPC designs and creates orthoses based on
  patients lifestyle
• Build orthoses for upper and lower limbs, as well
  as spinal orthoses
• University of Washington
• BS degree in orthotics
• Curriculum includes anatomy, materials and design

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Manufacturers(transtibial)

• Otto BOCK (ottobockus.com)
• Advantage DP 2 --Dynamic Response Foot
  SystemUltra lightweight with heavyweight
  credentials
• Springlite II

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Transtibial prosthetics

• Used after below the knee amputation.
• The type most often made.

Taken fromhttp//www.nupoc.northwestern.edu
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• Endolite ( endolite.com)
• Multiflex SystemThe Multiflex System combines
  the multi-talented combination of the Multiflex
  Foot and Ankle with the light weight and strength
  of our carbon fiber shin. Add the option of tube
  clamp or full alignment adaptors and you get a
  quality system perfect for the K1 or K2 activity
  level.

Prolite Below-Knee30mm prosthetic systems of
high grade aluminum alloys, available with the
Multiflex Foot and Ankle or the Stellar foot.
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• Kingsley (kingsleymfg.com)

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Support Organizations

• American Academy of Orthotists Prosthetists
  AAOP
• Amputee Coalition of America ACA
• Brittist Association of Prosthetists and
  Orthotists BAPO
• Barr/United Amputee Assistance Fund BARR
• Canadian Association of Prosthetists and
  Orthotists CAPO
• Californian Orthotics and Prosthetics Association
  COPA
• Disabled Sports USA DSUSA
• Eastern Amputee Golf Association EAGA
• Florida Association of Orthotists and
  Prosthetists FAOP
• Finger Lakes Amputee Support Web Site Finger
  Lakes Amputee Support
• Child Amputee Network I-CAN
• International Paralympic Committee IPC
• Illinois Society of Orthotists and Prosthetists
  ISOP
• International Society for Prosthetics and
  Orthotics ISPO
• Limbs For Life Foundation LFLF
• National Association for the Advancements of
  Orthotics and Prosthetics NAAOP
• National Commission on Orthotic and Prosthetic
  Education NCOPE
• National Amputee Golf Association NAGA
• National PO Licensing Fund NPOLE

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PROSTHETICS AND ORTHOTICSSCHOOLS IN THE UNITED
STATES(ispo.ws)

• TECHNICIAN PROGRAMS 
• Century College
• Median School
• Spokane Falls Community College
• PRACTITIONER PROGRAMS 
• Certificate Programs
•   California State University Dominguez Hill 
• Century College   Newington OP Certificate
  Program
•   Northwestern University Medical School
  Prosthetic-Orthotic Center 
• Rancho Los Amigos Medical Center
•  Baccalaureate Degree
•   California State University Dominguez Hill 
• University of Texas Southwestern Medical Center
  at Dallas
•   University of Washington School of Medicine 

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Sources

• http//www.orthomerica.com/
• http//web.mit.edu/jblaya/www/project/orthomed.htm
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• http//www.bauerfeindusa.com/
• http//www.med.umich.edu/pmr/op/orthotics.htm
• http//depts.washington.edu/rehab/po/