Most Common Types of Hip Knee Ankle Foot Orthotic

Hip Knee Ankle Foot Orthotics (HKFO)

Hip Knee Ankle Foot Orthotics is bilateral knee ankle foot orthotics joined with hip joints. The orthotic hip joints can be placed between the legs or connected laterally to a pelvic or lumbar band or a lumbosacral corset. Orthoses which include extensive trunk bracing sometimes referred to as nose -hip-knee-ankle-foot-orthotics.

By joining two knee ankle foot orthotics together, hip-knee-ankle-foot-orthotics substitute for paralysis of the hip abductor muscles and provide mediolateral stability during stance. In addition, they prevent the pelvis from tilting downwards on the unweighted swing leg. Assists this foot clearance during swing and reduces the need for the upper limbs to lift the swing leg.

However, the torques tending to tilt the pelvis downwards during swing are significant, especially in heavy patients to resist these torques, hip-knee-ankle-foot orthotics needs real lateral rigidity. If the orthotics are insufficiently rigid, swing leg clearance involved.

The three most common types of hip-knee-ankle-foot orthotic are the hip guidance orthotics, the reciprocating gait orthotics, and the medical-linkage orthotics. Various types of hip and knee joints can used in all three orthoses. A summary of each given below

Hip Guidance Orthotics

The hip guidance orthotics, also called the ParaWalker, was first introduced for children with spina bifida in the 1970s.

It consists of two knee ankle foot orthotics attached to a rigid body brace with laterally placed hip joints.

The hip joints are low friction and restrict flexion and extension, although they can be released to enable sitting. During the leg flexes like a pendulum, and swing phase of gait.

That is; hip flexion is achieved solely by the effects of gravity on the unweighted leg. Gravity will only act to flex the hip when the leg extended with the mass of the leg behind the hip joint.


Reciprocating Gait Orthotics

The reciprocating gait orthotics joints two knee ankle foot orthotics to a trunk corset with a laterally placed joints. An essential feature of the reciprocating gait orthosis is the coupling together of the hip joints, preventing, bilateral hip flexion instance. The hip mechanism designed so hip extension on one leg could assist hip flexion on the other foot when stepping. However, the effectiveness of this mechanism may be overstated. The hip joints can be unlocked to flex simultaneously, and it's essential for sitting.

Early versions of reciprocating gait orthotics coupled the two hip joints together with cables. The cables were attached under high tension so that forces from extension in one leg transmitted to flexion of the other. In more recent years, a pivot bar has replaced the cables. The pivot bar is positioned centrally and at the back of the corset in the lumber region. Reciprocating gait orthotics incorporating pivot blocks are called eccentric reciprocating gait orthotics. A variation is the advanced reciprocating gait orthotics.

Medical Linkage Orthotics

The medical linkage Orthotics, also known as the Walkabout orthosis, has a hinge-like joint positioned between the legs. The joints limit hip flexion and extension but do not mechanically assist either. Instead, gravity flexes the hip and moves the unweighted leg forward. Hip extension is achieved by leaning the trunk backwards and extending the lumbar spine. Consequently, even slight loss of passive hip extension can be a problem, increasing patient's reliance on their upper limbs to hold the trunk upright. The medical-linkage orthotics is aesthetically more appealing than other types of hip-knee-ankle-foot orthotics but it provides a slower and more energy consuming gait.

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Introduction to Orthotics

The field of orthotics includes appliances for the loweb limb trunk, neck, and upper limb. This Article outlines key concepts that apply to orthoses, regardless of the body segment on which the device is worn.

What is an orthosis?
Who is involved with orthotic prescrition?
How ancient are orthoses?
What mechanical priniciples govern orthotic design?
What materials are used in orthoses?
How are orthoses constructed?

 

TERMINOLOGY

Foot Orthotic (FO - Shoe Inserts)

Orthosis derives from the Greek expression “making straight.” An orthosis is an orthopedic appliance used to support, align, prevent, or correct deformities of a body part of the body.

Orhesis is synonymous with orthosis. A Splint is temporary orthosis. Some of the other common Terms that denote particular orthotic designs include sling, corset, pressure garment, and cuff. Surgical appliance is the board category that includes orthoses.

Orthotic is the adjective relating to orthoses, but it is sometimes used to designate a foot orthosis. An orthosist is the healthcare practitioner who designs, fabricates, and fits patients with orthoses. Orthotics refers to the field of knowledge relating to orthoses and their use.

HISTORICAL BACKGROUND

To understand the evolution of contemporary orthoses and to appreciate differences in orthotic practice, it is useful to highlight the history of orthoses. Additionally, some current orthoses are known by the name of the developer.

For Example: Paintings from the Fifth Egyptian dynasty, 2750 to 2625 BCE (Before Common Era) depict men wearing orthoses. Various braces and splints for the treatment of fractures, dislocations, and congential deformities have been attributed to Hippocrates, the Greek physican of the 4th century BCE. Galen, who subscribed to hippocratic teachings, wrote about scoliosis orthoses in the 2nd Century CE (Common Era). Amroise Pare, the father of modern surgery, “who first published his works in 1575, made a perforated steel orthosis for the correction of scoliosis and ankle-foot orthosis to correct club foot, among many other orthoses and prostheses.

Hieronymus Fabricius of Hilden, Germany described in 1607 an orthosis to reduce contractures caused by burns. Nicholas Andry, professor of medicine at the University of Paris, wrote in 1740 about correction and prevention of deformities in children, including trunck orthoses. He coined the word “orthopedic, “meaning straight child. Antonio Scarpa, a Venetian surgeon, published an 1803 treatise on congenital foot determines illustrating several club foot orthoses. The English orthopedist Hugh Owen Thomas designed lower-limb orthoses for weight – bearing, which apperared in his 1875 publication. His contemporary, James Knight, an American surgeon, designed a lumbosacral orthosis that bears his name. The German technican Friederich von Hessing advanced the art of brace-making in the latter part of the 19th Century.

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