Floor reaction orthosis

Dr Jipin Gopi
JR
Dept of Orthopaedics
Objectives

Definition
Principle
Indications
Advantages,
Disadvantages
Limitations

Definition
An externally applied device used to
modify the structural
or functional
characteristics of the neuromusculo-skeletal system.

An apparatus used to
support, align, prevent, or
correct deformities or
to improve the function of
movable parts of the body
Floor Reaction Orthosis
Custom Made Orthosis

Made up of
1. light weight Poly Propylene or
2. Carbon fibre reinforced PolyPropylene

Used in Quadriceps paralysis

Synonyms
1. Floor reaction orthosis ( FRO)
2. Floor reaction ankle foot orthosis (FR AFO)

3. Ground reaction orthosis
4. Ground reaction force ankle foot orthosis
(GRF AFO)

Components
1. Full toe base (foot) plate in equinus with
solid ankle

2. Uprights

3. Anterior/Pre tibial shell / knee piece
Combination of the three components allow
the
plantarflexion-knee extension couple (PF/KE) to
occur, causing a
knee-extension moment

Designs
One piece:
encloses the back of the lower calf,
the shin, and
bottom of the foot

Design
Two piece:
same as the one piece but
has a removable anterior (front) panel

Rear-opening:
encloses the front of the leg and
top of the foot.
May be articulated

SM FRO


Quadriceps - Stance
Early stance
Guides knee into flexion by eccentric
contraction (controls unlocking of the knee)


Buckling of knee
Quadriceps gait

Patient with paralyzed
quadriceps,

stance phase causes initial
contact at heel ....

the weight line to pass posterior
to the knee axis...

knee buckling.

Principle
Ankle held in slight equinus
(5-8deg) in the design

The initial floor contact
occurs at the forefoot rather
than heel



The axis of the weight bearing
from COG of body to
the floor contact point will pass
in front of knee joint


During mid stance phase ,
the body weight brings the heel
downwards,
there is an extension moment of
the prepatellar band
pushing the knee backwards,
prevent buckling

PRINCIPLE
Newtons third law

Here wt of the the body
over the orthosis and
over the ground is action

Foot & orthosis absorb ground reaction forces
which
enter the body and
keep the foot & knee straight.

Indications
1. Post Polio residual paralysis
2. Spinal cord injury
3. Meningomyelocele
4. Cerebral Palsy


Quadriceps weakness

Poliomyelitis
Common causes of disability in India

Quadriceps is commonly affected

Walks with "hand to knee" gait

Wearing schedule
1st day:
wear for one hour,
check skin
2nd day:
wear two hours,
check skin
3rd day onwards:
increase by one hour daily.

If red marks dont disappear by 30 mts, contact
orthotist.

Weak Quadriceps

KAFO with locked knee and
limited motion ankle joint

Walk with rigid knee and
unphysiologic, energy inefficient gait

Advantages
Light Weight-300gms

Swing Phase is not labored as with a KAFO
with locked knee

Two weeks training, easy to use, less
complicated

Advantages
FRO works as a KAFO without a
mechanical knee joint

Patient can utilize his anatomical knee joint
without buckling

Cosmeticaly acceptible-
can be worn under Shoe Compliance

Disadvantages
It must be correct fitting,
getting in close contact with the skin and bony
prominences,
Skin problems

difficulty in making - Custom Made Orthosis


Limitations
Hip and knee FFD > 10 deg
correct fixed deformities prior to bracing for
the coupling principle to be effective.

Quadriceps power > 2+/3-

Flail knee or ankle

Angular deformities
foot, ankle, tibia, trunk imbalance

Conclusion
Orthosis for quadriceps weakness

Plantar flexion knee extension couple" principle

PPRP limb is commonest indication

SM FRO is the commonly used

Flexion contractures / flail joints are
contraindication

JAIPUR FOOT
INTRODUCTION
The JAIPUR FOOT is an original research
product of Jaipur INDIA


The foot was developed in response to specific
sociocultural needs of Indian Amputees
(of squatting,
cross-legged sitting and
barefoot walking)
EVOLUTION
The development of the Jaipur prosthetic foot in
the early 1970s

JAIPUR centre started providing
conventional lower limb prostheses.


Rejection rates HIGH

ANALYSIS OF REJECTION
The reasons were not technical OR
biomechanical

BUT
Sociocultural

The team at Jaipur centre
realized that besides
functional aspects,
socioeconomic and cultural
demands of amputees needed
to be addressed.

CONCEPT & DESIGN
Look like Human foot
Permit squatting
Adapt to uneven terrain
Should be waterproof

Permit barefoot walking
Permit use within footwear
Should be affordable
Should be made of locally available materials
Professor P. K. Sethis first efforts were to
modify the SACH foot
Its solid wooden keel did not allow any movement
therefore a wedge was removed in order to allow
dorsiflexion


This produced limited movement and
resulted in the removal of
increasingly larger wedges until almost
nothing was left of the proximal section of the
keel.

At this stage he abandoned the SACH
foot and introduced a completely new design

This prosthesis, which he named the Jaipur
Foot, consisted of three separate blocks
One of micro-cellular rubber for the hind foot
other two of laminated wood for
the ankle and forefoot,

wrapped by an inner layer of tyre cord rubber
and an outer layer of skin-coloured soft rubber,
with tough rubber for the sole
The foot was then vulcanised in an
aluminium die to look life-like.

The forefoot wooden block was later
replaced with a
rubber block, similar to that of the hindfoot in order
to
provide pronation and supination, and
to allow stability on uneven ground

The foot was attached to an
aluminium socket covered with stockinette,
glued, water-proofed and
individually painted in the appropriate skin colour

The large sponge rubber block at the hind
foot acted as a universal joint, capable of providing
multidirectional movements including
dorsi- and plantar flexion, inversion, eversion,
adduction and abduction.


The foot could rotate on the leg

This allowed the amputee not
only to squat and sit cross-legged, but also to
walk comfortably on uneven terrain, since the
foot could adapt easily to the underlying surface
It consists of three structural blocks simulating
the anatomy of a normal foot
1. forefoot block
2. heel block
3. ankle block.
The forefoot and heel blocks are made of
sponge rubber while
the ankle block is made of
light wood.
These three blocks along with the toes are
bound together by tyre cord and
encapsulated in skin colored cushion
compound.


This structure is then vulcanized at
120 : under 23 psi for 30 minutes.

RANGE OF MOTION
Dorsiflexion : 20 35
Heel compression : 0.8mm to 2.8 mm.
Pronation 26 29
Supination : 15 22
Axial Internal Rotation : 10 12
Axial External Rotation : 4 8
Advantages
it does not require any shoe,
i.e., amputees can walk barefoot.

It is made of waterproof material enabling amputees
to walk in wet and muddy fields.

permits enough dorsiflexion and o
ther movements necessary to adapt itself while walking on
uneven surfaces.

most cost-effective foot-pieces available in the world
it is light in weight

Acceptance in the developed world
Unacceptable

Craftsmanship & fitting poor in 86%
patient acceptance 94%

How illogical /contradictory !
Research has been ongoing to improve on the
design.

Some aspects that still remain to be addressed
are
1. Jaipur foot is not available in nternational standards
2. Jaipur foot is not compatible with designs of Western
limbs.

3. Jaipur foot is heavier than the set international
4. Standards.

5. Jaipur foot still does not come with quality
assuranceassurance certification

Future course
sizing the jaipur foot to meet international standards

designing the jaipur foot to be compatible with the
western prosthetic designs.

material modifications to reduce weight and increase
durability

standardizing testing equipment for quality assurance