Transcript Lower Extremity Casting and Splinting

Lower Extremity Casting
and Splinting
Margo Prim Haynes, PT, DPT, MA, PCS
Mary Rose Franjoine PT, DPT, MS, PCS
Common Foot Deformities
Flexible pes planus = pronation
 Functional equinus = limitations in ankle
range (dorsiflexion)
 Equino valgus= equinus and pronation
 Equino varus= equinus and supination
 Crouch deformity=weakness in
plantarflexors
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MP Haynes, MR Franjoine
Serial Casts
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MP Haynes, MR Franjoine
Bivalved Cast
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MP Haynes, MR Franjoine
Serial Casting …. Purpose
Regain & ↑ extensibility in soft tissue
surrounding casted joint
 Sarcomere reorganization
 Hypoextensibility: Tardieu
 Imbalance of agonist/antagonist
 Dysfunction in growth regulation
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MP Haynes, MR Franjoine
Serial Casting …. Purpose
Influence Equinus Position (foot):
 Gastrocnemius
 Influence Crouch Position
 Hamstrings
 Goal /Outcome:
 Range: ↑ dorsiflexion (5º-10º)
 Function: + change gait pattern
 Prepare foot for splints
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MP Haynes, MR Franjoine
Serial Casting.... Process
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Cast wear:
 Cast application process
 Below
knee for gastroc length
 Above knee for hamstring length
 Length
of cast wear
 Number of cast applications
 Indications
 Contraindications
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MP Haynes, MR Franjoine
Often see…
Serial Casting used in
combination with Botox
Injections
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MP Haynes, MR Franjoine
Botox Injections
Acts as Neuromuscular block at neuomotor junction
 Produces selective denervation to
specific muscles and nerves
 ↓ force of agonist muscle contraction
 Allows expression of antagonist
muscles
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MP Haynes, MR Franjoine
Casting and Botox
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Is Botox injections used in conjunction
with serial casting beneficial? Aiona
Yes Booth
 No Kay
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If so, what is the best combination for
use
MP Haynes, MR Franjoine
Botox: A
Botox blocks the nerve from
releasing acetylcholine
www.botox-info.com
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MP Haynes, MR Franjoine
Orthotics / Splints
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MP Haynes, MR Franjoine
Purpose of splints ….
Protection of cartilaginous, soft tissue &
weak muscle groups
 Provides optimal joint alignment with
least restrictions
 Allow maximal joint movement possible
improving stance & gait
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Function
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MP Haynes, MR Franjoine
Stabilizing Foot Splints
Purpose …. Provides control

frontal plane: eversion/inversion
Foot plates, heel cups, hot dogs
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Stabilizing Foot Splints
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MP Haynes, MR Franjoine
Stabilizing Foot Splints/Orthotics
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When use splints successfully?
Mild foot deformities
 Keep subtalus & midtarsal joints in
alignment
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Indications
 Contraindications
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Fixed contractures in peroneals, gastrocs,
posterior tibialis & functional equinus
Treatment ideas
MP Haynes, MR Franjoine
Dynamic Ankle Foot Splints
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MP Haynes, MR Franjoine
Dynamic Ankle Foot Splints
Splints:
SMO
Sure Step
DAFO # 3½, 4, 5,
DAFO 3
http://www.surestep.net/
Hinged DAFO
DAFO 3 1/2
Cascade
http://www.dafo.com/
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MP Haynes, MR Franjoine
Dynamic Ankle Foot Splints/ Orthotics
Purpose …. Provides control
 SMO:
Control in frontal plane /allows
sagital plane motion
AFO/DAFO:
Control in frontal
plane with some sagital plane
stability
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MP Haynes, MR Franjoine
Dynamic Ankle Foot Splints
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When use these splints successfully?
Manage equinus deformity
 Severe pes plantus
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Indications
Ready to ambulate
 Adequate range (10-15º
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Contraindications
Fixed contracture
 Crouch problem ??
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Treatment Ideas
MP Haynes, MR Franjoine
Solid Ankle Splints
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Purpose
Standing
 Night splinting
 Knee hyperextension
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Indications
Protect foot in standing program
 Following Surgery
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Contraindications
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Interferes with functional activities
MP Haynes, MR Franjoine
Anti-Crouch Splint
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MP Haynes, MR Franjoine
Anti-Crouch Foot Splints
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Purpose: Supports STJ & keeps
calcaneus in mid-position
Keeps tibia from falling forward over
plantigrade foot (muscle weakness /
surgery overlengthening)
 Blocks excessive ankle & knee flexion
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Anti-Crouch Foot Splints
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Indications
Excessive weakness
 Excessive dorsi flexion
 Increased knee flexion
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Contraindications
Knee hyperextension
 Contractures: hamstrings / hip flexors
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Treatment Ideas
MP Haynes, MR Franjoine
Bibliography
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Booth MY, Yates CC, Edgar TS, Bandy WD. Serial
casting vs combined intervention with botulinum toxin A
and serial casting in the treatment of spastic equines in
children. Pediatr Phys Ther. 2003;15(4):216-220
Kay RM, Rethlefsen SA, Fern-Buneo A, et al. Botulinum
Toxin as an Adjunct to Serial Casting Treatment in
Children with Cerebral Palsy. The Journal of Bone and
Joint Surgery (American). 2004;86:2377-2384
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Aiona M, Sussman MD. Treatment of spastic diplegia in
patients with cerebral palsy: Part II. Journal of Pediatric
Orthopaedics B.2004; 13(3):1-43.
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See separate Splint Orthotics Reference
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MP Haynes, MR Franjoine
Margo Prim Haynes, PT, DPT, MA, PCS
Mary Rose Franjoine, PT, DPT, MS, PCS
Jan McElroy, PT, MS, PCS
2009