Prosthetics & Orthotics: Exam I Latest
Updated Study Guide.
Etiology of Amputations -
1. Vascular Disease (Diabetes & PAOD most common)
2. Infections
3. Trauma
4. Cancer
5. Congenital
Toe Amputation -
*Distal to MTP joint*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
Transmetatarsal Amputation -
Aka "partial foot" amputation; *proximal to MT heads & through MT shafts.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker bottom shoe
- Lift in shoes to allow heel-to-ground contact
ROM:
- Maintain DF ROM & prevent PF contracture
ISSUES:
- Healing of suture lines
,Myodesis vs. Myoplasty -
*Myodesis* - surgical attachment of tendon/muscle to bone.
*Myoplasty* - surgical attachment of tendon/muscle to other soft tissue.
Lisfranc Amputation -
Disarticulation of mid foot with *removal of metatarsals with preservation of tarsals*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker-bottom shoe
- Cushioned heal (promotes plantarflexion)
ISSUE:
- Disruption of fibularis brevis onto the base of the 5th metatarsal leads to varus deformity
Chopart Amputation -
Disarticulation of talonavicular and calcaneocuboid joints with *preservation of talus & calcaneus*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker-bottom shoe
- Cushioned heal (promotes plantarflexion)
ISSUES:
- *Equinovarus foot deformity* resulting from unopposed tendon action
Syme Amputation -
,Disarticulation of ankle joint with *removal of talus & calcaneus* from mortice (heel-pad is
preserved).
PROSTHETIC:
(1st level requiring prosthetic)
1. *SACH Foot* - solid ankle cushy heel that creates eccentric PF movement of the foot
2. *PTB Shelf* - patella tendon bearing adds weight to residual limb
Boyd Amputation -
amputation at the level of the ankle with preservation of the calcaneus and heel pad and
consequent fixation of the calcaneus to the tibia.
Allows for complete weight bearing and provides both stabilization of the heel pad and suspension
for a prosthesis.
Transtibial Amputation (surgery) -
*Below Knee Amputation (BKA)*.
SURGERY:
- Uses a *posterior flap* involving wrapping the residual heads of the gastrocnemius around &
nurturing anteriorly
- Amputation stays *above distal 1/4* of the residual limb due to skin irritations that occur in the
think skin of the distal 1/4 and below
Initial PT for Transtibial Amputation -
maintain mobility at and around suture line (mobilize ON suture line once it's healed)
ROM to prevent knee flexion contracture: pain will lead pt to stay in flexion, promote extension!
Knee Disarticulation (population, pros, cons) -
Amputation done between bone surfaces, rather than by cutting through bone.
POPULATION:
1. Children (to avoid cutting through growth plates)
2. Traumatic amputees
, 3. BKA with knee flexion contracture or non-functional knee
PROS:
- Thigh muscles tend to be stronger because they are cut at their distal tendons rather than muscle
bellies
CONS:
- Hard to get good prosthetic fitting due to *bulbous end*
- Asymmetrical prosthetic knee unit is lower than the anatomical knee (poor alignment)
Transfemoral Amputation -
*Above Knee Amputation (AKA)*.
SURGERY:
- The longer the residual limb, the better (no shorter than the greater trochanter) for ADductor
attachments
- However, longer residual limbs are NOT as good for myodesis (less padding due to intact muscle
belly) & prosthetic fitting
- Uses *long anterior flap* with suture are the bottom of the residual limb
What type of contractures are common in AKAs? -
Hip flexion & ABduction contractures.
Transfemoral Amputation (AKA) Kinematics -
hip ext to create knee ext
hip flex to create knee flex
LONGER LEVER important in controlling prosthetic knee
and less disruptive to your COG (the more mass that's lost, the more COG disruption)
more surface area = better balance, better for avoiding pressure sores
Transfemoral Amputation (AKA) Early Issues -
ROM: hip-flexion contractures common —> have them lay on their stomach!
Updated Study Guide.
Etiology of Amputations -
1. Vascular Disease (Diabetes & PAOD most common)
2. Infections
3. Trauma
4. Cancer
5. Congenital
Toe Amputation -
*Distal to MTP joint*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
Transmetatarsal Amputation -
Aka "partial foot" amputation; *proximal to MT heads & through MT shafts.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker bottom shoe
- Lift in shoes to allow heel-to-ground contact
ROM:
- Maintain DF ROM & prevent PF contracture
ISSUES:
- Healing of suture lines
,Myodesis vs. Myoplasty -
*Myodesis* - surgical attachment of tendon/muscle to bone.
*Myoplasty* - surgical attachment of tendon/muscle to other soft tissue.
Lisfranc Amputation -
Disarticulation of mid foot with *removal of metatarsals with preservation of tarsals*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker-bottom shoe
- Cushioned heal (promotes plantarflexion)
ISSUE:
- Disruption of fibularis brevis onto the base of the 5th metatarsal leads to varus deformity
Chopart Amputation -
Disarticulation of talonavicular and calcaneocuboid joints with *preservation of talus & calcaneus*.
ORTHOTIC:
- NONE
- Shoe filler for dead space
- Rocker-bottom shoe
- Cushioned heal (promotes plantarflexion)
ISSUES:
- *Equinovarus foot deformity* resulting from unopposed tendon action
Syme Amputation -
,Disarticulation of ankle joint with *removal of talus & calcaneus* from mortice (heel-pad is
preserved).
PROSTHETIC:
(1st level requiring prosthetic)
1. *SACH Foot* - solid ankle cushy heel that creates eccentric PF movement of the foot
2. *PTB Shelf* - patella tendon bearing adds weight to residual limb
Boyd Amputation -
amputation at the level of the ankle with preservation of the calcaneus and heel pad and
consequent fixation of the calcaneus to the tibia.
Allows for complete weight bearing and provides both stabilization of the heel pad and suspension
for a prosthesis.
Transtibial Amputation (surgery) -
*Below Knee Amputation (BKA)*.
SURGERY:
- Uses a *posterior flap* involving wrapping the residual heads of the gastrocnemius around &
nurturing anteriorly
- Amputation stays *above distal 1/4* of the residual limb due to skin irritations that occur in the
think skin of the distal 1/4 and below
Initial PT for Transtibial Amputation -
maintain mobility at and around suture line (mobilize ON suture line once it's healed)
ROM to prevent knee flexion contracture: pain will lead pt to stay in flexion, promote extension!
Knee Disarticulation (population, pros, cons) -
Amputation done between bone surfaces, rather than by cutting through bone.
POPULATION:
1. Children (to avoid cutting through growth plates)
2. Traumatic amputees
, 3. BKA with knee flexion contracture or non-functional knee
PROS:
- Thigh muscles tend to be stronger because they are cut at their distal tendons rather than muscle
bellies
CONS:
- Hard to get good prosthetic fitting due to *bulbous end*
- Asymmetrical prosthetic knee unit is lower than the anatomical knee (poor alignment)
Transfemoral Amputation -
*Above Knee Amputation (AKA)*.
SURGERY:
- The longer the residual limb, the better (no shorter than the greater trochanter) for ADductor
attachments
- However, longer residual limbs are NOT as good for myodesis (less padding due to intact muscle
belly) & prosthetic fitting
- Uses *long anterior flap* with suture are the bottom of the residual limb
What type of contractures are common in AKAs? -
Hip flexion & ABduction contractures.
Transfemoral Amputation (AKA) Kinematics -
hip ext to create knee ext
hip flex to create knee flex
LONGER LEVER important in controlling prosthetic knee
and less disruptive to your COG (the more mass that's lost, the more COG disruption)
more surface area = better balance, better for avoiding pressure sores
Transfemoral Amputation (AKA) Early Issues -
ROM: hip-flexion contractures common —> have them lay on their stomach!
