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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

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Lower Extremity Casting and Splinting

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  1. Lower Extremity Casting and Splinting Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine PT, DPT, MS, PCS

  2. 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 MP Haynes, MR Franjoine

  3. Serial Casts MP Haynes, MR Franjoine

  4. Bivalved Cast MP Haynes, MR Franjoine

  5. Regain & ↑ extensibility in soft tissue surrounding casted joint Sarcomere reorganization Hypoextensibility: Tardieu Imbalance of agonist/antagonist Dysfunction in growth regulation Serial Casting …. Purpose MP Haynes, MR Franjoine

  6. Influence Equinus Position (foot): Gastrocnemius Influence Crouch Position Hamstrings Goal /Outcome: Range: ↑ dorsiflexion (5º-10º) Function: + change gait pattern Prepare foot for splints Serial Casting …. Purpose MP Haynes, MR Franjoine

  7. Serial Casting.... Process • 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 MP Haynes, MR Franjoine

  8. Often see… Serial Casting used in combination with Botox Injections MP Haynes, MR Franjoine

  9. Botox Injections • Acts as Neuromuscular block at neuo-motor junction • Produces selective denervation to specific muscles and nerves • ↓ force of agonist muscle contraction • Allows expression of antagonist muscles MP Haynes, MR Franjoine

  10. Casting and Botox • Is Botox injections used in conjunction with serial casting beneficial? Aiona • Yes Booth • No Kay • If so, what is the best combination for use MP Haynes, MR Franjoine

  11. Botox: A Botox blocks the nerve from releasing acetylcholine www.botox-info.com MP Haynes, MR Franjoine

  12. Orthotics / Splints MP Haynes, MR Franjoine

  13. 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 Function MP Haynes, MR Franjoine

  14. Stabilizing Foot Splints • frontal plane: eversion/inversion Purpose …. Provides control Foot plates, heel cups, hot dogs MP Haynes, MR Franjoine

  15. Stabilizing Foot Splints MP Haynes, MR Franjoine

  16. Stabilizing Foot Splints/Orthotics • When use splints successfully? • Mild foot deformities • Keep subtalus & midtarsal joints in alignment • Indications • Contraindications • Fixed contractures in peroneals, gastrocs, posterior tibialis & functional equinus • Treatment ideas MP Haynes, MR Franjoine

  17. Dynamic Ankle Foot Splints MP Haynes, MR Franjoine

  18. Dynamic Ankle Foot Splints SMO Splints: Sure Step DAFO # 3½, 4, 5, http://www.surestep.net/ DAFO 3 Hinged DAFO DAFO 3 1/2 Cascade http://www.dafo.com/ MP Haynes, MR Franjoine

  19. Dynamic Ankle Foot Splints/ Orthotics • SMO: Control in frontal plane /allows sagital plane motion Purpose …. Provides control • AFO/DAFO: Control in frontal plane with some sagital plane stability MP Haynes, MR Franjoine

  20. Dynamic Ankle Foot Splints • When use these splints successfully? • Manage equinus deformity • Severe pes plantus • Indications • Ready to ambulate • Adequate range (10-15º • Contraindications • Fixed contracture • Crouch problem ?? • Treatment Ideas MP Haynes, MR Franjoine

  21. Solid Ankle Splints • Purpose • Standing • Night splinting • Knee hyperextension • Indications • Protect foot in standing program • Following Surgery • Contraindications • Interferes with functional activities MP Haynes, MR Franjoine

  22. Anti-Crouch Splint MP Haynes, MR Franjoine

  23. Anti-Crouch Foot Splints • 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 MP Haynes, MR Franjoine

  24. Anti-Crouch Foot Splints • Indications • Excessive weakness • Excessive dorsi flexion • Increased knee flexion • Contraindications • Knee hyperextension • Contractures: hamstrings / hip flexors • Treatment Ideas MP Haynes, MR Franjoine

  25. Bibliography • 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 • 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. • See separate Splint Orthotics Reference MP Haynes, MR Franjoine

  26. Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS Jan McElroy, PT, MS, PCS 2009

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