lower extremity casting and splinting margo prim haynes, pt, dpt, ma, pcs mary rose franjoine pt,...
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Lower Extremity Casting and Splinting
Margo Prim Haynes, PT, DPT, MA, PCS
Mary Rose Franjoine PT, DPT, MS, PCS
2009 MP Haynes, MR Franjoine
Common Foot Deformities
Flexible pes planus = pronationFunctional equinus = limitations in ankle
range (dorsiflexion)Equino valgus= equinus and pronationEquino varus= equinus and supinationCrouch deformity=weakness in
plantarflexors
2009 MP Haynes, MR Franjoine
Serial Casting …. Purpose
Regain & ↑ extensibility in soft tissue surrounding casted joint
Sarcomere reorganizationHypoextensibility: Tardieu
Imbalance of agonist/antagonistDysfunction in growth regulation
2009 MP Haynes, MR Franjoine
Serial Casting …. Purpose
Influence Equinus Position (foot):Gastrocnemius
Influence Crouch PositionHamstrings
Goal /Outcome:Range: ↑ dorsiflexion (5º-10º) Function: + change gait patternPrepare foot for splints
2009 MP Haynes, MR Franjoine
Serial Casting.... Process
Cast wear: Cast application process
Below knee for gastroc lengthAbove knee for hamstring length
Length of cast wearNumber of cast applications
IndicationsContraindications
2009 MP Haynes, MR Franjoine
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
2009 MP Haynes, MR Franjoine
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
2009 MP Haynes, MR Franjoine
Botox: A
Botox blocks the nerve from
releasing acetylcholine
www.botox-info.com
2009 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
Function
2009 MP Haynes, MR Franjoine
Stabilizing Foot Splints
frontal plane: eversion/inversion
Purpose …. Provides control
Foot plates, heel cups, hot dogs
2009 MP Haynes, MR Franjoine
Stabilizing Foot Splints/Orthotics
When use splints successfully?Mild foot deformities Keep subtalus & midtarsal joints in
alignmentIndicationsContraindications
Fixed contractures in peroneals, gastrocs, posterior tibialis & functional equinus
Treatment ideas
2009 MP Haynes, MR Franjoine
Dynamic Ankle Foot Splints
Splints:
DAFO # 3½, 4, 5, DAFO 3
DAFO 3 1/2
Hinged DAFO
Cascade http://www.dafo.com/
Sure Step
SMO
http://www.surestep.net/
2009 MP Haynes, MR Franjoine
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
2009 MP Haynes, MR Franjoine
Dynamic Ankle Foot SplintsWhen use these splints successfully?
Manage equinus deformity Severe pes plantus
IndicationsReady to ambulateAdequate range (10-15º
ContraindicationsFixed contractureCrouch problem ??
Treatment Ideas
2009 MP Haynes, MR Franjoine
Solid Ankle Splints
PurposeStandingNight splintingKnee hyperextension
IndicationsProtect foot in standing programFollowing Surgery
Contraindications Interferes with functional activities
2009 MP Haynes, MR Franjoine
Anti-Crouch Foot Splints
Purpose: Supports STJ & keeps calcaneus in mid-positionKeeps tibia from falling forward over
plantigrade foot (muscle weakness / surgery overlengthening)
Blocks excessive ankle & knee flexion
2009 MP Haynes, MR Franjoine
Anti-Crouch Foot Splints
IndicationsExcessive weaknessExcessive dorsi flexion Increased knee flexion
ContraindicationsKnee hyperextensionContractures: hamstrings / hip flexors
Treatment Ideas
2009 MP Haynes, MR Franjoine
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