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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

Lower Extremity Casting and Splinting

Margo Prim Haynes, PT, DPT, MA, PCS

Mary Rose Franjoine PT, DPT, MS, PCS

common foot deformities
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

serial casts
Serial Casts

MP Haynes, MR Franjoine

slide4

Bivalved Cast

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

Serial Casting …. Purpose

MP Haynes, MR Franjoine

serial casting purpose6
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

serial casting process
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

often see
Often see…

Serial Casting used in combination with Botox Injections

MP Haynes, MR Franjoine

botox injections
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

casting and botox
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

botox a
Botox: A

Botox blocks the nerve from

releasing acetylcholine

www.botox-info.com

MP Haynes, MR Franjoine

orthotics splints
Orthotics / Splints

MP Haynes, MR Franjoine

purpose of splints
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

stabilizing foot splints
Stabilizing Foot Splints
  • frontal plane: eversion/inversion

Purpose …. Provides control

Foot plates, heel cups, hot dogs

MP Haynes, MR Franjoine

slide15

Stabilizing Foot Splints

MP Haynes, MR Franjoine

stabilizing foot splints orthotics
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

slide17

Dynamic Ankle Foot Splints

MP Haynes, MR Franjoine

dynamic ankle foot splints
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

dynamic ankle foot splints orthotics
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

dynamic ankle foot splints20
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

solid ankle splints
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

slide22

Anti-Crouch Splint

MP Haynes, MR Franjoine

anti crouch foot splints
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

anti crouch foot splints24
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

bibliography
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

margo prim haynes pt dpt ma pcs mary rose franjoine pt dpt ms pcs jan mcelroy pt ms pcs 2009
Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS

Jan McElroy, PT, MS, PCS

2009