What is the first orthotic device that can be prescribed for Robert?
The first orthotic device that can be prescribed to Robert is a custom-made knee- ankle- foot orthosis (KAFO). The material used is metal to ensure that it is rigid and stiff to counteract the moments produced by the body weight. In order to maintain stability in the case of weakness of the quadriceps, the KAFO is accompanied by an offset knee joint, as it positions the anatomical axis anterior to the mechanical axis. Thus, it allows for a stable knee position by maximising the extension lever-arm during mid-stance. Also, 10 to 15 degrees of hyperextension is built in to ensure more stability. The patient retains the ability to flex their knee during the swing and avoids the position of deformity or pain.
Nevertheless, the patient completely refuses to obtain a device that may have to come above his knee, hence taking the patient’s concerns in consideration an ankle-foot orthosis (AFO) can be prescribed. The details of the device are as follows. Initially, the cast is taken with consideration to the gastrocnemius length, and as a plantigrade position can be achieved at the ankle when the knee is flexed and extended, the desired casting angle will be 90 degrees. Secondly, a ground reaction AFO will be prescribed as it is considered to be the best alternative to a KAFO design for individuals with the weakness of the quadriceps, as stated by.