orthotic therapy for malalignment · 2018. 5. 4. · varus wedge. calcaneocuoid arch. valgus wedge...
TRANSCRIPT
![Page 1: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/1.jpg)
Orthotic Therapy for Malalignment
아이레그 플러스 의원
송동호
![Page 2: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/2.jpg)
Transverse plane rotational deformity(In-Toeing) 1. Femoral internal position & Femoral internal torsion(Femur) 2. Interna Tibial Torsion& Internal Tibial position(Tibia) 3. Metatarsus Adductus(Foot)
Frontal Plane angular deformity 1. Genu valum,varum 2. Blount’s Disease 3. Lateral Tibial Translation 4. Pes planus
Sagittal Plane 1. Genu Recurvatum
Pelvic Malalignment
Malalignment of Lower Extremity
![Page 3: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/3.jpg)
In-Toeing
1. Femoral internal position & Femoral internal torsion(Femur)
2. Interna Tibial Torsion& Internal Tibial position(Tibia)
3. Metatarsus Adductus(Foot)
Transverse plane rotational deformity(In- toeing)
![Page 4: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/4.jpg)
Clinical impression of Hip ROM
![Page 5: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/5.jpg)
Posture correction Exercise
Stretching Pubofemoral ligament Ileofemoral ligament Ligament teres
Strenthening of external rotators
TTLL Gaitplate in foot orthosis
Treatment of Femoral internal position
![Page 6: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/6.jpg)
Treatment of Femoral internal position
Before After 8Mo.
![Page 7: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/7.jpg)
Internal Tibial Torsion (Internal tibial position)
정상경골 경골내염전
![Page 8: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/8.jpg)
Internal Tibial Torsion (Internal tibial position)
![Page 9: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/9.jpg)
Denis Browne splint
TCR(Tibial Counter Rotator)
Treatment
![Page 10: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/10.jpg)
Fig. 3. An Average Increasing Pattern of
Transmalleolar Angle before and after Treatment (274하지)
-20
-15
-10
-5
0
5
10
15
0 3 6 9 12
<2yr 2-<3yr 3-<4yr 4-<5yr5-<6yr 6-<9yr 9-<12yr Total
경비골 역회전교정장치(TCR)의 치료 효과 (송동호, 2007)
![Page 11: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/11.jpg)
2013-07-13 152.7cm
2014-03-01 155.9cm
치료기간 약 7개월간 3.2cm 성장
만 13세 여아 경골내염전 치료 전후에 따른 키 성장
![Page 12: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/12.jpg)
경골 내 염전의 치료 전 과 후
![Page 13: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/13.jpg)
발을 안으로 회전시킨 상태로 엉덩이를 깔고 앉을 경우 중족골 내전이 후천적으로 발생될 수 있다.
중족골 내전을 조장하는 요인
![Page 14: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/14.jpg)
Foot orthosis for metatarsus adductus
![Page 15: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/15.jpg)
1. Genu valum & varum
2. Blount’s Disease, Rickets, Skeletal Dysplasia
3. Lateral Tibial Translation
4. Pes planus
Malalignment in Frontal Plane
![Page 16: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/16.jpg)
Developmental changes of knee in frontal plane
![Page 17: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/17.jpg)
![Page 18: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/18.jpg)
Grading system by Morley(1957)
Grade 1 : intermalleaolar distance < 2.5cm
Grade 2 : 2.5 - 5cm
Grade 3 : 5.0 – 7.5cm
Grade 4 : > 7.5cm
Genu Valgum
![Page 19: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/19.jpg)
![Page 20: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/20.jpg)
6세 이후
IMD가 grade 4이상(8cm이상)
Tibiofemoral angle > 10-15°
Correction of Genu Valgum
![Page 21: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/21.jpg)
Physiologically normal genu varum
Often exacebated by internal femoral or tibial torsion
or position
Pathologic Genu Varum
Rickets,
Blount’s disease,
asymmetric epiphyseal development
Genu Varum
![Page 22: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/22.jpg)
Blount’s Disease
정상경골 블런트씨병
![Page 23: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/23.jpg)
Blount’s Disease 교정치료
치료 전 2011.11.08
치료 시작 2012.04.09
치료 후 2013.11.05
![Page 24: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/24.jpg)
Rickets 환아의 교정 전후 (Ⅲ)
생후5년3개월에 치료시작 (06년 10월)
치료 1년 8개월후 (08년 6월)
![Page 25: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/25.jpg)
Pathologic Genu varum
![Page 26: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/26.jpg)
Lateral Tibial Translation
정 상 LTT
![Page 27: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/27.jpg)
LTT 교정 전후
![Page 28: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/28.jpg)
LTT 교정 전후
![Page 29: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/29.jpg)
O자형 다리의 종류들
경골내염전 경골외측변위 대퇴골 전경
경골내반 O다리
![Page 30: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/30.jpg)
유연성 평발과 경직성 평발
![Page 31: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/31.jpg)
Radiographic evaluation
Talar-first metatarsal
bisection
‘neutral’ foot : 0°
Mild : 1-15°
Severe : 15°↑
Foot orthoses
![Page 32: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/32.jpg)
Change in RCSP
1yr : ‒6
4yr : ‒3
7yr : 0
(Normal RCSP : Children’ Age‒7)
RCSP(resting calcaneal stance position)
![Page 33: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/33.jpg)
만 7세 여아의 평발 치료 사례
Blake Inverted Orthoses
![Page 34: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/34.jpg)
Pelvic Examination
Pelvic Level
![Page 35: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/35.jpg)
Pelvic Rotation
Pelvic Examination
![Page 36: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/36.jpg)
Pelvic Tilt
Pelvic Examination
김윤솔 영상
![Page 37: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/37.jpg)
STJ pronation → Talus adduction& plantar Fx.→ Tibial Internal rotation→Femoral internal rotation→Hip flexion,Pelvis의 ant. Tilting & medial rotation→lumbar lordosis
Linkage Biomechanics of Lower Extremity (STJ to Pelvis)
![Page 38: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/38.jpg)
Pelvic Rotation Rt lateral rotation
Lt lateral rotation
Orthotic Prescription for Pelvic malalignment
Upper varus Wedge Varus wedge Calcaneocuoid arch
Valgus wedge Upper valgus Wedge
![Page 39: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/39.jpg)
Orthotic Prescription for Pelvic malalignment
BFO® Fabrication
Casting Negative mold Pouring
Platforming Extension Positive mold
![Page 40: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/40.jpg)
BFO® Fabrication
Orthotic Prescription for Pelvic malalignment
Grinding Molding
Posting Micro Grinding Finish
![Page 41: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/41.jpg)
Pelvic level & Pelvic tilt
Orthotherapy for pelvic malalignment
Full length lift Heel lift
![Page 42: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/42.jpg)
Pelvic Level & pelvic Tilt
Orthotherapy for pelvic malalignment
Shoe modification
![Page 43: Orthotic Therapy for Malalignment · 2018. 5. 4. · Varus wedge. Calcaneocuoid arch. Valgus wedge Upper valgus Wedge . Orthotic Prescription for Pelvic malalignment BFO](https://reader033.vdocuments.mx/reader033/viewer/2022052521/60a4182b0d88577b255847c4/html5/thumbnails/43.jpg)
경청해주셔서 감사합니다.