Kasturba medical college

Dept of orthopaedics

Floor Reaction Orthosis

Moderator:Prof .B. Seetharam Rao
Dr.K.R Kamath

Presenter:Dr.Gururaj
Date:28:07:09

ORTHOSIS: A device or external appliance which promote

limb or joint function

FLOOR REACTION ORTHOSIS:Custom fabricated, moulded

plastic device that supports the ankle and foot area of the body and extends
from below the knee down to and including the foot.
It was described by Saltiel for the use of weak quadriceps or plantar flexors
in 1969.

PRINCIPLE: Newton's third law

Action -Body weight acting on orthosis and ground
Reaction- foot & orthosis absorb ground reaction forces which enter the
FRO holds the ankle is slight equinus enough to prevent
the heel from touching the ground

WORKING PRINCIPLE: As the body weight brings the heel downwards

theres a turning point at the orthosis joint which will press the knee back;
preventing knee from flexing during stance phase
-Allow knee to flex during swing phase
-Foot absorbs ground reaction forces which keeps the knee & ankle straight
-Prevents knee from buckling during stance phase

USES:
1)Spina bifida
2)cerebral palsy
3)post polio paralysis
Quadriceps paralysis (sagittal plane instability)
Quadriceps paralysis is one of the most common problems encountered in polio that
requires bracing. The paralysis leaves the knee unstable with a tendency to collapse into
flexion. Complete paralysis of the muscle is not necessary to render the knee unstable.
Patients with a quadriceps power of MRC Grade III may also experience instability of
the knee especially while walking on a slope or on uneven ground. Such patients also
may need bracing.
The orthosis must
a. prevent the knee from flexing during the stance phase of gait
b. permit flexion of the knee during the swing phase
The floor reaction orthosis (FRO) which holds the ankle in a few degrees of
plantarflexion. This ensures that the initial contact with the ground is made by the
forefoot rather than the heel. This causes the body-weight line to pass in front of the axis
of the knee joint, thereby stabilising it. The same mechanism is involved when a mild
equinus contracture stabilises a paralysed knee effectively without the patient having to
resort to the hand-on-thigh gait. In addition to holding the foot in plantarflexion, the
upper part of the orthosis exerts a backward pressure in front of the knee and the
suprapatellar region, forcing it into extension. This design of orthosis (which is a
modification of the Salteil brace and advocated by Professor Sethi) has been found to be
extremely effective. The FRO is much lighter than a conventional KAFO and it has the
advantage that the knee is not kept locked.
There are however, a few situations where the floor reaction orthosis cannot be used viz.:
1. In patients with a flexion deformity of the knee the brace will not stabilise the knee
if there is a flexion deformity
2. In patients with a severe degree of recurvatum the orthosis tends to increase any preexisting genu recurvatum

3. In patients with bilateral quadriceps paralysis patients cannot cope with bilateral
FROs and here at least one side would need a knee-ankle-foot orthosis.

genu recurvatum
The Lehneis modification of the FRO is an excellent orthosis for controlling recurvatum.
Here the posterior trim line of the orthosis is raised up to the popliteal fossa so as to give
good counter-pressure. The Lehneis FRO can control both recurvatum and the quadriceps
paralysis and hence is one orthosis that can effectively deal with instability of the knee in two
directions while retaining free knee flexion during the swing phase of gait.

4)Flexion conracture of knee

5)Myelomeningocele
Patients with myelomeningocele tend to stand in a crouched position
(flexed hips, knees, and ankles) due to lower-extremity weakness.
Compound this problem with knee-flexion contractures, and the patient's
ability to achieve an efficient gait pattern is severely decreased. The loss
of knee extension due to the contractures result in a shortening of step
length seen at terminal swing. The inability to appropriately extend the
knee in mid and terminal stance increases the force on the quadriceps. In
this crouched position, the ground-reaction forces generally act posterior
to the knee center, encouraging further knee flexion. A floor-reaction
ankle-foot orthosis (FRAFO) may be prescribed with the goal of shifting the
ground-reaction force more anterior to the knee center, providing a kneeextension moment and increasing knee extension in stance

Advantages over other orthosis:

-Light weight -300 gms
-Swing phase is not laboured
-Floor reaction prevents knee from buckling
-2 wks of training is enough to walk

-Self locking joints

-Ground clearance easier
-Stabilize knee, leg, ankle, foot
-Cosmetically better
-Stabilises knee without muscle action.
Designs:
One piece encloses the back of lower calf the skin &
bottom of foot
Two piece:- same as one piece but has a removable anterior (front) panel
Rear opening encloses the front of leg & top of foot may be articulated
References:
Paediatric orthopaedic society of india news letter 2000.
Benjamin Joseph and s. Natarajan ,poliomyelitis, oxford text book of
orthopaedics 1522-1523.
Atlas of lower limb orthotic practice ,ankle foot orthosis 47-51.
Harrington ED, Lin RS, Gage JR. Use of anterior floor reaction orthosis
in patients with cerebral palsy. Orthotics and Prosthetics, 1984;4:34-42