Post on 18-Jan-2021
Orthotic Therapy for Malalignment
아이레그 플러스 의원
송동호
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
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)
Clinical impression of Hip ROM
Posture correction Exercise
Stretching Pubofemoral ligament Ileofemoral ligament Ligament teres
Strenthening of external rotators
TTLL Gaitplate in foot orthosis
Treatment of Femoral internal position
Treatment of Femoral internal position
Before After 8Mo.
Internal Tibial Torsion (Internal tibial position)
정상경골 경골내염전
Internal Tibial Torsion (Internal tibial position)
Denis Browne splint
TCR(Tibial Counter Rotator)
Treatment
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)
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
경골 내 염전의 치료 전 과 후
발을 안으로 회전시킨 상태로 엉덩이를 깔고 앉을 경우 중족골 내전이 후천적으로 발생될 수 있다.
중족골 내전을 조장하는 요인
Foot orthosis for metatarsus adductus
1. Genu valum & varum
2. Blount’s Disease, Rickets, Skeletal Dysplasia
3. Lateral Tibial Translation
4. Pes planus
Malalignment in Frontal Plane
Developmental changes of knee in frontal plane
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
6세 이후
IMD가 grade 4이상(8cm이상)
Tibiofemoral angle > 10-15°
Correction of Genu Valgum
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
Blount’s Disease
정상경골 블런트씨병
Blount’s Disease 교정치료
치료 전 2011.11.08
치료 시작 2012.04.09
치료 후 2013.11.05
Rickets 환아의 교정 전후 (Ⅲ)
생후5년3개월에 치료시작 (06년 10월)
치료 1년 8개월후 (08년 6월)
Pathologic Genu varum
Lateral Tibial Translation
정 상 LTT
LTT 교정 전후
LTT 교정 전후
O자형 다리의 종류들
경골내염전 경골외측변위 대퇴골 전경
경골내반 O다리
유연성 평발과 경직성 평발
Radiographic evaluation
Talar-first metatarsal
bisection
‘neutral’ foot : 0°
Mild : 1-15°
Severe : 15°↑
Foot orthoses
Change in RCSP
1yr : ‒6
4yr : ‒3
7yr : 0
(Normal RCSP : Children’ Age‒7)
RCSP(resting calcaneal stance position)
만 7세 여아의 평발 치료 사례
Blake Inverted Orthoses
Pelvic Examination
Pelvic Level
Pelvic Rotation
Pelvic Examination
Pelvic Tilt
Pelvic Examination
김윤솔 영상
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)
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
Orthotic Prescription for Pelvic malalignment
BFO® Fabrication
Casting Negative mold Pouring
Platforming Extension Positive mold
BFO® Fabrication
Orthotic Prescription for Pelvic malalignment
Grinding Molding
Posting Micro Grinding Finish
Pelvic level & Pelvic tilt
Orthotherapy for pelvic malalignment
Full length lift Heel lift
Pelvic Level & pelvic Tilt
Orthotherapy for pelvic malalignment
Shoe modification
경청해주셔서 감사합니다.