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.