Orthotics and Prosthetics

Fig. 31. During donning of the orthosis, the patient
inserts the anterior PTB shell; final fitting and "checkout"
complete the process.
1. A length of stockinette is applied to the
patient's leg.
2. The shank section is donned by spreading
apart the patellar-tendon groove and sliding the
foot through (Fig. 31).
3. The section is applied by sliding in from the
anterior section until the section keys into the
shank section.
4. Velcro is placed around the patellar-tendon
area and the mid-point of the anterior section.
5. The patient's shoe is placed on the orthosis
and the patient is asked to stand.
6. Normal checkout for the PTB is performed
making sure weight-bearing is on the patellar tendon
and medial flare of tibia. If the orthosis is
fitted correctly, the patient should experience a
contact of the sole on the footplate of the orthosis
but no weight-bearing.
Fig. 30. Following completion of the second lamination,
the orthosis is marked for cutting away from the
cast.
FITTING
SUMMARY
Our experience with plastic patellar-tendonbearing
orthoses in ten individuals with varying
musculoskeletal defects of their lower limbs has
been presented. We concluded that several disabilities
of the lower limb can be successfully
managed with this device, affording superior
cosmesis, reduced orthotic weight, more comfort,
and improved physiological and anatomical
alignment. Disadvantages included increased
cost, frequent replacement in children, and potential
skin problems in those individuals with
impaired vascular and sensory areas.
Our preliminary 18-month experience led us to
the conclusion that the plastic patellar-tendon
orthosis is a valuable tool in the care of disabled
adults and children; we are continuing our clinical
trials and will publish a subsequent paper
outlining our experiences with neuromuscular
disabilities.