Relevance of Gait-Related Posture Casting in Lower-Limb Orthotics

Many of us have had the pleasure of witnessing the rapid evolution of O&P through the years, but despite the technological advances, many aspects of the field are still grounded in traditional fundamental elements. Some of these tools, principles, and habits have been passed down through generations.

We learned to fabricate metal orthoses by taking measurements and using specific anatomical landmarks with the patient lying down and tracing the leg over paper. This is a fascinating technique for creating a three-dimensional device that transfers the outline of the leg to the reverse side to make the contour of the uprights, bands, stirrup, and the location of the mechanical axis of the ankle joint. One of the landmarks used as a reference for the anatomical joint was the apex of the medial malleolus. But why the medial malleolus? In 2015, I was asked this question while visiting Fior & Gentz, a company in Germany that developed a novel orthotic component, and attending a presentation as the orthotics instructor in the master’s program in prosthetics and orthotics at the University of Pittsburgh. I repeated that the medial malleolus was the landmark for the ankle’s anatomical joint, but my answer was based on a habit acquired over the years, and lacked solid scientific evidence. I didn’t know why exactly. Fabricating a metal AFO or KAFO requires strict adherence to protocols and steps to ensure the closest anatomical fitting. The primary goal was to design a device that is as aligned as closely as possible with the three planes—a significant challenge, considering the only elements available were a trace and measurements without a model.