DECEMBER 1974

Orthotics
and
Prosthetics

COPYRIGHT 1974 BY THE AMERICAN ORTHOTIC AND PROSTHETIC

ASSOCIATION, PRINTED IN THE UNITED STATES OF AMERICA,
ALL RIGHTS RESERVED

EDITOR
A. Bennett Wilson, Jr.

Orthotics
and
Prosthetics
V O L U M E 28, N O . 4

D E C E M B E R 1974

MANAGING EDITOR
Philip M . P a y n e

CONTENTS

EDITORIAL BOARD

EDITORIAL
Bert R. Titus

B e r t R. T i t u s , C . P . O .

SOME OBSERVATIONS ON UPPER-LIMB

C h a i r m a n (1974)
H . B l a i r H a n g e r , C P . (1974-75)
A l v i n L. M u i l e n b u r g ,

C . P . O . (1974-75)
S i e g f r i e d P a u l , C . P . O . (1974-76)
R o y S n e l s o n , C . P . O . (1974-75)
R o b e r t E. T o o m s , M,D. (1974)
David A.H. Roethel, M.S.

Ex Officio

PROSTHETICS A N D ORTHOTICS
David G.

Murray

EXPERIENCE WITH PLASTIC

PATELLAR-TENDON-

BEARING ORTHOSES
James

T. Demopoulos

and John E. Escften

A THERMOPLASTIC STRUCTURAL AND ALIGNMENT

SYSTEM FOR BELOW-KNEE PROSTHESES

Orthotics and Prosthetics is is

sued in March, J u n e , Sep
tember and December. Sub
scription price, payable in ad
vance, is $10.00 a year in the
U.S. and Canada. Rate else
where is $11.00 a year. Single
issues, $3.00 each. Publication
does not constitute official en
dorsement of opinions pre
sented in articles. The Journal
is the official organ of the pub
lisher, The American Orthotic
and Prosthetic Association in
collaboration with the Ameri
can Academy of Orthotists and
Prosthetists, and serves as the
U.S. organ for Interbor. All
correspondence should be ad
dressed to: Editor: Orthotics
and Prosthetics, 1444 N St.,
N . W . , Washington, D . C .
20005. Telephone, Area Code
202, 234-8400.
Orthotics and Prosthetics is
indexed by Current Con
tents/Clinical Practice.

*****
INTERBOR
(US ISSN 0030-5928)

Hans Richard

DEVELOPMENT O F A THERMOPLASTIC

BELOW-KNEE

PROSTHESIS WITH QUICK-DISCONNECT FEATURE

Charles

H.

31

Pritham

A PROPOSED N O M E N C L A T U R E FOR LIMB PROSTHETICS

Hector

23

Lehneis

37

W. Kay

A PROPOSED PROSTHETICS TERMINOLOGY

49

E. E. Harris
X-RAYS: A "FITTING T O O L " FOR T H E PROSTHETIST
James

55

L. Byers

THE PRESENT USE O F T H E UCBL FOOT ORTHOSIS

Michael J.

59

Quigley

NEW PUBLICATIONS

65

METRIC SYSTEM CONVERSION FACTORS

70

N E W 1974 A B C C E R T I F I E D P R A C T I T I O N E R S

74

Index to Advertisers
BECKER ORTHOPEDIC APPLIANCE CO.

VIII
IX, X, XI, XII

CAMP INTERNATIONAL

XIII

C. D. DENISON CO.

XXIII

IRVING DREW CORP.

FILLAUER ORTHOPEDIC

XV

FLORIDA BRACE CORP.

XVI

FREEMAN MANUFACTURING CO.

XIX

JOHNSON & JOHNSON

XX

JAMES R. KENDRICK CO.

VI

KINGSLEY MANUFACTURING CO.

XVII

KNIT-RITE

XIV

PEL SUPPLY CO.

VII

RODEN LEATHER CO.

VIII

E. J . SABEL CO.

XXI
V

SOUTHERN PROSTHETIC
SUTTON SHOE

XVIII

UNITED STATES MANUFACTURING CO.

IV

WASHINGTON PROSTHETIC SUPPLIES

XXII

Classified Advertisements

XXIV

A d v e r t i s e r s s h o w n in b o l d - f a c e t y p e a r e m e m b e r s of
The American Orthotic & Prosthetic Association.

II

THE AMERICAN ORTHOTIC AND PROSTHETIC ASSOCIATION

OFFICERS
P r e s i d e n t R a l p h R. ( R o n n e y ) S n e l l ,
CP., Memphis, Tennessee
P r e s i d e n t - E l e c t H o w a r d R. T h r a n h a r d t ,
Secretary-TreasurerDaniel G. Rowe,
C P . , Atlanta, G e o r g i a
C.P.O., St. P a u l , M i n n e s o t a
V i c e - P r e s i d e n t B e n B. M o s s ,
I m m e d i a t e - P a s t P r e s i d e n t R o b e r t V. B u s h ,
W i n t e r Park, F l o r i d a
C.P.O., A l b u q u e r q u e , New M e x i c o

REGIONAL DIRECTORS
Region IMichael M. Amrich, C P .
Needham, Massachusetts
R e g i o n IIKurt M a r s c h a l l , C P .
S y r a c u s e , New York
R e g i o n IIIJ. D o n a l d C o g g i n s , C P .
Berwyn, Pennsylvania
Region IVWilliam H e a t h Harvey, C P . O .
Columbus, Georgia
R e g i o n V E u g e n e Filippis, C P . O .
Detroit, M i c h i g a n
Region VIStephen Kramer, C P . O .
C h i c a g o , Illinois

R e g i o n VIIRobert A . B r o w n , C P .
Minneapolis, Minnesota
R e g i o n VIIIGeorge E. S n e l l , C P . O .
Little R o c k , A r k a n s a s
R e g i o n I X D o n a l d F. C o l w e l l , C P .
Downey, California
Region XWalter M . Joslin, C P . O .
A l b u q u e r q u e , New M e x i c o
R e g i o n X I L o r e n R. C e d e r , C P . O .
Tacoma, Washington

THE AMERICAN BOARD FOR CERTIFICATION IN

ORTHOTICS AND PROSTHETICS, INC.
OFFICERS
P r e s i d e n t W i l l i a m B. S m i t h , C O .
K a n s a s City, M i s s o u r i
President-ElectWade Barghausen, C P .
S e c r e t a r y - T r e a s u r e r C h a r l e s D a n k m e y e r , Jr., C P . O .
Columbus, Ohio
Baltimore, Maryland
V i c e - P r e s i d e n t L o r e n R. C e d e r , C P . O .
I m m e d i a t e - P a s t P r e s i d e n t R o b e r t F. H a y e s , C P .
Tacoma, Washington
W. S p r i n g f i e l d , M a s s a c h u s e t t s

DIRECTORS
F r e d L. H a m p t o n , C P .
Miami, F l o r i d a
P a u l R. M e y e r , Jr., M.[
C h i c a g o , Illinois
J o s e p h H. Z e t t l , C P .
Seattle, Washington

N e w t o n C . M c C u l l o u g h , I I I , M.D.
Miami, F l o r i d a
R o b e r t L. R o m a n o , M.D.
Seattle, Washington

THE AMERICAN ACADEMY OF ORTHOTISTS AND PROSTHETISTS

OFFICERS
P r e s i d e n t R i c h a r d D. K o c h , C O .
Ann Arbor, M i c h i g a n
President-ElectJoseph M. Cestaro, C P . O .
Secretary-Treasurer Thorkild Engen, C O .
Washington, D.C
Houston, Texas
V i c e - P r e s i d e n t H o w a r d E. T h r a n h a r d t , C P . O .
I m m e d i a t e - P a s t P r e s i d e n t - H e n r y F. G a r d n e r , C P . O .
O r l a n d o , Florida
N e w York City, New York

DIRECTORS
Stephen Kramer, C P . O .
C h i c a g o , Illinois

Michael J . Quigley, C P . O .
Washington, D C .

NATIONAL OFFICE
David A. H. Roethel, Executive Director

III

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LOW P R O F I L E
MOLDED S.A.C.H. FOOT

PartNo.guso

FEATURES:
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natural a p p e a r a n c e . It is made of the highest quality moldable plastic which is long lasting and also
very flexible. The material has an excellent "memory" with the ability to return to its original
s h a p e . The heel wedge is available in three densities soft, medium or firm and is interchange
able. The keel is m a d e of highest grade, straight grained maple hardwood.
This foot offers the patient the possibility of having a smoother stride from heel-strike to toe-off.
Each foot is supplied with a % " bolt and a short inverted S.A.C.H. nut.
When ordering specify:
Catalog No.
Shoe Size
Length in inches or centimeters
Left or right
Heel density Soft, Medium or Firm

Sold on prescription only

U N I T E D STATES MANUFACTURING CO.

P.O. Boi 110,623 South Central Ave., Glendale, CA 91209, U.S.A. Phone (213) 245-6855 Cable: LIMBRACE

IV

PROSTHETIC SOPPLY CO.

9 4 7 JUNIPER STREET, N . E.

ATLANTA, GEORGIA
Telephone 8 7 5 - 0 0 6 6

P. O . BOX 7 4 2 8
30309

Area Code 4 0 4

Distributor For

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"Everything

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DEMAND THE
FOR

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YOUR

CUSTOMERS

KENDRICK'S
sacro-lumbar
supports of
dacron mesh

No. 8468-S Kendrick Sacro-lumbar Sup

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PRESCRIBED BY P H Y S I C I A N S . . . SOLD WITH CONFIDENCE

F o r y o u r c u s t o m e r s , there s h o u l d be n o substitute for the finest. Kendrick's
Sacro-lumbar Supports of D a c r o n , a n a m a z i n g synthetic fabric, provide the
m o s t reliable and comfortable support possible. T h e p o r o u s w e a v e of D a c r o n
is ideal for s u m m e r w e a r lets the skin breathe or all-the-year around.
Kendrick's D a c r o n Sacro-lumbar Supports are lighter and far m o r e c o m
fortable their durable, p o r o u s construction gives safe, long-lasting support t o
the wearer. L u m b a r stays are r e m o v a b l e s o the supports are easy t o w a s h , quick
t o dry. Styles for m a l e or female.
Specify surgically correct Kendrick products for y o u r c u s t o m e r s . T h e i r
confidence in y o u will result in m o r e frequent repeat sales and higher profits.
You

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JAMES
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K E N D R I C K
Philadelphia, P a . 19144

with

Kendrick
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COMPANY,
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N e w York, N . Y .
10016

POST-SURGICAL SUPPLIES

Heavy duty cables in housing with

strap attachment hangers on each
end of cable To be used with
the above knee suspension
corset to provide controlled
suspension of the cast.

ABOVE-KNEE SUSPENSION CORSET

Heavy canvas belt with suspension and
shoulder straps used to suspend above-knee.
cast in the immediate post-surgical routine.
May be used as right or left, with full felt
apron. Small, medium and large sizes.

Short cable 20"

Long cable 24"

Small 27* to 32" circumference

Medium 31" to 39* circumference
Large 40* to 46" circumference
BELOW-KNEE
SUSPENSION BELT
(LEFT AND RIGHT)
Light weight webbing waist
belt, with elastic suspension
strap, and cast attachment
strap with buckle.

fozr-uo
MOVUMEE CASTING FIXTURE
(LEFT MO RIGHT)
Light weight plastic casting fixture for
abort knee amputations features an
adjustable anterior-posterior
i, flexible plastic "SCARPA'S"
plastic posterior and medial contoured
brim and extension.

SPLIT
QUADRILATERAL
SOCKETS

No. 21-245
ADJUSTABLE B/K
PROSTHETIC UNIT
SuppNed with anterior
and posterior tHt ad
justments and quick
disconnect Tubing cut
to length at time of

No. 2L-241
ADJUSTABLE A/K
PROSTHETIC UNIT
Features all the align*
ment djustability of
the B/K, plus selective
manual knee lock and
adjustable knee fric-

STUMP SOCKS
(SPANDEX)
Especially woven for
immediate F7S pros*
theses. Rolled top to
toe for ease of appk-

Len
14"
18"

RUHRSTERN ELASTIC
PLASTER BANDAGE

LAMB'S WOOL

r.\ r widths

PEL SUPPLY
4472

WEST

1 CTOTH S T . ,

CLEVELAND.

PAUL

E.

OHIO

18-

COMPANY
44135

LEIMKUEHLEfl.

VII

la
ir

Toe
Width
314"
4"
56"
7"

BELOW-KNEE
FELT PADS
Felt pads tor relief
of pressure-sensitive
areas in immediete
post-surgical casting of
B/K stumps. In sets of
three:
1. Pre-patella pad
2 Medial tibial crest
3. Litem tibial crest

PHONE:

potsiDlHT

216.267-5775

BECKER ORTHOPEDIC APPLIANCE COMPANY

1776 SOUTH WOODWARD AVE.
BIRMINGHAM, MICHIGAN 48011

BYWORD

J
LEATHERS FOR THE

ORTHOPEDIC a n d
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& BRACE

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Orthopedic
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LEATHERS:

S h e a r l i n g s f o r Pads

Cowhide

Carving & Tooling

Elkhide

Molding

Russet S t r a p

Glazed & Molding

Cowhide

CalfKipSheepPigskin
Satisfied

ORDERS
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Customers Throughout

SHIPPED

SAME

DAY

TRADE

the United

States Since

1924

RODEN LEATHER CO., INC.

1725 CROOKS ROAD
ROYAL OAK, MICH. 48068
Area Code

VIII

313-542-7064

Choose it Because body conditions can vary so greatly with individual patients,
Camp makes a variety of spinal orthoses.
And there's only one method to insure the patient gets the right
support, and the results the physician wants.
Choose a Camp orthotic support.
Camp offers the widest selection of orthoses available including
Taylor-type and Knight-type spinal orthoses. Made to strict quality
control standards, each is designed to help solve specific orthotic
support problems.
And each Camp orthosis is designed and manufactured to allow you
to fit it more precisely to the individual patient.
With the complete Camp line, you don't have to choose a support
that is "generally" right. You can be precise.
All this, plus your own fitting skill (assisted by our free training
seminars which you may attend), means the patient is much more
likely to leave your store with an orthotic support that he or she can
wear with confidence. And it is better designed to achieve the re
sults prescribed by the physician.
Make sure your line of Camp products is complete. (Today, many
doctors are prescribing them by name and number.) Send for our
complete set of Camp Orthotic Support Selector catalogs.
When you want to make certain you've fitted a patient with the best
possible appliance, choose Camp.
Precisely.

C A M P
TUM

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preci

MODEL C35 Hyperextension

orthosis uses pelvic basin as
foundation. Pelvic band creates
lateral stability by anchoring on
lateral halves of Ilium, eliminates
bladder pressure. Swivel sternal
pad and adjustable lumbar pad.
Aluminum, covered with Naugahide.

r"
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C A M P INTERNATIONAL, INC.

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Let me be specific. Please send me your Orthotic Support Selector.

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Address

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CAMP TAYLOR-TYPE O R T H O S E S

a r e full b a c k a p p l i a n c e s c o v e r i n g
b a c k from c o c c y x t o u p p e r t h o r a c i c s p i n e . T h e y limit m o t i o n in l u m b a r a n d l o w e r
t h o r a c i c s p i n e , limit r o t a t i o n of t h o r a c i c s p i n e , a n d p r o v i d e mild h y p e r e x t e n s i o n o r
flexion of l u m b o s a c r a l joint.

M O D E L 8 0 5 7 - T a y l o r - t y p o or
thosis, a p r o n pad front, M o d e l
8 4 6 2 . S t r a p s c o m p l e t e w i t h side
b u c k l e s for a t t a c h i n g front pad
truss h o o k s .

M O D E L 8 1 7 7 - T a y l o r - t y p e or
thosis w i t h l e a t h e r slip c o v e r for
m e n or w o m e n . A l u m i n u m f r a m e ,
leather cover. W h i t e cotton cou
th g a r m e n t front, M o d e l 2 8 3 2 .

M O D E L 8 1 6 6 - M e n s Taylort y p e orthosis with slip-on c o v e r .

M o d e l 2 8 3 0 . P e r i n e a l straps or
h o s e s u p p o r t e r s must b e o r d e r e d
s e p a r a t e l y . Front, M o d e l 2 8 3 2 ,
a t t a c h e d to orthosis by side l a c e .
A l u m i n u m frame, white cotton
coutil c o v e r .

KNIGHT-TYPE SPINAL O R T H O S E S a r e e f f e c t i v e in limiting a n t e r i o r ,

p o s t e r i o r a n d lateral m o v e m e n t s of s p i n e . P a r t i c u l a r l y a p p l i c a b l e for s u p p o r t of
l u m b a r s p i n e . F u n c t i o n a l l y c o r r e c t a n a t o m i c a l d e s i g n g i v e s s u p p o r t a n d mild h y p e r
e x t e n s i o n o r flexion t o l u m b a r c u r v e a s r e q u i r e d .

M O D E L 8 1 4 2 Lumbosacral
f l e x i o n orthosis e x e r t s c o n s t a n t
f o r c e o n l u m b a r s p i n e , lumbo
s a c r a l joint, a n d pelvis r e d u c i n g
e x c e s s i v e lordotic c u r v e . Per
mits f r e e f l e x i o n of l u m b a r s p i n e .
R e d u c e s e x t e n s i o n a n d lateral
bending.

M O D E L 8 1 1 5 - M e n ' s Knightt y p e orthosis w i t h g a r m e n t front,

M o d e l 2 8 5 2 . N o p e r i n e a l straps.
W h i t e cotton coutil. Front laces
into p o s t e r i o r c o v e r . A l t e r n a t i n g
truss h o o k c l o s u r e .

M O D E L 8115
Model 8115.

B a c k v i e w of

No
Postage Stamp
Necessary
If Mailed In The
United States

BUSINESS REPLY MAIL

First Class Permit No 166. Jackson. Mich.
P o s t a g e will be paid by:

CAMP INTERNATIONAL, INC.

Jackson, Michigan 49204

SPREADING THE WORD

S e v e r a l y e a r s a g o , s o m e o n e a s k e d , " W h e r e m a y I find literature o n P r o s t h e t i c s
a n d O r t h o t i c s ? " If this p e r s o n had b e e n f r o m the m e d i c a l o r allied h e a l t h f i e l d s , h e
c o u l d h a v e b e e n referred t o t h e m e d i c a l library b u t t h e f i n d i n g s w o u l d h a v e b e e n
m e a g e r . If t h e y w e r e n o t r e l a t e d t o t h e m e d i c a l field, t o tell t h e m t o g o t o t h e p u b l i c
library w o u l d h a v e b e e n virtually u s e l e s s b e c a u s e t h e y w o u l d p r o b a b l y find o n l y
s o m e fairy t a l e s o f pirates w i t h e i t h e r a h o o k or a p e g l e g .
In 1972 o n e o f the f e w p u b l i c a t i o n s in t h e f i e l d s o f p r o s t h e t i c s a n d o r t h o t i c s
s t a t e d , " U n t i l r e l a t i v e l y r e c e n t l y , there w a s e s s e n t i a l l y n o p r o f e s s i o n a l literature to
b e f o u n d p e r t a i n i n g to t h e field o f p r o s t h e t i c s a n d o r t h o t i c s . " W h y h a s this b e e n s o ?
Is it b e c a u s e w e h a v e n o t h i n g n e w to tell? I c a n n o t b e l i e v e that this is s o . E v e r y
patient p r e s e n t s a n e w c h a l l e n g e t o t h e p r o s t h e t i s t or o r t h o t i s t a n d o t h e r m e m b e r s
o f t h e clinic t e a m , and t h u s there s h o u l d b e a g o o d d e a l o f m a t e r i a l that s h o u l d b e
presented.
Is it b e c a u s e w e d o n ' t h a v e t i m e ? W e s e e m to find t i m e to d o m o s t o f t h e t h i n g s
that w e really w a n t to d o .
Is it b e c a u s e w e are afraid that w e m a y b e c r i t i c i z e d b y s o m e o f o u r c o l l e a g u e s ?
T h i s m a y b e true in s o m e s i z a b l e p r o p o r t i o n .
Is it b e c a u s e w e d o n ' t k n o w h o w to w r i t e or d o n ' t k n o w h o w t o o r g a n i z e t h e
m a t e r i a l t o write a n e d u c a t i o n a l , i n f o r m a t i v e and i n t e r e s t i n g a r t i c l e ? P e r h a p s , but
m o s t o f us are m a n a g i n g a v e r y s u c c e s s f u l o r g a n i z a t i o n that r e q u i r e s m a n y l e t t e r s
and o t h e r f o r m s o f c o m m u n i c a t i o n .
M a n y o f u s u s e o n e o r m o r e o f t h e s e r e a s o n s for not w r i t i n g a r t i c l e s that s h o u l d b e
p u b l i s h e d a n d t h u s m a d e a v a i l a b l e to o u r c o l l e a g u e s a r o u n d t h e w o r l d . V e r y f e w
useful b o o k s , j o u r n a l s , and o t h e r p u b l i c a t i o n s are a v a i l a b l e to c l i n i c i a n s in p r o s t h e
t i c s and o r t h o t i c s , partly b e c a u s e o f t h e rapid rate o f c h a n g e that h a s b e e n m a d e
during the p a s t c o u p l e o f d e c a d e s .
Orthotics
and Prosthetics
and its p r e d e c e s s o r s h a v e b e e n a s o u r c e o f r e f e r e n c e
for m a n y y e a r s , a n d i s n o w a v a i l a b l e in m a n y m e d i c a l libraries. Its q u a l i t y h a s
v a r i e d , but s i n c e 1972 it h a s d e v e l o p e d into a truly p r o f e s s i o n a l s o u r c e o f informa
t i o n . T h e E d i t o r i a l B o a r d h a s had little to d o w i t h t h i s , and t h e b u l k o f t h e c r e d i t
s h o u l d g o t o A . B e n n e t t W i l s o n , Jr., w h o h a s s e r v e d as t h e e d i t o r during t h e s e p a s t
three years.
If m e m b e r s o f A O P A , A A O P , and o t h e r r e a d e r s w a n t Orthotics
and
Prosthetics
to c o n t i n u e as a p r o f e s s i o n a l p u b l i c a t i o n , w e m u s t p r e p a r e a n d s u b m i t a r t i c l e s for
p u b l i c a t i o n . S t y l e is n o t i m p o r t a n t . T h e editorial staff c a n r e m e d y a n y l a c k o f s t y l e .
T h e i m p o r t a n t f a c t o r is t h e p r e s e n t a t i o n o f i d e a s and m e t h o d s o f p r o v i d i n g s e r v i c e
that will b e useful t o f e l l o w p r a c t i t i o n e r s .
It h a s b e e n a v e r y e n l i g h t e n i n g e x p e r i e n c e for m e t o s e r v e a s C h a i r m a n o f t h e
E d i t o r i a l B o a r d for t h e p a s t t w o y e a r s . T h e c o m p l e t e c o o p e r a t i o n o f all m e m b e r s o f
t h e c o m m i t t e e , the staff in t h e W a s h i n g t o n o f f i c e , and the o f f i c e r s o f A O P A , A A O P
a n d A B C h a v e m a d e this j o b v e r y e a s y . I w i s h t h e n e w C h a i r m a n the s a m e p l e a s u r e .
Bert R. T i t u s , C P . O .
Chairman
Editorial C o m m i t t e e

SOME OBSERVATIONS ON UPPER-LIMB

PROSTHETICS AND ORTHOTICS
1

David G. M u r r a y , M . D .

On behalf of the State University of N e w Y o r k

Upstate Medical Center, the D e p a r t m e n t of Or
thopedic Surgery, and the Division of Orthotics
R e s e a r c h and E d u c a t i o n , I would like to take this
opportunity to welcome you to S y r a c u s e .
It has been my observation that w h e n persons
organizing a seminar or conference in the winter
time want to insure a good a t t e n d a n c e , they
schedule the meeting for s o m e place like Aspen
o r a cruise ship in the C a r i b b e a n . W h e n you are
caught with S y r a c u s e , N e w Y o r k , during one of
the rainiest M a y ' s in history, you are left with
only one alternative to attract a group of people;
that is, to assemble the best program and faculty
possible. Judging from the n u m b e r I see here
t o d a y . I would say that the program C h a i r m e n
have been extremely successful; and it is cer
tainly a tribute to their organization ability and
the quality of the papers you are going to hear.
I have a n o t h e r observation I would like to pass
on to you after having looked o v e r the sophisti
cated list of topics in this program. Fifteen years
ago as I was training in O r t h o p e d i c Surgery, I
developed an interest in prosthetics and spent
some time at that point working on early fitting of
below-knee a m p u t e e s with plaster sockets and
pylons. In the course of this work, I a t t e n d e d the
standard c o u r s e s in prosthetics and orthotics
learned about plastic laminated sockets,
triceps p a d s , control c a b l e s , D o r r a n c e terminal
d e v i c e s , shoulder h a r n e s s e s , and so forth.
O v e r t h e y e a r s , the n u m b e r of other respon
sibilities has e n c r o a c h e d nearly 100 percent on
the amount of time I have had to d e v o t e to a
c o n t i n u i n g interest in p r o s t h e t i c s . S u d d e n l y ,

1Welcoming remarks given at the Advanced Seminar

o n External Energy in Upper-Limb Prosthetics and
Orthotics sponsored by the American Academy of
31, 1974.
2

Professor, Orthopedic Surgery, Upstate Medical

Center, Syracuse, N e w York.

after a long hiatus, I w a s called upon to attend a

prosthetics clinic at the Upstate Medical C e n t e r
last month as a substitute. Mind you, in the inter
val, we have seen t h e d e v e l o p m e n t of portable
color television, the landing of men on the moon,
the production of pocket-sized electronic c o m
p u t e r s , and c a m e r a s which spit out instantane
ously a snapshot that is developed before your
e y e s . Therefore, it was with a certain a m o u n t of
uncertainty and a feeling of inadequacy that I
a p p r o a c h e d my assignment to the prosthetics
clinic. The first patient was a y o u n g s t e r with a
congenital below-elbow a m p u t a t i o n . Would you
believe I suddenly found myself back in the old
world, talking about plastic laminated s o c k e t s ,
triceps pad placement, shoulder h a r n e s s adjust
ment, ring position, and cable tension? E v e n the
plastisol was peeling off the terminal device (a
hook) in the s a m e way that it used to peel off
w h e n 1 was attending clinic 15 years ago. In a
w a y , it was comforting to realize that in this
d y n a m i c d e c a d e , s o m e t h i n g at least h a d n ' t
changed. On s e c o n d thought, it was a bit surpris
ing and not a little disappointing.
My o w n particular efforts o v e r the past few
years have been d e v o t e d for the most part to
studying and utilizing internal prostheses such as
hip joints and knee j o i n t s . O v e r the y e a r s , there
have been t w o w a y s in approaching the problem
of a d e s t r o y e d joint. O n e group has attacked the
problem by attempting to replace the joint with a
biologic substituteeither a joint from a n o t h e r
h u m a n being o r a m e c h a n i s m for internal repair of
the d a m a g e d j o i n t . T h e o t h e r g r o u p has a p
p r o a c h e d the problem from the standpoint of
creating an artificial substitute of inert material
which could be implanted in the body. T h e r e is no
question as to which g r o u p has been the most
successful. W e are currently implanting artificial
Orthotists
and Prosthetists, Syracuse, N e w York, M
joints in great n u m b e r s and the current success of
these artificial substitutes have eclipsed a t t e m p t s
to improve on m e t h o d s of biologic substitution.
M u c h the same thing seems to be going o n in

the area of substitution for destroyed o r missing

limbs. At the Veterans Administration Hospital
several blocks a w a y , Dr. Robert B e c k e r is work
ing o n m e t h o d s for r e g r o w i n g n o r m a l limbs
through electrical stimulation of tissue at the end
of the amputation s t u m p . It is his contention that
lost limbs will eventually be replaced biologi
cally. H o w e v e r , as evidenced by this program,
o t h e r groups are actively at w o r k developing
sophisticated prosthetic r e p l a c e m e n t s . If I had to
bet on which a p p r o a c h would turn out to be the
most feasible, there is no question but that logi
cally I would place my m o n e y on t h e prosthetic
r e p l a c e m e n t s . Judging from my recent experi
e n c e , h o w e v e r , on the practical i m p r o v e m e n t s
m a d e in this field o v e r the past 15 y e a r s , I a m
afraid I might have to hedge my bet.
T h e r e are generally three types of stimuli for
a c c o m p l i s h m e n t in any particular s p h e r e . First of
all, there may be a crying need for a solution. T h e
d e v e l o p m e n t of the polio vaccine is an e x a m p l e of
a r e s p o n s e to this stimulus. Secondly, a problem
may simply present a challenge. T h e climbing of
Mt. E v e r e s t fits in this category as being a drama

tic feat, but of no particular practical benefit.

Thirdly, technological a d v a n c e s may suddenly
make something possible that had been merely a
pipe d r e a m up to that point. We could place space
exploration in this c a t e g o r y .
N o w as we look at the field of upper-limb
prosthetics and o r t h o t i c s , I think that all three of
these factors apply. T h e r e is unquestionably a
crying need for i m p r o v e m e n t t h e challenge of a
difficult problem is inescapable and I have to
believe that the technologic capabilities are now
at hand.
It seems like the time has arrived for e d u c a t o r s
and innovators in this field to get off the mark, to
stop talking about the amazing features of the
D o r r a n c e 5XA hook and to apply their talents to
the o b v i o u s , unsolved p r o b l e m s . F r o m the topics
listed for discussion at this meeting, I sense that a
start is being m a d e . I am sure that it will be a
valuable day and a half, and I hope that seminars
such as this, combining the talents of the leaders
in this field, are heralding an e r a of innovative
a d v a n c e m e n t in the o r t h o t i c s and p r o s t h e t i c s
fields.

EXPERIENCE WITH PLASTIC

PATELLAR-TENDON-BEARING ORTHOSES
J a m e s T. D e m o p o u l o s , M . D . ,
John E. Eschen, C.P.O.

and

T h e m a n a g e m e n t of patients with lower-limb

deficiencies that p r o d u c e gait abnormalities has
u n d e r g o n e c o n s i d e r a b l e evolution during t h e last
d e c a d e . C u r r e n t c o n c e p t s in lower-limb orthotics
include the d e v e l o p m e n t and use of plastics, cre
ation of a new functional n o m e n c l a t u r e , introduc
tion of t h e multidisciplinary a p p r o a c h p r o v e n so
valid in prosthetics, and the use of instrumenta
tion and d a t a s y s t e m s to monitor results.
T h e application of the a b o v e c o n c e p t s to the
field of " l o w e r - l i m b b r a c i n g " is a rather recent
d e v e l o p m e n t , d e m o n s t r a t i n g new trends as re
viewed b y L e h m a n and his colleagues (8, 9).
O t h e r investigators, including C o r c o r a n (1),
(14), have utilized plastic materials and technol-

1Director, Rehabilitation Medicine, Hospital for

Joint Diseases and Medical Center, 1919 Madison
Ave., New York, N.Y. 10035.
Eschen Prosthetic and Orthotic Laboratories Inc.,
156-158 East 116th St., New York, N.Y. 10029.
2

ogy in prescribing lower-limb o r t h o s e s . Addi

tionally, the a u t h o r s have prescribed and fabri
c a t e d o v e r 200 lower-limb plastic o r t h o s e s for a
wide range of musculoskeletal defects found in
adults and children (2, 3, 4).
T h e principle of using t h e patellar-tendon and
c o n d y l a r areas of the tibia for weight-bearing in
the below-knee a m p u t e e w a s successfully trans
ferred to t h e discipline of orthotics by
Mcllmurray
the d e v e l o p m e n t of the V A C P patellar-tendonbearing " b r a c e . " T h e early design c o m b i n e d a
pretibial plastic shell and conventional metal up
rights to " u n l o a d " the tibia and the foot-ankle
Jebsen
(5), Simons
(15), reduction
L e h n e i s (10,of 11), and S a r
com
p l e x . In an effort
to achieve
weight, to i m p r o v e c o s m e s i s a n d comfort, and to
provide more physiological motion, the a u t h o r s
h a v e d e v e l o p e d an all-plastic patellar-tendonbearing o r t h o s i s .
This paper relates o u r e x p e r i e n c e with the plas
tic p a t e l l a r - t e n d o n - b e a r i n g o r t h o s i s a n d d e
scribes the details of fabrication.

T A B L E 1.

DIAGNOSIS AND AGE O F R E V I E W E D P O P U L A T I O N

CLINICAL MATERIAL
T h e patient-study population consisted of ten
patients w h o were evaluated and provided with
plastic patellar-tendon-bearing o r t h o s e s .
O u r initial experience dates to July 1972 and
our follow-up e x t e n d s o v e r an 18-month period.
Chronologically, our youngest patient was 7
years old; the oldest, 72. T h e study g r o u p in
cluded three females and seven males. T h e diag
noses of the population are listed in Table 1.

T h e completed orthosis w a s delivered and both

patient and d e v i c e w e r e s u b j e c t e d to a final
analysis, with attention focused o n relief of pain,
comfort, fit, a p p e a r a n c e , alignment, degree of
deformity c o r r e c t i o n , and total overall functional
i m p r o v e m e n t . Both static and loading conditions
w e r e used in our d e t e r m i n a t i o n s . Finally, serial
reexaminations were c o n d u c t e d o v e r a period of
m o n t h s , o u r longest follow-up being 18 m o n t h s .
RESULTS

METHOD
Eight of the ten patients w h o received a plastic
patellar-tendon-bearing orthosis were referred to
us by t h e s t a f f of t h e D e p a r t m e n t o f O r
t h o p a e d i c s , and therefore had the benefit of c o m
plete o r t h o p a e d i c e v a l u a t i o n s , including radio
graphic d e t e r m i n a t i o n s , prior to prescription.
T h e m e m b e r s of the Orthotic Clinic T e a m of
the D e p a r t m e n t of Rehabilitation Medicine, in
cluding the physicians and allied health profes
sionals, m e a s u r e d and r e c o r d e d data relating to
muscle strength, joint motion, p r e s e n c e of con
t r a c t u r e s , gait, elevation ability, spasticity, sen
sation, joint stability, and the degree of e d e m a if
p r e s e n t . T h e unit's orthotist provided the techni
cal expertise n e e d e d to formulate the final pre
scription. As required, pre-orthotic and postorthotic physical t h e r a p y was prescribed. In ad
dition, the patients' psychosocial and vocational
characteristics were m e a s u r e d .

Our e x p e r i e n c e with the plastic patellartendon-bearing orthosis in ten patients indicates

that many musculoskeletal defects of the lower
limb can be managed with this d e v i c e , offering
many a d v a n t a g e s o v e r conventional designs. T h e
a d v a n t a g e s are:
Superior c o s m e s i s
Lighter weight
I m p r o v e d comfort
Superior alignment
I m p r o v e d biomechanics
F a v o r a b l e strength-weight ratio
E a s e and c o n s t a n c y of application
Minimal m a i n t e n a n c e
H o w e v e r , not all a d v a n t a g e o u s features were
present in e a c h c a s e . Disadvantages included the
considerably higher cost of the plastic orthosis.
Problems w e r e e n c o u n t e r e d with growing chil
dren w h o required frequent r e p l a c e m e n t . It was
most important to o b s e r v e carefully those pa
tients with vascular and sensory problems since

t h e p l a s t i c o r t h o s i s is a p p l i e d s n u g l y . E d e m a o f

T h e a l t e r n a t i v e o r t h o s i s r e q u i r e d for m o s t of t h e

the foot-ankle area had to be carefully controlled

disabilities listed w o u l d be a h e a v y , b u l k y , ischial

also.

w e i g h t - b e a r i n g o r t h o s i s ( F i g . 1).

T h e various disabilities that are a m e n a b l e to

orthotics

management

utilizing

the

T h e lighter, m o r e c o s m e t i c , plastic

patellar-

plastic

t e n d o n - b e a r i n g o r t h o s i s is s h o w n in F i g u r e s 2 a n d

p a t e l l a r - t e n d o n - b e a r i n g o r t h o s i s a r e listed b e l o w :

3 . T h e o r t h o s i s is d o n n e d p r o p e r l y w i t h e a s e ; t h e

Congenital d e n e r v a t i o n of ankle joint

separate

A c q u i r e d d e n e r v a t i o n of a n k l e j o i n t

s e r t e d w h e n t h e k n e e is f l e x e d at 9 0 d e g . T h e

D e l a y e d or n o n u n i o n of fractured tibia

Imminent

fracture

of tibia, s e c o n d a r y

patellar-tendon-bearing

panel

is

in

o r t h o t i c f o o t - a n k l e s e c t i o n is m o l d e d s o t h a t it is
to

tumor, bone atrophy and development de

highly c o n g r u o u s

with the patient's

foot

and

a n k l e ; a n d the position of t h e p a t i e n t ' s a n k l e c a n

fects

b e f i x e d in t h e d e s i r e d a t t i t u d e . A s p e c i a l

D e g e n e r a t i v e d i s e a s e of a n k l e j o i n t

h e e l is u s e d ( c o m p a r a b l e t o a p r o s t h e t i c

I n f l a m m a t o r y d i s e a s e of a n k l e j o i n t

heel), together with a rocker assembly when " u n

T r a u m a of foot-ankle j o i n t

l o a d i n g " o f t h e p o s t e r i o r a s p e c t o f t h e f o o t is

Failed foot-ankle

d e s i r a b l e . In o t h e r i n s t a n c e s , a n o r d i n a r y

Infectious d i s e a s e of foot

D i s e a s e of t r a u m a of sole of foot

surgery

shoe

SACH

shoe

suffices.
A n u m b e r o f c a s e d i s c u s s i o n s will i l l u s t r a t e t h e
c r i t e r i a u s e d in p r e s c r i b i n g the

patellar-tendon-

b e a r i n g o r t h o s i s ; fabrication details a p p e a r at the

e n d of the p a p e r .

Fig. I. C o n v e n t i o n a l is
chial weight-bearing or
t h o s i s is h e a v y a n d
bulky.

Fig. 2. F r o n t view of
the plastic patellartendon-bearing ortho
sis.

Fig. 3 T h e r e m o v a b l e P T B section is easily d o n n e d .

CASE PRESENTATIONS
Case N o . 1. F . G . is a 9-year-old boy with con
genital a b s e n c e of intra-articular innervation of
his knees and ankles (Fig. 4). Functionally, the
left knee and right ankle c r e a t e d considerable
difficulties in ambulation and elevation activities.
In our initial experience with patellar-tendonbearing o r t h o s e s , we adhered to the original con
cept of using plastic materials for patellar and

tibial c o n d y l a r weight support and conventional

metal uprights attached to a molded leatherc o v e r e d footplate; the uprights were extensible
and the ankle-joint position was adjustable (Fig.
5). A plastic quadrilateral socket, attached to
c o n v e n t i o n a l u p r i g h t s , w a s u s e d to r e d u c e
weight-bearing forces at the left knee and ankle
( F i g . 6). C l e a r l y , t h e right p a t e l l a r - t e n d o n -

Fig. 4. Congenital absence of intra-articular innerva

tion produced severe deformities of left knee and right
ankle. Case No. 1.

Fig. 5. The early design combined plastic and metal

components.

bearing orthosis w a s more a c c e p t a b l e to the pa

tient. As we evolved the all-plastic PTB o r t h o s i s ,
we substituted this device for the original or
thosis. A 65 percent weight reduction w a s a c
complished, with more efficient alignment of the
foot and ankle, with resultant reduction of t h e
a b n o r m a l l y high i n t r a - a r t i c u l a r forces at t h e
ankle.

C a s e N o . 2. L . H . is a 54-year-old w o m a n with
severe deformity of the tibia following malunion
of pathological fractures. Figure 7 illustrates the
original P T B o r t h o s i s ; the n e w e r plastic P T B or
thosis p r e v e n t e d r e c u r r e n c e of fractures for an
11-month period, until t h e patient s u c c u m b e d t o
metastatic d i s e a s e .

Fig. 6. An "early" PTB orthosis is used to reduce

trauma to the right ankle. Case No. 1.

Fig. 7. Use of a PTB orthosis prevented recurrence of

pathological fractures of the tibia. Case No. 2.

C a s e N o . 3. A . S . , a 58-year-old mechanical
engineer, was admitted to our hospital with a
h i s t o r y o v e r s e v e r a l y e a r s of p r o g r e s s i v e
C h a r c o t ' s a r t h r o p a t h y of both ankles. T h e right
foot required a below-knee amputation secon
dary to intractable osteomyelitis. In an effort to
prevent a similar process in the aneural left ankle,

Fig. 8. The patient's functional level

was significantly improved with pro
vision of a PTB orthosis. Case No. 3.

we prescribed a plastic patellar-tendon-bearing

orthosis. T h e patient was able to return to work
as an engineer, with a below-knee prosthesis and
a P T B orthosis (Fig 8). Figures 9 and 10 a r e ,
respectively, front and lateral views of the patient
wearing the P T B o r t h o s i s . N o t e the removable
panel in Figure 10.

Fig. 9. The PTB orthosis

reduced
ankle
intra
articular forces and pro
vided mediolateral knee
stability. Case No. 3.

Fig. 10. The PTB panel is inserted

with the knee flexed to 90 deg.
Case No. 3.

Case N o . 4. H . S . , a 61-year-old individual em

ployed as a truck driver, sustained a chronic sub
luxation of his subtalar joint with increasing pain
and inability to walk more than a few s t e p s . T h e
abnormalities are s h o w n on the radiograph in
Figure 11. A plastic patellar-tendon-bearing or
thosis prevented further malalignment, reduced
the pain considerably, and permitted resumption
of relatively unlimited a m b u l a t i o n .

Case N o . 5. M.R., a 48-year-old w o m a n , sus

tained severe b u r n s of t h e plantar surface of her
foot, with multiple grafting that repeatedly failed
b e c a u s e of i n a d e q u a t e o r t h o t i c m a n a g e m e n t .
Figure 12 depicts the pathology, while Figure 13
d e m o n s t r a t e s use of the plastic P T B o r t h o s i s .

Fig. 11. Subtalar subluxation produced considerable

pain and limited ambulation. Case No. 4.

Fig. 12. Multiple grafting of the plantar surface was

required prior to prescription of a PTB orthosis. Case
No. 5.

CASTING
The cast is t a k e n in two sections. T h e first
section includes the foot-ankle to the mid-calf
areas. T h e second section includes the mid-calf
area to a point a b o v e the femoral c o n d y l e s .

First Section

(Fig. 14)

1. Patient is seated on a plinth or chair with the

foot held in 5 deg. of dorsiflexion on the properly
selected last.
2. S t o c k i n e t t e , sewn at the t o e s , is placed on
the leg and brought a b o v e the k n e e .
3. T h e leg is brought into 5 deg. of dorsiflexion
relative to the floor.
4. With the indelible pencil the patella is lo
cated and its b o r d e r s m a r k e d ; tibial tubercle,
crest of tibia, head of fibula, lateral flare of tibia,
medial condyle flare, both medial and lateral mal
leoli, first and fifth metatarsal h e a d s , and any

Fig. 13. The plastic PTB orthosis effectively elimi

nated contact between the orthosis-shoe unit and the
ground. Case No. 5.
FABRICATION DETAILS
MATERIALS AND EQUIPMENT
FOR C A S T I N G

NEEDED

T w o rolls of elastic plaster bandages

C o t t o n stockinette 3 in. wide, to place o v e r
knee d o w n to and including the foot
Indelible pencil
W a t e r in basin 6 in. d e e p
Surgical tubing o r webbing strip
C a s t cutter
Bandage shears
Yardstick
Tape m e a s u r e
Ritz stick
M e a s u r e m e n t chart
Casting lasts for matching heel height of shoe
to orthosis

Fig. 14. The major bony landmarks are outlined on the

cotton stockinette; elastic plaster-of-Paris bandage is
used to wrap the foot while it is positioned on a last.

other pertinent bony p r o m i n e n c e s . T h e midpoint

of the patellar tendon is also marked (Fig. 14).
5. A strip of surgical tubing is placed along the
medial side of the knee and down the anterior
midline of the leg, extending to the t o e s , to permit
removal of the cast later (Fig. 15).
6. Elevate the foot and w r a p with elastic plas
ter bandage going to the mid-calf level.
7. Replace the foot on the last and hold in the
correct position until plaster has hardened (Fig.
14).
Second

Section

4. After t h e p l a s t e r has h a r d e n e d , several

horizontal orientation lines are placed along the
outline of the surgical tubing. Removal of the cast
is now accomplished by cutting down the outline
of the surgical tubing with a cast cutter (Fig. 15).
T h e hash lines are used to reestablish the cast,
which is then filled with plaster of Paris (Fig. 15).
The plaster bandage is stripped off in the c o n v e n
tional m a n n e r .
MEASUREMENTS

1. After the foot-ankle cast has hardened suf

ficiently, extend the knee to 30 deg. of flexion.
2. W r a p from t h e mid-calf area to a point
a b o v e the femoral c o n d y l e s with t h e s e c o n d
plaster-of-Paris b a n d a g e .
3. L o c a t e the patellar tendon and popliteal
fossa, and c o m p r e s s as is done regularly for any
PTB casting p r o c e d u r e .

The m e a s u r e m e n t s required are:

Calf circumference
Ankle circumference
Femoral condyles width
Malleoli width
Height from floor to mid-patellar-tendon
level
A n t e r o p o s t e r i o r w i d t h of k n e e at midpatellar-tendon level

Fig. 15. The negative wrap has been removed. Note

the patellar-tendon indentions and cast reference lines.

Fig. 16. The completed negative wrap is ready forfilling

with plaster of Paris.

CAST MODIFICATION
1. T h e proximal section of the cast is modified
in the same m a n n e r r e c o m m e n d e d for the con
ventional PTB down to the mid-leg level (Figs.
17, 18, and 19).
2. E x t r a relief is given to the medial and lateral
malleoli and any o t h e r prominences as appro
priate.
3. A metatarsal arch is cut into the sole of the

footlocated 1/2 in. behind the apices of the

metatarsals, the high point being u n d e r the sec
ond metatarsal and extending into a triangular
shape under the shaft of the metatarsals (Fig. 20).
4. T h e longitudinal a r c h is defined further
(Fig. 21).
5. T h e cast is then s m o o t h e d and prepared for
lamination in the conventional m a n n e r (Fig. 22).

Fig. 17. The negative wrap has been stripped away,

and reference lines outlining bony prominences have
been reinforced on the crude positive model.

Fig. 18. Plaster has been removed in the area of the

patellar tendon, under the medial condyle, and along
the proximal part of the tibia and fibula.

Fig. 20. Finished p l a n t a r surface of positive mold; note

formation of m e t a t a r s a l and longitudinal a r c h e s and
relief for base of fifth m e t a t a r s a l .

Fig. 19. Plaster of Paris has been a d d e d o v e r the head

of the fibula, lateral tibial c o n d y l e , proximal tibial shaft,
and the tibial t u b e r c l e . P o s t e r i o r l y , the popliteal area is
built up and flared for the hamstring t e n d o n s .
Fig. 2 1 . The finished positive mold is r e a d y for the first
lamination p r o c e s s : note relief for malleoli.

PLASTIC LAMINATION
T h e lamination process is carried out in t w o
steps.
Anterior-Proximal

Section

(Figs. 22, 23, and 24).

1. A layer of P V A foil is placed o v e r the mod

ified c a s t .
2. F o u r layers of Perlon stockinette are ap
plied to the distal section.
3. F o u r layers of fiberglass stockinette are ap
plied.
4. O n e layer of reinforced fiberglass matting is
added.

5. F o u r additional layers of Perlon stockinette

are applied.
6. T h e second PVA bag is then applied.
7. A mixture of 80% L a m i n a r H a r z * and 20%
Degaplast* with 4% color and 3 % catalyst is lami
nated u n d e r suction (Fig. 25). A batch of 300g is
usually a sufficient quantity.
8. T h e lamination is removed taking care not
to damage the anterior section of the cast.

Fig. 22. The completed positive mold has been lacquered and sprayed with silicone; the first
PVA foil has been applied and the pipe cast drilled for the suction attachment.

*Otto Bock Industries, Duderstadt, West Germany

Fig. 23. The positive mold has

Fig. 24. The prepared positive
been wrapped with 4 layers of
Perlon mold,and
3 layersby
of fiberglass
covered
a second stock
PVA
inette; a single layer of fiberglass
foil, is ready for lamination.
stockinette has been applied to the
anterior mold surface.

Fig. 25. Laminar Harz (dark

area) is flowing through a PVC
tube, impregnating the stock
inette and fiberglass areas of
the proximal knee section.

9. The anterior section is marked and trimmed

(Fig. 26) according to the following criteria:
a. mid patella anteriorly;
b . going p r o x i m a l l y at least 2-2 1/2 in.
a b o v e the mid-patellar tendon medially and
laterally;
c. at mid A-P of the leg, two vertical lines
are d r o p p e d and the lamination trimmed to
this line;
d. the distal edge is a horizontal line any
w h e r e b e t w e e n the proximal third to proxi
mal half of the leg.
10. T h e anterior section is reapplied to the cast
after all edges have been s m o o t h e d .
Shank

Section

1. A strip of Dacron webbing is placed d o w n

the c e n t e r of the anterior section (Fig. 27).
2. T h e hindfoot section is built up to a thick
ness b e t w e e n 3/8 and 1/2 in. with a material such as
S A C H foot rubber to allow relief during weightbearing (Fig. 28).

Fig. 26. The first lamination has been completed; the

anterior insert (shell) has been marked prior to its re
moval from the cast.

Fig 27. The anterior PTB shell is placed on the cast. A strip of 1 in. Pelite is placed on the shell
prior to the second lamination process.

3. A PVA bag is placed o v e r the cast and the

anterior section.
4. W h e n patient weighs less than 175 lb, four
layers of Perlon stockinette are applied to cast.
For heavier patients, two layers of fiberglass are
used.
5. O n e piece of fiberglass mat a b o u t 2 in.
wide is placed u n d e r the medial flare of t h e tibia
running distally along the medial side under the
sole of the foot, going proximal along the lateral
side of foot and ending u n d e r head of the fibula.
6. A T-shaped fiberglass mat is placed under
the sole of the foot cupping the heel and going
proximally halfway up the medial and lateral
sides.
7. T w o layers of fiberglass stockinette are
applied.
8. F o u r additional layers of Perlon stock
inette are applied.

9. T h e second PVA bag is applied.

10. L a m i n a t i o n is t h e n a c c o m p l i s h e d with
700g of resin - 8 0 % L a m i n a r H a r z - 2 0 %
Degaplast
than 175 lb., an additional fiberglass mat is placed
under the medial flare and under the sole of the
foot to neck of the fibula.
11. L a m i n a t i o n is carried o u t u n d e r a v a c u u m
of 20 kg/sq c m .
12. Lamination is removed by cutting through
the anterior part of the shank section, taking care
not to cut through the first section.
13. T h e trimlines of the shank section are then
d r a w n (Fig. 30).

Fig. 28. The hindfoot section of the cast has been built
up with hard SACH-foot rubber to allow relief of the
hindfoot during weight-bearing.
Fig. 29. The second lamination process is begun fol
lowing the addition of layers of Perlon, fiberglass stock
inette, fiberglass matting, and a PVA foil.

Fig. 31. During donning of the orthosis, the patient

inserts the anterior PTB shell; final fitting and "check
out" complete the process.

don and medial flare of tibia. If the orthosis is

fitted correctly, the patient should experience a
c o n t a c t of the sole on the footplate of the orthosis
but no weight-bearing.
Fig. 30. Following completion of the second lamina
tion, the orthosis is marked for cutting away from the
cast.

FITTING
1. A length of stockinette is applied to the
p a t i e n t ' s leg.
2. T h e shank section is d o n n e d by spreading
apart the patellar-tendon g r o o v e and sliding the
foot through (Fig. 31).
3. T h e section is applied by sliding in from the
anterior section until the section keys into the
s h a n k section.
4. Velcro is placed a r o u n d the patellar-tendon
a r e a and the mid-point of the anterior section.
5. T h e p a t i e n t ' s shoe is placed on the orthosis
and the patient is asked to stand.
6. Normal c h e c k o u t for the P T B is performed
making sure weight-bearing is on the patellar ten-

SUMMARY
O u r e x p e r i e n c e with plastic p a t e l l a r - t e n d o n bearing o r t h o s e s in ten individuals with varying
musculoskeletal defects of their lower limbs has
been p r e s e n t e d . We concluded that several dis
abilities of the lower limb can be successfully
managed with this d e v i c e , affording superior
c o s m e s i s , reduced orthotic weight, more com
fort, and improved physiological and anatomical
a l i g n m e n t . D i s a d v a n t a g e s included i n c r e a s e d
cost, frequent replacement in children, and po
tential skin problems in those individuals with
impaired vascular and sensory a r e a s .
O u r preliminary 18-month e x p e r i e n c e 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 clini
cal trials and will publish a s u b s e q u e n t paper
outlining o u r e x p e r i e n c e s with n e u r o m u s c u l a r
disabilities.

8. Lehmann, J. F., B. J. DeLateur, C . G . Warren,

and B.C. Simons, Trends in lower extremity bracing.

LITERATURE CITED

Arch. Phys. Med. Rehabil.

1. Corcoran, P. J., Evaluation of a plastic short leg

brace. A thesis for Degree of Master of Science, Uni
versity of Washington, May 1968.
2. Demopoulos, J. T., and A. Cassvan, Experience
with plastic orthoses in children: preliminary observa
tions. Bull Hosp. Joint Dis. 32:148-167, October 1971.
3. Demopoulos, J.T., A. Cassvan, and J. M.

51:6:338-353, June 1970.

9. Lehmann, J.F., and C . G . Warren, Ischial and

patellar-tendon weight-bearing braces: function, de
sign, adjustment, and training. Bull Pros.
Res.
10-19:6-19, Spring 1973.
10. Lehneis, H . R . , Brace alignment consideration,
Orthop.

Pros. Appl. J., 18:2:110-114, June 1964.

11. Lehneis, H . R . , New concepts in lower extrem

ity orthotics. Med. Clin. N. Amer. 53:3:585-592, May
Snowden,1969.Experience with plastic lower extremity othoses.

Bull. Hosp. Joint Dis. 33:22-46, April 1972.

4. Demopulos, J. T., and J. E. Eschen, Modification

of plastic orthoses for children. Bull. Hosp. Joint Dis.
34:156-160, October 1973.
5. Jebsen, R.H., B . C . Simons, and P. J. Corcoran,
Experimental plastic short leg braces. Arch Phys. Med.
Rehabil. 49:2:108-109, February 1968.
6. Kay, H. W., Clinical applications of the Veterans
Administration Prosthetics Center patellar-tendonbearing brace. Artif. Limbs 15:1:46-67, Spring 1971.
7. Kay, H. W., and H. Vorchheimer, A Survey of
Eight Wearers
of the Veterans
Administration
Prosthetics
Center Patellar Tendon-Bearing
Brace.

School of Engineering and Science, New York Univer

sity, July 1965.

12. Mcllmurray, William, and Werner Greenbaum,

A below-knee weight bearing brace. Orth. Pros. Appl.
J. 12:2:81-82, June 1958.
13. Mcllmurray, William, and Werner Greenbaum,
The application of SACH foot principles to orthotics.
Orth. Pros. Appl. J. 13:4:37-40, December 1959.

14. Sarno, J . E . , and H. R. Lehneis, Prescription

considerations for plastic below-knee orthoses. Arch.
Phys. Med. Rehabil. 52:11:503-510, November 1971.
15. Simons, B. C , R. H. Jebsen, and L. E. Wildman,
Plastic short leg brace fabrication. Orth. and Pros.
21:3:215-218, September 1967.
16. Veterans Administration Prosthetics Center, A
Manual for Fabrication
Weight-Bearing
Brace,

and Fitting of the

April 1967.

Below-Knee

A THERMOPLASTIC STRUCTURAL AND

ALIGNMENT SYSTEM FOR
BELOW-KNEE PROSTHESES
H a n s Richard L e h n e i s , C . P . O .

B e c a u s e changes in alignment are often indi

cated as the a m p u t e e patient progresses through
the various stages of gait training, ideally pros
theses should be provided with relatively simple
m e a n s of changing alignment, d a y s , w e e k s , o r
e v e n m o n t h s after the prosthesis is first applied.
Until the a m p u t e e is able to walk unaided, i.e.,
without c r u t c h e s or c a n e s , often c h a n g e s are re
quired in the alignment of the prosthesis owing to
the increased shift of weight t o w a r d s the injured
side and o t h e r c h a n g e s in his gait p a t t e r n .
Although the system described in this paper
will not lend itself completely to e x t e n d e d postfitting c h a n g e s , it r e p r e s e n t s a step in that direc

tion. T h e s y s t e m c o n s i s t s of a t h e r m o p l a s t i c
polyvinyl chloride (PVC) tubing t h a t is available
c o m m e r c i a l l y from p l u m b i n g s u p p l y h o u s e s .
During the early fitting stage of a m p u t e e man
a g e m e n t , this tubing r e p r e s e n t s both the struc
tural c o n n e c t i o n b e t w e e n the socket and foot as
well as a m e a n s of aligning t h e p r o s t h e s i s .

1Director, Orthotics and Prosthetics, New York

University Medical Center, 400 East 34th St., New
York. N.Y. 10016.

VFJ-100; A . J . Hosmer Corporation, P.O. Box 37,

Campbell, Calif. 95008.

STATIC A L I G N M E N T
F o r the p u r p o s e of statically aligning the pros
thesis, a vertical alignment j i g is used with a
minor modification which c o n s i s t s of the ex
c h a n g e of the mandrel b u s h i n g with a metal
2

sphere which is held in the mandrel c l a m p (Fig.

1). T h e sphere is drilled to receive a standard
7/8-in. pipe inserted in the plaster cast so as to
permit universal m o v e m e n t of the cast-socket up
on the alignment jig for proper orientation of the
socket in s p a c e .
A polyvinyl chloride (PVC) footplug and a
wood b a s e of plywood 1.5 to 2 c m thick is fas

Fig. 1.

tened to the foot base of the vertical alignment jig

with screws (Fig. 2). T h e relationship b e t w e e n
the socket and the foot is established, using stan
dard p r o c e d u r e s which need not be elaborated
upon h e r e .
O n c e this relationship has been established,
the socket is m o v e d proximally o n the vertical
bar of the alignment jig, a n d a P V C t u b e with t w o

Spherical insert for use with VFJ-100 fabricating jig.

longitudinal cuts of 15 cm d e p t h at right angles to

each o t h e r on the proximal end of the tubing is
installed on the foot block with a hose clamp (Fig.

Fig 2 A PVC footplug on a plywood base is placed in

the alignment jig.

3) Before the tubing is cut longitudinally, two

holes should be drilled through the tubing at the
distal end of each of the planned cuts to prevent

Fig. 3.

Installation of the PVC tube.

stress c o n c e n t r a t i o n s at the end of the saw c u t s .

T h e proximal end of the tube is heated to allow
spreading of the tubing at the saw cuts made
previously, and thus to produce four straps for
a t t a c h m e n t of the tube to the socket.
The socket with its outer surface roughed up is

lowered to the appropriate level into the spreaded

section of the tubing at the proximal end (Fig. 4).
T h e plastic straps are heated, are made to con
form to the shape of the socket, and are held in
place temporarily by masking tape (Fig. 5). O n e
layer of fiberglass stockinette is then pulled o v e r

Fig. 5.

First step in attaching the tube to the socket.

the P V C tubing from the foot block to the inter

section of the plastic straps and the socket, at
which point the fiberglass is tied to the P V C tub
ing (Fig. 6), A mixture of rigid polyester resin and
silica p o w d e r is then spread over the socket and
the plastic-strap area, and the tubular stockinette
is pulled up to c o v e r the portion of the socket
o v e r which the plastic straps e x t e n d .
W h e n the stockinette has been pulled o v e r the
socket, additional a m o u n t s of the resin-silica
mixture are spread o n t o the stockinette (Fig. 7).
This may be done easily when plastic gloves are
worn. After the resin has h a r d e n e d , the foot is
attached to the foot block and w o o d e n b a s e , and
the prosthesis is ready for fitting (Fig.8).
DYNAMIC ALIGNMENT

Fig. 4. View of setup showing the attachment straps

before being formed in place.

Any alignment c h a n g e s can be accomplished

readily by heating the P V C tubing for either angu
lar or translatory alignment adjustments. For ex
ample, to increase socket flexion, the proximal

tubing area should be heated near the a t t a c h m e n t

o r d e r to m o v e the s o c k e t a n t e r i o r l y o v e r the foot

t o t h e s o c k e t . If, h o w e v e r , a t r a n s l a t o r y

(Fig. 9). T h e s e

move

adjustments

can

be m a d e

by

m e n t is d e s i r e d , e . g . . a n t e r i o r m o v e m e n t o f t h e

m e a n s of a heat g u n directly on the t u b e while the

s o c k e t o v e r t h e f o o t , t h e p r o x i m a l a r e a of t h e

p a t i e n t is s t a n d i n g b e t w e e n p a r a l l e l b a r s o r , a l

t u b i n g i m m e d i a t e l y b e l o w t h e s o c k e t a s w e l l a s at

ternately,

its a t t a c h m e n t t o t h e P V C p l u g m u s t b e h e a t e d in

m a d e b y p l a c i n g t h e p r o s t h e s i s in t h e

the

adjustments

indicated

may

be

vertical

Fig. 7. Impregnating the stockinette with p o l y e s t e r

resin and silica p o w d e r .

a l i g n m e n t jig and by a p p r o p r i a t e l y indexing the

various a d j u s t m e n t scales on the jig w h e r e the
alignment c h a n g e s n e e d to be m a d e . T h e tubing
c a n then be h e a t e d and a m o r e a c c u r a t e

adjust

ment c a n be carried o u t .

FINISHING
If a h a r d e x t e r i o r f i n i s h is d e s i r e d , a r i g i d f o a m
b u i l d u p is m a d e , s h a p e d , a n d l a m i n a t e d in t h e
conventional

m a n n e r , i.e.. e x t e n d i n g from

the

wood ankle base over the socket.

W h e n a soft e x t e r i o r f i n i s h is d e s i r e d , t h e P V C
t u b i n g is r e i n f o r c e d b y l a m i n a t i n g t w o l a y e r s o f
nylon stockinette over the tube and

extending

o v e r t h e w o o d b a s e a n d t h e s o c k e t . A soft f o a m
Fig. 6. Application of fiberglass stockinette used in
attaching tube to s o c k e t .

c o v e r is t h e n a p p l i e d , s h a p e d , a n d f i n i s h e d a p
propriately.

Fig. 8.

Prosthesis ready for fitting.

IMMEDIATE POSTOPERATIVE
PROSTHETICS FITTING
T h e tube system has also been applied in a
n u m b e r of cases of below-knee immediate post
o p e r a t i v e fittings, resulting in a c o n s i d e r a b l e
weight reduction, a condition especially impor
tant to geriatric a m p u t e e s . T h e r e are no provi
sions for q u i c k d i s c o n n e c t i o n , but t h e light

Fig. 9.

Aligned prosthesis.

weight of the prosthesis seems to alleviate the

need for removal of the prosthetic c o m p o n e n t s
from the socket.
SUMMARY
A below-knee prosthetics structural s u p p o r t
and alignment system consisting of a PVC tube
has been described. It results in e x t r a o r d i n a r y

weight reduction, especially when a soft exterior

finish is intended and, at least in the early stages
of prosthetics fitting, provides the possibility of
infinite alignment changes to accommodate the
patient's changing gait pattern. When a rigid ex
terior finish is indicated, this type of prosthesis is
at least of the same or superior strength as the
conventional BK prosthesis, and with a soft
with fiberglass laminate as described above. It

has also been found to possess definite advan

tages in postoperative prosthetics fittings in
geriatric amputees to reduce the weight substan
tially. The utility of this system, i.e., whether a
rigid or soft exterior finish is desired, or for the
purpose of immediate postoperative fittings, has
proven to be successful in its exclusive applica
exterior
finish amputees
of adequate
strength
when
reinforced
tion
for below-knee
over
the past
three
years at the Institute of Rehabilitation Medicine,
N e w York University Medical Center.

DEVELOPMENT OF A THERMOPLASTIC
BELOW-KNEE PROSTHESIS
WITH QUICK-DISCONNECT FEATURE
Charles H. Pritham, C . P .

In recent y e a r s , considerable interest has been

focused on the d e v e l o p m e n t of endoskeletal,
modular s y s t e m s for the various levels of ampu
tation. Logically, such s y s t e m s should be fully
competitive with conventional fabrication tech
niques in regard to cost, ease and speed of fabri
cation, function, and weight. In addition, they
should offer improved c o s m e s i s and interchangeability of c o m p o n e n t s . T h e most success
ful application has been in the hip-disarticulation
c a s e , and perhaps the least satisfactory has been
in the b e l o w - k n e e c a s e , particularly in reference
to weight and e x p e n s e . In an attempt to redress
this situation, Richard L e h n e i s in conjunction
with various c o - w o r k e r s has developed a belowknee prosthesis utilizing a pylon of commerically
available polyvinylchloride pipe, a thermoplas
tic. (See preceding article.
Ed.)
In their t e c h n i q u e , o n e e n d of a piece of a p
proximately 11/4in. I.D. pipe is attached to a
socket, cut to length, and a foot is applied by
using an ankle plug of metal or P V C . Any align
ment c h a n g e s indicated by walking trials are
made by heating and bending the pipe. T h e pros
thesis can then be equipped with a cosmetic
cover. This pylon has been used for immediate
postoperative p r o s t h e s e s even though no quickdisconnect feature is provided.
Inspired by this, and at the instigation of Virgil
F a u l k n e r , C . P . O . , the a u t h o r late in the winter of
1973 began investigating the possibilities of de
veloping a similar system from locally available
materials. It soon b e c a m e a p p a r e n t that the small
est size pipe suitable and available locally is of
about 1 5/8 in. I.D. with a 3/16 in. wall thickness.
PVC pipe of this size is used extensively in the

1Staff Prosthetist, Department of Orthopedics, Divi

sion of Prosthetics and Orthotics, University of Vir
ginia Medical Center, 1224 West Main Street, Char
lottesville, Va. 22903.

plumbing trade, and therefore a wide variety of

fittings is available for use with this size. C o n s e
quently, the decision w a s m a d e to provide a
quick-disconnect feature by utilizing s o m e of
these fittings. One method used consists of ce
menting a threaded male c o n n e c t o r to the pipe
and adding s o c k e t - a t t a c h m e n t straps to the
matching female c o n n e c t o r . (Figs. 1 and 2).
For their original p u r p o s e , the mating pieces
were designed to be softened by heat and/or a
solvent c e m e n t before being s c r e w e d together.
For our p u r p o s e s , it has been necessary to reform
the threads using heat and a tap and die impro-

Fig. 1. Various components of the plastic pylon. The

primer and solvent cement are shown also.

satisfactory. T h e resulting a s s e m b l y c a n be lami

nated

into a

plaster-of-Paris

rigid d r e s s i n g ,

Lite-Cast

II t e m p o r a r y

socket,

or a

laminated

s o c k e t ( F i g s . 4. 5, a n d 6). T h e

polyester
last

m e n t i o n e d p r o c e d u r e r e s u l t s in a t e m p o r a r y p r o s
thesis of particularly pleasing a p p e a r a n c e

(Fig.

7).

Fig. 4. Pylon laminated into a rigid d r e s s i n g .

Fig. 2. An assembled pylon with galvanized straps.

vised f r o m c o r r e s p o n d i n g m e t a l fittings ( F i g . 3).

S o c k e t - a t t a c h m e n t s t r a p s of c o n v e n t i o n a l

(and

e x p e n s i v e ) stainless steel h a v e b e e n used as well

a s l e s s e x p e n s i v e s t r a p s of g a l v a n i z e d

material

t h a t is g e n e r a l l y u s e d t o h a n g w a t e r p i p e s ( F i g . 1).
T h e s e straps are a t t a c h e d to the female r e c e p t a
cle with m a c h i n e s c r e w s , but p o p rivets m a y be

Fig. 3 . I m p r o v i s e d t a p a n d die s h o w i n g flats and

g r o o v e s needed for cutting t h r e a d s .

Fig. 5 . Pylon laminated into a Lite-Cast II socket with

foot a t t a c h e d .

Fig. 6. Cutaway view of pylon laminated into a polyes

ter socket.

Various ankle plugs have been used including

some of modified P V C fittings, wood with adap
tor nuts, and cut-down aluminum pylon tubes
(Fig. 8). T h e latter have proven to be the most
practical to d a t e . Currently, w o r k is under way to
d e v e l o p ankle plugs of either aluminum or PVC
stock.
W h e n using the pylon for an immediate post
operative prosthesis, a locking pin is provided to
assure proper alignment of the various segments
when the lower assembly is removed and re
placed by the nurses and therapists (Figs. 1, 4,
and 9). In surgery, the s o c k e t - a t t a c h m e n t straps
are incorporated in the cast and aligned while the
pipe is still a t t a c h e d . T h e patient is " s q u a r e d - u p "

Fig. 7. Assembled temporary prosthesis.

and the pipe is marked at a point c o r r e s p o n d i n g to

the sole of the opposite foot: the pipe is then
r e m o v e d . T h e foot is then attached to the pipe
making suitable allowance for the height of the
foot.
W h e n the female receptacle is laminated into a
polyester socket, considerable care must be
taken in aligning it to avoid the necessity of mak
ing excessive b e n d s . While not detracting mate
rially from the strength of the prosthesis, these
b e n d s can present quite a peculiar a p p e a r a n c e . In
this instance, no pin is used and the two sections
are forcefully " s c r e w e d h o m e " so as to insure
that no slippage o c c u r s during use. For m a x i m u m
strength, the t h r e a d e d end of e a c h fitting should

perience and if due care is taken in the laminating

procedure.
This system has not yet been used in a defini
tive prosthesis as it is still in the process of being
proven and refined. H o w e v e r , no significant dif
ficulties can be seen as the w o r k of others bears
out. This system h a s been in general use for
sometime n o w , a n d no significant failures have
occurred. S o m e 15 t e m p o r a r y and 5 immediate
postoperative p r o s t h e s e s have been fitted o v e r a
period of 6 to 9 months using these c o m p o n e n t s .
In the a u t h o r ' s opinion, this constitutes a suffi
cient sampling o v e r a sufficiently long period to
w a r r a n t s e r i o u s c o n s i d e r a t i o n of further d e
velopment.
CONCLUSIONS
Fig. 8. Various ankle plugs and1/4.in. spacers.

Fig. 9. Disassembled immediate postoperative pros

thesis with locking pin.

be resting solidly on the s h o u l d e r of the o p p o s i t e

piece. This has proven satisfactory to d a t e , al
though additional security can be obtained by
heating the male c o n n e c t o r slightly beforehand.
If desired, the t w o sections could also be
c e m e n t e d together, of c o u r s e .
T o make height changes readily possible, the
prosthesis is assembled 1/2 in. short and the dif
ference is m a d e up with1/4,in. s p a c e r s , a n u m b e r
of which are on hand at the time of fitting (Figs. 5
and 8). Any b e n d s in the pipe should be made in
the proximal portion so as to leave the distal
portion unaffected for better observation of re
sults. While such changes are m a d e readily, con
siderable heat is needed. T h e necessity for exten
sive alignment c h a n g e s can be avoided with ex

T h e foregoing portion of this article describes

our early experience in the use of P V C pylons.
Since J a n u a r y of 1974, o u r experience with this
early system and o u r dissatisfaction with it have
resulted in adoption of t h e s y s t e m we a r e pres
ently using. This system consists of a female con
nection m a d e from a commerically available P V C
slip-fitting coupling with three short galvanized
straps fastened to the proximal portion with pop
rivets. T h e c o n n e c t i o n to the pipe distally is m a d e
by either a simple pin or t w o machine screws and
n u t s . This modification eliminates the tedious recutting of t h r e a d s that w a s necessary in the pre
vious design as well as b r e a k a g e . At the distal
portion of the pipe, a P V C ankle plug fastened to
the pipe by sheet metal s c r e w s is used to c o n n e c t
the foot. D u e to the furor o v e r the possibility of
PVC causing c a n c e r , the use of PVC solvent glue
has been avoided lately.
T h e s e changes have simplified production and
reduced the time required as well as eliminating
the breakage that occurred formerly at the base of
the t h r e a d s of the male c o n n e c t o r . Alignment
c h a n g e s of t e m p o r a r y p r o s t h e s e s h a v e n o t
proven to be a problem as attention to detail
during socket lamination results in an alignment
that c o m m o n l y needs only minor c h a n g e s . Be
cause of the large external d i a m e t e r of loosely
available c o m p o n e n t s (which results in increased
bulk and weight), the system is not c o m m o n l y
used for definitive p r o e s t h e s e s . Early a t t e m p t s at
fabricating soft c o s m e t i c c o v e r s for a waterbased foam recently available on a n experimental
basis from Alimed have been inconclusive. H e r e ,

too, the external diameter of the pylon poses a

problem.
The author wishes to make full acknowledg
ment of the work of Messrs. Lehneis and
to point out that his o w n contribution has been in
the matter of a quick-disconnect feature which
seems to offer significant advantages. Further

more, the d e v e l o p m e n t o f a comparable

commercial system at reasonable cost involving
the use of such a disconnect feature and a smaller
size
pipe appears as
to well
be feasible.
Such
a commer
Wunder,
as others
in the
N e w York area, and
cial system should logically include an ankle plug
of PVC and a locking pin on a lanyard for optional
use.

A PROPOSED NOMENCLATURE
FOR LIMB PROSTHETICS
H e c t o r W . Kay

This report reflects decisions made at two 1974

meetings of the Task Force on Standardization
of
Prosthetic-Orthotic
Terminology,
one on Feb
ruary 21 at Rancho Los Amigos Hospital, Inc., in
Downey, California, and the other on July 9 at
the Rehabilitation
Institute of Chicago,
Illinois.
Jacquelin Perry, M.D., is the General
Chairman
of the Task Force; Paul R. Meyer, Jr., M.D., and
Robert G. Thompson, M.D., were Acting Chair
men, respectively,
at the two sessions under dis
cussion, which dealt primarily with
prosthetics
matters. Present at both meetings were Task
Force members; liaison representatives
from the
prosthetics education institutions; the American
Academy
of Orthotists
and Prosthetists;
the
American Board for Certification
in Orthotics
and Prosthetics, Inc.; the American Orthotic and
Prosthetic
Association;
and the Veterans
Ad
ministration. A list of participants is appended to
this report.
T h e T a s k F o r c e o n S t a n d a r d i z a t i o n of
Prosthetic-Orthotic T e r m i n o l o g y , established by
the C o m m i t t e e o n Prosthetic-Orthotic E d u c a t i o n
( C P O E ) , N a t i o n a l A c a d e m y of S c i e n c e s
N a t i o n a l R e s e a r c h C o u n c i l , with J a c q u e l i n
Perry as C h a i r m a n met on J a n u a r y 2 1 , 1971. At
this initial meeting both H e r b e r t W . W a r b u r t o n ,
on behalf of the A m e r i c a n Orthotic and Prosthet
ic A s s o c i a t i o n A m e r i c a n B o a r d for Certifica
tion ( A O P A - A B C ) , and A n t h o n y Staros for t h e
V e t e r a n s Administration presented r e a s o n s for
the d e v e l o p m e n t of a standardized prosthetics

1Assistant Executive Director, Committees on

Prosthetics Research and Development and
Prosthetic-Orthotic Education (CPRD-CPOE), Na
tional Academy of Sciences, Washington, D.C. 20418.

and orthotics n o m e n c l a t u r e . S o m e of the n e e d s

advanced were:
T h e establishment of bases for prices of de
vices in c o n n e c t i o n with M e d i c a r e , Medicaid,
and similar p r o g r a m s . P r o p o s e d c o m p u t e r i z a t i o n
of g o v e r n m e n t billing information reinforced the
need in this area.
T h e elimination of p r o b l e m s resulting from
inconsistencies in n o m e n c l a t u r e as they affect
examinations for certification of prosthetists and
orthotists.
C o n s i s t e n c y in the use of orthotics t e r m s in
the field, in clinical and educational situations,
a n d in Volume 1 of the Orthopaedic
Appliances
Atlas now being rewritten.
D e v e l o p m e n t of a glossary of prosthetics
and orthotics t e r m s in r e s p o n s e to a suggestion
made by the International Society for Prosthetics
and Orthotics (ISPO). T h e p r o p o s e d glossary
should lend itself to translation into o t h e r lan
guages, m a k e m a x i m u m use of Latin and G r e e k
t e r m s , and avoid " A m e r i c a n i s m s . "
Completion of a VA project to s t a n d a r d i z e
n o m e n c l a t u r e for preparation of c o n t r a c t s , for
control of statistical information, and for use in
coding, filing, and retrieving n u m e r o u s docu
ments and o t h e r types of literature stored by the
V e t e r a n s Administration.
T h e T a s k F o r c e has met on a continuing basis,
usually once or twice a year, and has m a d e major
progress in the a r e a of o r t h o t i c s n o m e n c l a t u r e .
As a result of the T a s k F o r c e ' s efforts a new set of
termsactually a c r o n y m s h a s been d e v e l o p e d ,
and this language is already being used exten
s i v e l y . T h e b a s i c p r i n c i p l e of t h e o r t h o t i c s
n o m e n c l a t u r e is essentially simple, being that of
categorizing o r t h o s e s by the joints they e n c o m
p a s s . T h u s , an " F O " (foot orthosis) is one which
pertains to the joints of the foot; an " A F O "
(ankle-foot orthosis) e n c o m p a s s e s the ankle as

well as the foot; and a " K A F O " (knee-ankle-foot

orthosis) spans the knee as well as the ankle and
foot, e t c . This new orthotics n o m e n c l a t u r e has
now been incorporated into technical analysis
forms for the u p p e r and lower limbs and the
spine; a prescription p r o c e d u r e ; and com
puterized billing p r o c e d u r e s . The n o m e n c l a t u r e
is also being included in the revision of Volume 1
of the Orthopaedic Appliances Atlas now in pro
c e s s , o n e of its applications being to provide a
basis for the description of orthotic c o m p o n e n t s
and s y s t e m s for the u p p e r limb, lower limb, and
spine. Cognizance of the new system is also t a k e n

T A B L E I.

in the revision of d e s c r i p t o r s , o r key w o r d s , for

the Winnipeg Information Retrieval S y s t e m . A
c o m p r e h e n s i v e report covering the applications
of the new orthotics n o m e n c l a t u r e is in prepara
tion and will be published in the near future.
Despite the m a r k e d progress m a d e with the
standardization of orthotics n o m e n c l a t u r e , very
little progress w a s m a d e with regard to the stan
dardization of prosthetics t e r m s . T h e reasons for
the lack of progress in t h e prosthetics a s p e c t of
the Task F o r c e ' s assignment probably w e r e :
P r o s t h e t i c s n o m e n c l a t u r e w a s m u c h less
confusing than was the c a s e in orthotics w h e n the

AMPUTATION LEVELSUPPER LIMB

1To identify the level when the amputation was close to a joint, it was agreed that the epiphyseal growth plate or
scar would be the reference line, e.g., an amputation at or above the proximal humeral growth plate would be
"arm, complete"; one a little lower than this would be "arm, partial (or upper 1/3)."
" Partial arm" would be the new general term for above-elbow (AE); "partial forearm" for below-elbow (BE).
2

T a s k F o r c e began its meetings. T h u s , there has

been less incentive or urgency to c h a n g e the cur
rent terminology, which many people find quite
acceptable.
Following the success achieved in the revi
sion of the orthotics n o m e n c l a t u r e , an a t t e m p t
was m a d e to follow the same organizational pat
tern in prosthetics. It took two or t h r e e unpro
ductive trials t o convince the g r o u p that the ap
proach used in orthotics was not applicable to
prosthetics.
C o n v e r s e l y , n u m e r o u s individuals c o n t i n u e d
to be disturbed by the fact that such terms as

" k n e e disarticulation," " k n e e exarticulation,"

"through
knee,"
"Gritti-Stokes,"
and
" S t o k e s - G r i t t i " were all applied to a m p u t a t i o n s
which were or appeared to be essentially the
same from a functional standpoint. M o r e o v e r ,
the needs of the V e t e r a n s Administration and
other purchasers of prosthetic devices and ser
vices for a n o m e n c l a t u r e which described c o m
ponents in functional t e r m s rather than brand
n a m e s continued to exist, and so the search for a
standardized prosthetics nomenclature con
tinued.
At t h e F e b r u a r y 1974 meeting of the g r o u p a

Fig. 1. An Arm, complete amputation (shoulder dis

articulation).

Fig. 2. An Fo, complete amputation (elbow disarticu

lation).

fresh a p p r o a c h to the problem w a s m a d e along

two lines:

Here the incentive was a report on a new ter

minology for the classification of congenital limb
deficiencies developed at an international work
s h o p held in D u n d e e , S c o t l a n d , in J u n e 1973. It
a p p e a r e d likely that this new terminology would
be a c c e p t e d internationally. In the new s y s t e m
for the classification of limb deficiencies, all de
fects were classified u n d e r one or two major

categoriestransverse or longitudinal. The

t r a n s v e r s e deficiencies present as amputation
like s t u m p s , and prosthetics m a n a g e m e n t is e s
sentially the same as with surgical a m p u t a t i o n s
deriving from t r a u m a or disease. After extensive
consideration and discussion, therefore, the T a s k
Force decided to adopt the n o m e n c l a t u r e for
t r a n s v e r s e congenital defects in designating am
putation levels for non-congenital a m p u t a t i o n s .
T h e present report describes this p r o p o s e d new
n o m e n c l a t u r e . It has been designated as Part I of
the T a s k F o r c e ' s r e c o m m e n d a t i o n s on prosthet
ics n o m e n c l a t u r e .

Fig. 3. A Ca, complete amputation (wrist disarticula

tion).

Fig. 4. An Arm, partial or upper 1/3 amputation

(short above-elbow).

Amputation Levels and Prosthesis T y p e s

 T e r m i n o l o g y of P r o s t h e t i c
Based o n Function

Components

H e r e the T a s k F o r c e simply took each c o m p o

nent of a p r o s t h e s i s s o c k e t , knee joint, ankle
joint, e t c . a n d a t t e m p t e d to classify each in
functional yet relatively simple t e r m s . T h e out
c o m e of this work is being written up as Part II of
the T a s k F o r c e ' s prosthetics report.
T h e e s s e n c e of the new s y s t e m for naming
t r a n s v e r s e congenital deficiencies or surgical
a m p u t a t i o n s is that the n a m e designates the level
at which the limb terminates (or the most proxi

mal segment that is missing). It is u n d e r s t o o d that

all elements distal to the level n a m e d are also
a b s e n t . F o r e x a m p l e , a short below-elbow a m p u
tation would be identified as a " f o r e a r m , upper
1/3." An elbow disarticulation or through-elbow
a m p u t a t i o n would be n a m e d " f o r e a r m , c o m
plete," thus indicating the most proximal missing
portion (Table 1 and Figs. 1-5).
T h e n e w terminology for lower-limb amputa
tions (with a b b r e v i a t i o n s ) and the equivalent
levels in current terms as s h o w n in Table II and
illustrated in Figures 6-10 are in conformity with
the format previously presented for u p p e r limbs.

Fig. 5. An F o , partial or lower 1/3 amputation (long

below-elbow).

Fig. 6. A Th, complete amputation (hip disarticula

tion).

TABLE II.

AMPUTATION LEVELSLOWER LIMB

1When the amputation was close to a joint, the epiphyseal growth plate or scar would be the reference line, e.g.,
an amputation just above the level of the distal femoral growth scar would be "Th, partial (or lower 1/3)"; one at the
scar or between the scar and joint would be "leg, complete."
"Partial thigh" would be the new general term for above-knee (AK); and "partial leg" for below knee (BK).
2

PROSTHETICS TYPES
During the c o u r s e of the discussion on nomen
clature to describe amputation levels, it b e c a m e
a p p a r e n t that t h e same n o m e n c l a t u r e should be
used to identify the prostheses which would be
fitted to these levels. F o r e x a m p l e , a c o m p l e t e leg
prosthesis would be fitted to a " l e g , c o m p l e t e "
(or k n e e disarticulation) a m p u t a t i o n (Figs.
11-13).

Fig. 7. A Leg, complete amputation (knee disarticu

lation).

NEXT STEPS
AMPUTATION LEVELS
Following adoption of the new n o m e n c l a t u r e
to d e s i g n a t e a m p u t a t i o n levels a n d t y p e s of
p r o s t h e s e s , the T a s k F o r c e m a d e three additional
recommendations:
T h a t an article describing the new n o m e n
clature be d e v e l o p e d for possible publication in
Orthotics and Prosthetics
and o t h e r j o u r n a l s .
3

Fig.

8. A Ta, complete amputation (ankle disarticula-

This document was prepared in response to this

request.

 That from six to ten prosthetics facilities

with large case loads be a s k e d to field-test the
new prosthetics n o m e n c l a t u r e . (This r e c o m m e n
dation is now being implemented and the results
will be reported at a later date.)
T h a t the article describing the new n o m e n
c l a t u r e for a m p u t a t i o n levels and p r o s t h e s i s
types (and the results of the field study when
available) be transmitted to the International Soc
iety for Prosthetics and Orthotics for considera
tion by that b o d y ' s S u b c o m m i t t e e on Orthotics
and Prosthetics N o m e n c l a t u r e at its meeting in
O c t o b e r 1974.

Fig. 9. A Th, partial or middle 1/3 amputation

(medium above-knee).

FUNCTIONAL DESCRIPTIONS
Similarly it was r e c o m m e n d e d that the T a s k
F o r c e ' s work on the functional description of
prosthetic c o m p o n e n t s be written for publica
tion, field-tested, and referred to the ISPO S u b
c o m m i t t e e on O r t h o t i c s and P r o s t h e t i c s
N o m e n c l a t u r e . Implementation of these recom
mendations is now under way (see the following
article by E . E . Harris).
SUMMARY
In the c o u r s e of t w o meetings held in 1974, the
T a s k F o r c e on Standardization of ProstheticOrthotic Terminology of C P R D - C P O E e n d o r s e d
a new prosthetics n o m e n c l a t u r e to designate 1)

Fig. 10. A Leg, partial or upper 1/3 amputation (short

below-knee).

a m p u t a t i o n l e v e l s . 2) p r o s t h e s i s t y p e s , a n d 3) t h e
functional description of c o m p o n e n t s .
In t h e f i r s t t w o c a t e g o r i e s t h e n e w n o m e n c l a
t u r e ( a s d e s c r i b e d in t h i s r e p o r t ) is e s s e n t i a l l y
identical with the terminology d e v e l o p e d by the
ISPO Subcommittee on N o m e n c l a t u r e and Clas
s i f i c a t i o n in C o n g e n i t a l L i m b D e f i c i e n c y f o r t h e
classification of c h i l d r e n ' s t r a n s v e r s e congenital
deficiencies. The recommended new nomencla
t u r e is b e i n g f i e l d - t e s t e d in s e l e c t e d f a c i l i t i e s in
North

America.

A detailed report on the T a s k F o r c e ' s recom

m e n d a t i o n s concerning the functional

descrip

tion of p r o s t h e t i c c o m p o n e n t s has b e e n p r e p a r e d
a n d is p u b l i s h e d in t h i s i s s u e o f Orthotics

and

Prosthetics.

Fig. 12. A T a r s a l , c o m p l e t e , p r o s t h e s i s for a c o m p l e t e

tarsal a m p u t a t i o n .

Fig. 11. A L e g , c o m p l e t e , prosthesis for a c o m p l e t e leg

amputation.

Fig. 13. A Thigh, middle 1/3, prosthesis for a middle

1/3 thigh a m p u t a t i o n .

ACKNOWLEDGMENTS
T h e T a s k F o r c e w a s initially established by the
C o m m i t t e e on P r o s t h e t i c - O r t h o t i c E d u c a t i o n
( C P O E ) , and is now jointly s p o n s o r e d by C P O E
and the C o m m i t t e e on Prosthetics R e s e a r c h and
Development (CPRD). The joint committees
c o n d u c t their activities u n d e r C o n t r a c t V101
(134) P-75 b e t w e e n t h e V e t e r a n s Administration
and the National A c a d e m y of Sciences, and Con
tract N o . S R S 72-6 b e t w e e n the Social and R e
habilitation Service, D e p a r t m e n t of Health, E d u
cation, and Welfare, and t h e National A c a d e m y
of Sciences.
A p p r e c i a t i o n is e x p r e s s e d to M r s . J u n e D .
N e w m a n , C P R D - C P O E staff, for her valuable
assistance in t h e preparation of this report.

LITERATURE CITED
1. American Academy of Orthopaedic Surgeons,
Orthopaedic

Appliances

Atlas,

Vol.1, J. W. Edwards,

Ann Arbor, Mich., 1952.

2. Committee on Prosthetic-Orthotic Education,
Report of First Workshop-Standardization

of

Prosthet

ic and Orthotic Terminology.

Dallas, Texas, March
28-30, 1971, National Academy of Sciences.
3. Committee on Prosthetic-Orthotic Education,
Report on Second Workshop-Task
Force on Standar
dization of Prosthetic-Orthotic
Terminology.
Washing

ton, D . C , September9-11, 1971, National Academy of

Sciences.
4. Harris, E . E . , A new orthotics terminology: a
guide to its use for prescription and fee schedules. Orth.
and Pros. 27:2:6-19, June 1973.
5. Kay, Hector W., When information is needed.
Inter-Clinic

Inform.

Bull. 13:3, December 1973.

6. McCollough, Newton C , III, Charles M. Fryer,

and John Glancy, A new approach to patient analysis
for orthotic prescriptionpart I: the lower extremity.
Artif. Limbs 14:2:68-80, Autumn 1970.
7. Working G r o u p , International Society for
Prosthetics and Orthotics, A proposed international
terminology for the classification of congenital limb
deficiencies, (prepared by Hector W. Kay). Orth. and
Pros. 28:2:33-48, June 1974.
PARTICIPANTS
(In one or both of the 1974 Meetings of the Task Force
on Standardization
of Prosthetic-Orthotic
Terminol
ogy.)

Meyer, Paul R., Jr. M.D.. (Acting Chairman), Assistant

Professor of Orthopaedic Surgery, Northwestern
University Medical School, Chicago, Illinois.
Thompson, Robert G., M.D. (Acting Chairman), As
sociate Professor of Orthopaedic Surgery, North
western University Medical School, Chicago, Il
linois.
Billock, John N., Research Prosthetist, Prosthetic Re
search L a b o r a t o r y , N o r t h w e s t e r n University
Prosthetic-Orthotic Center, Chicago, Illinois.
Bray, John J., Director, Training Program in
Prosthetics-Orthotics Education, University of
California at Los Angeles Rehabilitation Center, Los
Angeles, California.
Compere, Clinton L., M.D., Program Chairman,
N o r t h w e s t e r n University Prosthetic-Orthotic
Center, and Professor of Orthopaedic Surgery,
Northwestern University Medical School, Chicago,
Illinois.
Cortright, Everett S., Staff Assistant, Prosthetics Re
search and Development, Department of Medicine
and Surgery, Veterans Administration, Washington,
D.C.
Fannin, Robert E., Columbus Orthopaedic Appliance
Co., Columbus, Ohio.
Fryer, Charles M., Director, Prosthetic-Orthotic
Center, Northwestern University Medical School,
Chicago, Illinois.
Harris, E.E., M.R.C.S., Staff Surgeon, Committees on
Prosthetics Research and Development and
Prosthetic-Orthotic Education (CPRD-CPOE), Na
tional Research Council, Washington, D . C .
Hayes, Robert F., President, Starkey Artificial Limb
Co., Inc., West Springfield, Massachusetts.
Kay, Hector W., Assistant Executive Director, Com
mittees on Prosthetics Research and Development
and Prosthetic-Orthotic Education (CPRD-CPOE),
National Research Council, Washington, D . C .
Kolanowski, Stanley J., Technical Information
Specialist, Research Center for Prosthetics, Veter
ans Administration, New York, New York.
Lewis, Earl A., Assistant Director, Research Center
for Prosthetics, Veterans Administration, New
York, New York.
McCollough, Newton C , III, M.D., Director of Re
habilitation, Department of Orthopaedics and Re
habilitation, University of Miami School of
Medicine, Miami, Florida.
Murphy, Eugene F., Ph. D., Director, Research Center
for Prosthetics, Veterans Administration, New
York, New York.

Nelson, Peter J., Project Engineer, Library,

Prosthetic-Orthotic Research and Development
Unit, Health Sciences Centre, Winnipeg, Canada.
Perry, Jacquelin, M.D. (Chairman), Chief, Research Peizer, Edward, Ph. D., Assistant Director, Veterans
and Development Group, Kinesiology Service,
Rancho
Los Amigos
Hospital,
Inc., Downey,
California.
Administration
Prosthetics
Center,
New York,
New
York.

Pellicore, Raymond, M.D., Clinical Assistant Profes

sor of Orthopaedic Surgery, Abraham Lincoln
School of Medicine, University of Illinois, Chicago,
Illinois.
Simons, Bernard C , Director, Prosthetics and Orthot
ics Division, Rehabilitation Medicine, University
Hospital, University of Washington, Seattle,
Washington.
Snell, Ralph R., Snell's Limbs and Braces, Memphis,
Tennessee.

Springer, Warren, Assistant Coordinator, Prosthetics

and Orthotics, New York University Post-Graduate
Medical School, New York, New York.
Staros, Anthony, Director, Veterans Administration
Prosthetics Center, New York, New York.
Storrs, Ralph A., General Manager, Pope Brace Com
pany, Kankakee, Illinois.
Zettl, Joseph H., Director, Prosthetics Research
Study, University of Washington, Seattle, Washing
ton.

A PROPOSED PROSTHETICS TERMINOLOGY

E. E. H a r r i s , M . R . C . S .

This report has been prepared for the Task

Force on the Standardization
of
ProstheticOrthotic Terminology established
by the Com
mittee on Prosthetic-Orthotic
Education of the
National Academy of SciencesNational
Re
search Council which first met on January 21,
1971, under the chairmanship of Jacquelin
Perry,
M.D. Many informed members of the various
professions concerned with prosthetics from uni
versity, government,
and private sectors
have
over the years contributed to the discussions at a
number of meetings under the general
chairman
ship of Dr. Perry. The proposed terminology
pre
sented here was mostly formulated
at the two
meetings at Rancho Los Amigos Hospital,
Inc.,
Downey, California, and the Rehabilitation
Insti
tute of Chicago, Illinois, under the acting chair
manship of Robert G. Thompson,
M.D.,
and
Paul R. Meyer, Jr., M.D. The participants
of
these two meetings are listed in the previous arti
cle by Hector W. Kay.
T h e T a s k F o r c e on S t a n d a r d i z a t i o n of
Prosthetic-Orthotic T e r m i n o l o g y ( C P R D - C P O E )
has agreed that the a c c e p t e d n o m e n c l a t u r e for
a m p u t a t i o n and prosthetics levels shall be that
devised for t r a n s v e r s e congenital deficiencies by
the S u b c o m m i t t e e on N o m e n c l a t u r e and Clas
sification in Congenital Limb Deficiency, Inter
national Society for Prosthetics a n d O r t h o t i c s , as
described by H e c t o r Kay in the preceding article.
T h e n o m e n c l a t u r e can be used independently of
a n y t e r m i n o l o g y of s y s t e m s , c o m p o n e n t s , o r
materials. It is currently undergoing field trials in
selected c e n t e r s .
TERMINOLOGY
A descriptive terminology of s y s t e m s , c o m p o
nents, and materials w a s devised by the T a s k
F o r c e at its meeting on July 9, 1974, in Chicago,
and is described h e r e . This terminology can be

1Staff Surgeon, Committee on Prosthetics Research

and D e v e l o p m e n t , National A c a d e m y of S c i e n c e s ,

Washington, D . C . 20418.

used with any required degree of detail for pre

scription, e d u c a t i o n , fabrication m a n u a l s , fee
s c h e d u l e s , information retrievals, or c o m p o n e n t
c a t a l o g s . It is i n t e n d e d to be used with t h e
n o m e n c l a t u r e described in the preceding article,
but could also be used independently. It has been
proposed that a field trial be started in the fall of
1974, preferably as an international evaluation
project through I S P O .
The following is a description of the p r o p o s e d
t e r m i n o l o g y of systems,
components,
and
materials. It is proposed that a prosthesis be de
scribed in an orderly m a n n e r , proceeding from
the general to the more detailed as follows:
A. General Characteristics
1.
2.
3.
4.

Prosthetics Level
Major Structural F e a t u r e
Durability
Cosmetic T r e a t m e n t

B. Interface Characteristics
1. Socket
2. Suspension
3. F o r c e Distribution
C. S y s t e m s and M e c h a n i c s
1. Joints at E a c h Level from Proximal to Dis
tal
2. Joint Controls
3. P o w e r Source of Controls
4. Alignment Devices
5. Terminal Devices - U p p e r L i m b
D.

Materials

GENERAL CHARACTERISTICS
1. Prosthetics level should be described ac
cording to the description in the preceding
article by Kay (2).
2. Major S t r u c t u r a l F e a t u r e . By i n t e r n a
tional a g r e e m e n t p r o s t h e s e s are
endoskeletal
be a hybrid element but o n e o r the o t h e r
will be the " m a j o r " feature. Therefore
p r o s t h e s e s are:
Endoskeletal
Exoskeletal

or

3. Durability. S o m e indication of temporarin e s s or p e r m a n e n c e of a p r o s t h e s i s is

needed and w h e t h e r it is robust. S o m e
agreement was reached at H e a t h r o w (1)
about t h e need for different strengths of
p r o s t h e s e s . Durability, therefore, n e e d s
t w o d e s c r i p t o r s , o n e from list " a " and o n e
from list " b . "
a
I m m e d i a t e Postsurgical
Training (Diagnostic)
Definitive

b
Geriatric
Standard
H e a v y Duty

4. C o s m e t i c T r e a t m e n t . At Chicago it w a s
agreed that " a n t h r o p o m o r p h i c " and
" n o n a n t h r o p o m o r p h i c " were clumsy
w o r d s , and since " c o s m e s i s " was an ac
ceptable and used term, " a c o s m e t i c " was
suggested.
It has been suggested further by An
t h o n y Staros that w e d o not want to say
that a prosthesis is " a c o s m e t i c " ; that is to
say it is ugly. W h a t is intended is to distin
guish b e t w e e n special cosmetic t r e a t m e n t
and standard p r o c e d u r e s .
C o s m e s i s should therefore refer to spe
cial c o s m e t i c t r e a t m e n t and would be:
Cosmetic Cover
Plastic on W o o d or Metal
Plastic F o a m and Skin
None
T o say that there is no special cosmetic
t r e a t m e n t does not infer that the pros
thesis is necessarily ugly.

INTERFACE CHARACTERISTICS
T h e reaction of the work load across the inter
face b e t w e e n prosthesis and patient takes
place in the socket and sometimes in the sus
pension. W h e r e that major reaction occurs
must be specified but is recorded in the d e
scription of t h e s o c k e t and s u s p e n s i o n .
1. S o c k e t s . Sockets need three descriptors
and may need a fourth for s u s p e n s i o n . T h e
first descriptor is the nature of the s o c k e t ;
the second is t h e n a t u r e of t h e materials
c o n s t r u c t i n g the s o c k e t ; the third is the site
of major force distribution. T h e fourth will
be the s o c k e t ' s contribution to suspen
sion. Sockets are therefore:

a
Total C o n t a c t
Non-total
Contact
b
Rigid
Semirigid
(e.g., liner)
Compliant
Hybrid

Proximal Bearing
Distal Bearing
Total Bearing
Materials (see section on Materials) can
also be d e s c r i b e d , for e x a m p l e , the P T B air
cushion socket could be " p l a s t i c (or e v e n
e p o x y r e s i n g l a s s fiber) t o t a l - c o n t a c t
semirigid distal compliant proximal bear
ing s o c k e t . "
2. S u s p e n s i o n . Ideally, s u s p e n s i o n is from the
socket w h e r e it may be " p r e s s u r e differen
t i a l " o r " s u c t i o n " or it may be body c o n t o u r
as in the complete t a r s u s , c o m p l e t e leg, c o m
plete hip, s o m e partial leg, and s o m e partial
forearm p r o s t h e s e s , e t c .
Many p r o s t h e s e s need additional suspen
sion by a h a r n e s s , belt, e t c . This is called
auxiliary h a r n e s s . T h e T a s k F o r c e did not
consider that distinction need be made bet
ween cuffs, b a n d s , c o r s e t s , e t c .
T h e c o n n e c t i o n b e t w e e n the s u s p e n s i o n
and t h e prosthesis is a " j o i n t " and if it is a
strap or s t r a p s , it is indicated under the joint at
the a p p r o p r i a t e level as " f l e x i b l e . "
W h e n the auxiliary s u s p e n s i o n also a c c e p t s
a work load additional to the forces required to
s u s p e n d , the a n a t o m i c a l site of t h a t load
should be indicated. S u s p e n s i o n is therefore:
P r e s s u r e Differential (socket)
B o d y C o n t o u r (socket)
Auxiliary
Thigh Bearing
Ischial Bearing
A r m Bearing
S h o u l d e r Bearing
etc.
3. F o r c e Distribution. This is a function of the
interface but is described in the a p p r o p r i a t e
place u n d e r socket o r auxiliary s u s p e n s i o n .

The nature of the distribution will itself deter

mine some of the character o f the socket and
auxiliary suspension, e.g., in a partial leg pros
thesis, the presence of uniaxial joints and the
need for thigh and ischial bearing require a full
length corset or thigh lacer.

SYSTEMS A N D MECHANISMS
1. Joints. Joints are described by the number
of axes and the number of planes in which
they move. There was some discussion
about the use of "rigid" where no mechan
ical joint exists, but it was agreed that
where there is no prosthetic mechanical
joint at an anatomical joint level, this
should be so described. Joints are there
fore:
N o motion at an anatomical joint level
Rigid
Motion in one plane
about one axis
about multiple axes

Uniaxial
Polycentric

Motion in two planes

about two axes

Dual axis

Motion in three planes

about finite axes
about infinite axes

Multiaxial
Flexible

Coronal
Abduction
Adduction
Valgus
Varus

b. Type of control mechanisms

Constant or
Intermittent and are:
Mechanical linkage
Hydraulic
Pneumatic
Electric
Other
The term "constant" is necessary to
describe certain types of lower-limb
swing phase controls and s o m e upperlimb power actuators, etc. "Intermit
tent" indicates the reverse.
c. Purpose of control mechanisms at each
joint movement
Free
Assist
Resist
Stop

modified as required by
Variable
Lock

Hold

2. Control Mechanisms. In the lower limb,

descriptors from a , b , c , and d, below, will
have to be given as required for both
stance and swing phases. Since stance is
usually a greater requirement than swing,
this should be stated first.
a. Plane and direction of movement (plane
need not be stated)
Sagittal
Extension
Flexion

Axial
Internal rotation
External rotation
Pronation
Supination
Eversion
Inversion
Opposition

d. Method of controlling mechanisms

Automatic
Biomechanical, Direct
Biomechanical, Transducer
Bioelectric
3. Power Source
N o n e (e.g., passive terminal devices)
Body
Electric
Hydraulic
Mechanical
Hybrid
4. Alignment
Bench

Mechanical

Single Integral
Dual
Removed
Bench alignment is always present and
need not be specified. When an alignment
device is used, it should have two descrip
tors to denote whether it is at a single site
or is at both ends of a " b o d y " segment. It

must also say w h e t h e r it remains as an

integral part or is r e m o v e d at completion
of fabrication.
5. Terminal Devices
Cosmetic
Functional
H o o k o r Special Tools

are often sufficient to distinguish b e t w e e n

c o m p a r a b l e p r o s t h e s e s or prosthetic c o m
p o n e n t s w h i c h a r e m a d e to a k n o w n
specification o n c e the major grade has
been decided.
2. Semispecific
Willow
etc.

They may be:

Voluntary opening
Voluntary closing
Both
Neither

Box calf
Chamois
Block leather
etc.

T h e y may b e :
P o w e r e d as a b o v e
Passive

Aluminum
Stainless Steel
etc.

MATERIALS.
T h e need to specify materials d e p e n d s upon a
n u m b e r of factors. In prescription, it will de
pend u p o n the relative k n o w l e d g e of t h e
physician and prosthetist which varies
greatly in the international field. It may also
be necessary in s o m e countries to give fabri
cation details to satisfy governmental specifi
c a t i o n s . Instructional and fabrication manu
als will need far greater detail than are re
quired in ordinary usage.
Terminology for materials can be in general
t e r m s or can be specific; it can be a descrip
tion in general of a whole s y s t e m or can be
applied to a c o m p o n e n t , e.g., one can refer to
a " w o o d e n l e g " or " a w o o d e n f o o t , " a " p l a s
tic a r m " or a " p l a s t i c s o c k e t . " T h e r e are
three grades of specification: first, general
t e r m s ; s e c o n d , semispecific t e r m s ; and third,
specific t e r m s . T h e first and s o m e t i m e s the
s e c o n d grades are usually sufficient for pre
scription or normal description. T h e third will
be necessary in professional instruction and
fabrication manuals. For this third grade of
specification, t h e national or international
description and s t a n d a r d s should be used.
1. General
Wood
Leather
Metal
Webbing
Rubber
Plastic
etc.

Nylon webbing
Coutil
etc.
Silastic
Polypropylene
Polycarbonate
Glass fiber
etc.

T h e s e terms are rather more specific and

are sometimes desirable in description and
prescription.
3. Specific. W h e n specific materials need to
be d e t a i l e d , t h e r e a r e s p e c i f i c t e r
minologies which are in use either interna
tionally or nationally. Most of these ter
minologies are also given specific m e c h a n
ical s t a n d a r d s , an e x c e p t i o n being leather
which has not yet been successfully stan
dardized.
E a c h nation should use its o w n national
specification first; if n o n e is available, it
should be the international s t a n d a r d ; a n d if
neither is available, it should c h o o s e from
a n o t h e r n a t i o n ' s terminology.
F o r m s that have been proposed for use
in t h e field trials are s h o w n in A p p e n d i x e s
A a n d B.

LITERATURE CITED
1. D e p a r t m e n t of Health and Social S e c u r i t y , E n
gland and W a l e s , Report of Conference
on Physical
Testing of Prostheses.
S k y w a y M o t e l , H e a t h r o w , Lon
d o n , E n g l a n d , M a r c h 25-27, 1974 (in p r e s s ) .
2. K a y , H e c t o r W . , A p r o p o s e d n o m e n c l a t u r e for
limb p r o s t h e t i c s , Orth. and Pros., 28:4, D e c e m b e r

1974.

APPENDIX A
P R O S T H E T I C S F O R M / U p p e r Limb

APPENDIX B
PROSTHETICS FORM/Lower

Limb

X-RAYS: A "FITTING TOOL"

FOR THE PROSTHETIST
1

J a m e s L. B y e r s

T h e p u r p o s e of this article is to d e m o n s t r a t e
the usefulness of x-rays as a "fitting t o o l " for t h e
prosthetist, i.e., as a m e a n s of c h e c k i n g fit of the
prosthesis before completion of fabrication. T h e
use of x-rays eliminates s o m e questionable points
t h a t m a y a r i s e at t i m e a b o u t p r o s t h e s i s fit,
w e i g h t - b e a r i n g a r e a s , t r i m l i n e s , reliefs, e t c . ,
where conventional m e t h o d s may fail or are not
wholly satisfactory.
CONVENTIONAL METHODS OF
CHECKING CONTACT BETWEEN
PROSTHESIS AND PATIENT
T o check for total contact, the prosthetist gen
erally uses either a ball of clay or p o w d e r in the
distal end of the socket. This method does show
that the patient has c o n t a c t on the distal end of his
s t u m p , but does not show that the patient has
total contact a r o u n d the periphery of the distal
end of the s t u m p .
After static alignment of the prosthesis has
been established to the p r o s t h e t i s t ' s satisfaction,
the prosthesis is r e m o v e d , and visual inspection
and palpation of the s t u m p are e m p l o y e d to c h e c k
for fit of the socket.
M a r k s m a d e by either the cast or s t u m p sock
are reflected on the patient's s t u m p . This method
c a n s o m e t i m e s be m i s l e a d i n g b e c a u s e s o c k
marks o v e r the entire surface of his s t u m p do not
necessarily mean that total contact is present.
With the sock s t r e t c h e d tightly o v e r the s t u m p
and then placed into the p r o s t h e s i s , the sock
m a y , s o m e t i m e s , reflect m a r k s due to the tension
in a snug fitting sock.
Weight-bearing a r e a s will also reflect s o c k
m a r k s , b u t should show increased p r e s s u r e by

1This work was performed with fiscal support under

Veterans Administration Contract V663P-656.
Chief of Prosthetics and Orthotics, Prosthetics Re
search Study, 1102 Columbia Street, Room 409, Seat
tle, Wash. 98104.
2

some discoloration (i.e., r e d n e s s ) in these a r e a s .

H o w e v e r , in cases of o b e s e patients or patients
with r e d u n d a n t s t u m p tissue, these areas have a
t e n d e n c y to m o v e distally once the prosthesis has
been r e m o v e d . A prosthetist must rely on his
j u d g m e n t a n d e x p e r i e n c e to know when these
areas are in the p r o p e r location when the check
out is m a d e by visual inspection.
T h e mediolateral trimlines of the prosthesis are
c h e c k e d while the patient bears weight on the
prosthesis and while sitting with t h e knee flexed
to 90 deg. T h e mediolateral and a n t e r i o r trimlines
are c h e c k e d by palpation of the s t u m p a r o u n d the
proximal b o r d e r of the socket to determine the
degree of fit with respect to the femoral c o n d y l e s ,
the patellar, and the popliteal a r e a s . With o b e s e
patients, it is s o m e t i m e s difficult to palpate these
a r e a s , a condition that limits the reliability of t h e
technique.
T h e relationship of t h e patellar-tendon pro
t u b e r a n c e to the posterior trim is c h e c k e d after
the prosthesis has been r e m o v e d . Again, this de
pends on the p r o s t h e t i s t ' s experience and j u d g
ment.
PROCEDURE
T h e x-rays are taken using the s t a n d a r d knee
technique and taken for soft tissue. T h e same
p r o c e d u r e is also used for o t h e r levels of a m p u t a
tions. X-rays are taken at the initial fitting after
static and d y n a m i c alignment have been c o m
pleted and the patient is comfortable. At this
point, the information provided by the x-rays is
most useful to the prosthetist. After examination
of the x-rays, adjustments are m a d e to the pros
thesis. W h e n p r o b l e m s arise, t h e y are reviewed
and discussed with the clinic chief and a p p r o
priate remedial m e a s u r e s are t a k e n . Generally,
t w o weight-bearing views of the s t u m p - s o c k e t
relationship are t a k e n : a n t e r o p o s t e r i o r and lat
eral (Figs. 1 and 2). If n e c e s s a r y , a third view is
t a k e n while t h e patient is sitting.

Fig. 2. Lateral view h a s also been outlined for clarity.

(a) Area b e t w e e n the t w o solid lines r e p r e s e n t s socket
shell.
(b) Area b e t w e e n dotted line and solid line r e p r e s e n t s
" C o r d o " interfacing.

Fig. 1. A n t e r o p o s t e r i o r view reflects mediolateral rela

tionship of stump to socket. X-ray is outlined for clarity
of interfacing a n d socket shell.

L A T E R A L V I E W (Figs. 2 . 3 . a n d 4)
T h e l o c a t i o n a n d a d e q u a c y o f fit in t h e a r e a o f
t h e p a t e l l a r - t e n d o n p r o t u b e r a n c e is d e t e r m i n e d .

ANTEROPOSTERIOR
The

proximal

V I E W ( F i g . 1)

mediolateral

trimlines are

c h e c k e d f o r a d e q u a t e h e i g h t a n d fit a r o u n d t h e
femoral condyles.
a n d l o c a t i o n o f t h e m e d i o t i b i a l shelf.
fibula,

adequacy

the patellar-tendon

protuberance.

R e l i e f o f t i b i a l t u b e r c l e is c h e c k e d .
T h e f l e x i o n a n g l e o f t h e s o c k e t is c h e c k e d .

T h e m e d i o t i b i a l f l a r e is c h e c k e d f o r a d e q u a c y
The

A t t h e s a m e t i m e , t h e p o s t e r i o r b r i m is c h e c k e d
f o r h e i g h t a n d a m o u n t o f f l a r e in t e l a t i o n s h i p t o

of relief for t h e h e a d o f t h e

t h e d i s t a l e n d o f t h e fibula, a n d t h e s h a f t o f

the fibula a r e c h e c k e d .

T h e o v e r a l l fit o f t h e p r o s t h e s i s f o r p e r i p h e r a l
c o n t a c t is a s s e s s e d .
T h e d i s t a l e n d o f t h e s t u m p is v i e w e d a g a i n for

total contact.
F i g u r e 3 is a l a t e r a l v i e w o f a c o n d i t i o n w h e r e

T h e d i s t a l e n d o f t h e s t u m p is c h e c k e d f o r total

t h e p a t e l l a r - t e n d o n b a r is l o c a t e d t o o f a r d i s t a l l y

contact. ( T h e d i s t a l total contact is a l s o c h e c k e d

a n d a l a c k o f t o t a l c o n t a c t in t h e r e g i o n o f t h e

from t h e lateral view.)

anterodistal tibia.

Fig. 4. Closed S y m e ' s p r o s t h e s i s ; a and b illustrate

medial and lateral a r e a s that have not maintained total
c o n t a c t u n d e r weight-bearing c o n d i t i o n s .
into the hamstrings or c a u s e e x c e s s i v e displace
m e n t o f t h e s t u m p in t h e s o c k e t .
T h e location of t h e p a t e l l a r - t e n d o n
Fig. 3. Lateral view.
(a) I m p r o p e r location of patellar-tendon p r o t u b e r a n c e .
It should be located inferior to the patella at the level of
the tibial plateau.
(b) Total c o n t a c t not maintained at the anterodistal
tibia.

protuber

a n c e in r e l a t i o n s h i p t o t h e t i b i a l t u b e r c l e is e x
a m i n e d t o m a k e c e r t a i n t h e r e is a d e q u a t e relief.
T h i s v i e w is u s e d o n l y if d o u b t s a b o u t t h e fitting
have been raised by the other x-rays.
T h e m o r e c o n v e n t i o n a l m o d e s of p r o s t h e t i c s
c h e c k o u t should not be disregarded; but, u n d e r

F i g u r e 4 is a l a t e r a l v i e w o f a S y m e ' s p r o s t h e s i s
and

stump where

total c o n t a c t

has

not

been

achieved.
LATERAL
(Optional)

proper supervision, x-rays can be a valuable "fit

ting t o o l " for the p r o s t h e t i s t a s s u r i n g him that t h e
p a t i e n t is g i v e n t h e m o s t e f f e c t i v e fit a v a i l a b l e in

VIEW

IN

SITTING

Proximal displacement

POSITION

o f t h e s t u m p in

prosthetics service.

ACKNOWLEDGMENT

the

p r o s t h e s i s is r e l a t e d t o t h e c o n f i g u r a t i o n o f t h e

T h e a u t h o r w i s h e s to e x p r e s s his a p p r e c i a t i o n

p o s t e r i o r b r i m o f t h e s o c k e t ; w h e n t h e b r i m is n o t

to D r . G u s t a v

of t h e p r o p e r h e i g h t , t h e d i s p l a c e m e n t will b e

Veterans

e i t h e r i n a d e q u a t e o r e x c e s s i v e . T h e fare of t h e

N e w Y o r k . N e w Y o r k , for h i s i n t e r e s t , c o o p e r a

p o s t e r i o r b r i m s h o u l d b e r o u n d e d so as not to c u t

t i o n , a n d a i d w i t h t h e p r e p a r a t i o n of t h i s a r t i c l e .

Rubin, Orthopedic

Administration

Consultant,

Prosthetics

Center.

THE PRESENT USE OF THE

UCBL FOOT ORTHOSIS
Michael J. Quigley, C . P . O .

In A u g u s t 1971, the C o m m i t t e e o n P r o s t h e t i c s
R e s e a r c h and D e v e l o p m e n t ( C P R D ) of the N a
tional R e s e a r c h Council c o m p l e t e d a n e v a l u a t i o n
of four
VAPC

lower-limb
Single-Bar

orthoses. They

were

Knee-Ankle-Foot

the

Orthosis

( K A F O ) . the U C B L Dual Axis A n k l e - F o o t Or

thosis ( A F O ) , the N e w York University

insert

Ankle-Foot Orthosis, and the U C B L Shoe Insert

F o o t O r t h o s i s ( F O ) (Figs. 1 a n d 2). T h e latter t w o
o r t h o s e s w e r e c o n s i d e r e d to be valuable
tions to patient services, and

it w a s

addi

recom

m e n d e d t h a t t h e y b e i n c l u d e d in o r t h o t i c s e d u c a
tion p r o g r a m s (2).

Fig. 2. Principles of the U C B L foot o r t h o s i s applied to

the foot section of a p o l y p r o p y l e n e ankle-foot o r t h o s i s .

To determine

the a c c e p t a n c e

of the

UCBL

s h o e insert foot o r t h o s i s , h o w the t e c h n i q u e w a s

l e a r n e d , a n d s o m e t h i n g a b o u t t h e e x p e r i e n c e s in
the field,
Thirty-five

limited

certified

survey

was

conducted.

orthotics

and

prosthetics-

o r t h o t i c s facilities w e r e s e l e c t e d r a n d o m l y
the

1974 Registry

of Accredited

Facilities

from
(1).

T h i s r e p r e s e n t e d a n equal d i s t r i b u t i o n of p r a c
titioners from t w e n t y cities. T h e questionnaires
( A p p e n d i x A) c o n s i s t e d of a section to be c o m
p l e t e d by the p h y s i c i a n a n d a s e c t i o n to be c o m
Fig. 1. The U C B L foot o r t h o s i s .

pleted
quested

1Staff P r o s t h e t i s t / O r t h o t i s t . C o m m i t t e e on Prosthet
ics R e s e a r c h and D e v e l o p m e n t . National A c a d e m y of
S c i e n c e s , W a s h i n g t o n , D. C. 20418.

by the orthotist. T h e orthotist w a s

to forward

the questionnaire

to

p h y s i c i a n after his s e c t i o n w a s c o m p l e t e d .

re
the
The

q u e s t i o n n a i r e s w e r e s e n t o u t in J a n u a r y 1974. B y
M a r c h 1974. t w e n t y - n i n e of the f o r m s w e r e re-

t u r n e d . T h e following information w a s t a k e n
from these forms.
T h e U C B L foot orthosis w a s used by 75 per
cent [21]of the surveyed practitioners. H o w e v e r ,
only seven of the t w e n t y - o n e practitioners w h o
use this orthosis d o so regularly. Of the remaining
fourteen r e s p o n d e n t s , five use t h e orthosis only
w h e n it is requested by a certain physician, five
rarely use it, two use it for special conditions
only, and one stated he uses the orthosis only as a
last resort.
An a t t e m p t w a s made to d e t e r m i n e how the
practitioners were m a d e a w a r e of the U C B L foot
o r t h o s i s . T h e literature rated as the most c o m
m o n s o u r c e of i n f o r m a t i o n . A r t i c l e s o n t h e
U C B L foot orthosis a p p e a r e d in the Bulletin of
Prosthetics Research (3) in S e p t e m b e r 1969 and
in Orthotics and Prosthetics (4)in March 1972. In
a d d i t i o n . N e w Y o r k U n i v e r s i t y published an
evaluation report (5) on the orthosis in 1969. T h e
prosthetics-orthotics education c o u r s e s were the
second most c o m m o n source of information on
the subject. Word of m o u t h rated as the third
main channel of c o m m u n i c a t i o n s , since s o m e re
s p o n d e n t s stated that orthotists, podiatrists, e t c . ,
had informed t h e m of the t e c h n i q u e .
PRESCRIPTION CONSIDERATION
Eight areas considered to influence the pre
scription and use of the U C B L foot orthosis w e r e
c o v e r e d in the q u e s t i o n n a i r e . T h e most c o m m o n
prescription was bilateral o r t h o s e s for a patient
25-40 years old with pes planus.
T h e pathologies most c o m m o n l y treated with
the U C B L foot orthosis are pes planus and ar
thritis. Following t h e s e , in o r d e r of frequency,
are plantar fasciitis, metatarsalgia, polio, cere
bral palsy and peroneal palsy.
R e s p o n d e n t s indicated that the orthosis is used
equally on males and females and is fitted bilater
ally the vast majority of the time. T h e age groups
that use the U C B L foot orthosis most often are
between 1-12 years of age and b e t w e e n 25-40
years of age.
T h e major disadvantage of using this orthosis is
the e x p e n s e , a fact that was underscored by half
of t h e r e s p o n d e n t s . T h e o t h e r d i s a d v a n t a g e s
c h e c k e d off by the practitioners are that a wider
shoe is s o m e t i m e s n e e d e d , that the orthosis slips
up and d o w n in the shoe, and that breakage oc
c u r s . T w o practitioners felt the orthosis is dif
ficult to fit.

T h e major a d v a n t a g e s of using this orthosis is

that is provides proper foot support, allows the
patient to change s h o e s , eliminates shoe modifi
cations and the need for o r t h o p e d i c s h o e s . T h e
practitioners also felt that the U C B L foot or
thosis provides i m p r o v e d c o s m e s i s and gives
consistent relief from pain.
Most of the r e s p o n d e n t s indicated that the or
thosis usually lasts longer t h a n a year before re
placement is n e c e s s a r y , although a few prac
titioners stated that it only lasts up to one year.
T h e major reason that the U C B L foot orthosis
n e e d s r e p l a c e m e n t is a loss of fit with t i m e .
Breakage is the second most c o m m o n reason re
placement w a s needed. O n e practitioner stated
that he replaces the o r t h o s e s in cases when he
wants to increase progressively the a m o u n t of
foot c o r r e c t i o n .
CASTING, FABRICATION AND FITTING
This part of the survey w a s structured to de
termine if the original t e c h n i q u e is still practiced,
w h a t materials and m e t h o d s are presently used
for fabrication, fitting p r o b l e m s e n c o u n t e r e d and
solutions to these p r o b l e m s .
Nearly e v e r y practitioner stated that he uses
the s a m e m e t h o d of wrapping to obtain the mold
as was d e s c r i b e d originally in the l i t e r a t u r e .
Manual alignment of t h e foot and ankle is prac
ticed by all r e s p o n d e n t s , as is the use of the
c o n t o u r e d casting b o a r d s for positioning the pa
tient. O n e - q u a r t e r of the orthotists use standard
plaster b a n d a g e rather than the elastic type origi
nally r e c o m m e n d e d , and one-third of the or
thotists no longer use the balloon method for
casting.
Polyester resin is used exclusively by eight of
the o r t h o t i s t s , four use both polyester resin and
p o l y p r o p y l e n e , five use p o l y p r o p y l e n e exclu
sively, one uses polyethylene and one uses acryl
ic.
It is interesting that of the seven practitioners
that had breakage p r o b l e m s , six use polyester
resin for fabrication and o n e uses polyethylene.
N o n e of the orthotists that utilize polypropylene
exclusively mentioned breakage p r o b l e m s .
T h e most c o m m o n fitting problem is pain at the
location of the navicular (scaphoid) b o n e , which
is located medially at the apex of the arch of t h e
foot. Shoes being too tight w h e n the orthosis is
w o r n is the next most c o m m o n problem, followed
by pistoning of the foot in the s h o e , and difficul-

ties in establishing t h e trimline at t h e metatarsal

area. O n e practitioner stated that he has his pa
tients acquire a pair of shoes that will a c c o m m o
date t h e o r t h o s i s .
N o n e of t h e orthotists d o a n y shoe modifica
tions in addition to using the U C B L foot o r t h o s i s .
Six orthotists consistently modify t h e foot or
thosis. Wedges and metatarsal relief pads are
added by t w o practitioners. O n e orthotist uses
S p e n c o * buildups, p r e s u m a b l y for better weight
d i s t r i b u t i o n a n d r e d u c t i o n of s h e a r s t r e s s e s .
A n o t h e r adds a Velcro s t r a p o v e r t h e d o r s u m of
the foot t o prevent t h e foot from pistoning. T o
d e c r e a s e t h e sliding of t h e foot orthosis o n the
insole of the s h o e , o n e o r t h o t i s t lines the b o t t o m
surface of the orthosis with moleskin or thin
non-skid rubber.
DISCUSSION
T h e U C B L foot orthosis w a s first publicized in
S e p t e m b e r 1969, and introduced in t h e education
programs in late 1971. T h e fact that 75 p e r c e n t of
the s u r v e y e d practitioners had used t h e orthosis
by J a n u a r y 1974 is a t e s t i m o n y to t h e speed t h a t
p r o v e n r e s e a r c h in this field is applied to t h e
*A foam rubber that is impregnated with nitrogen
bubbles.

patient. P r o b a b l y n o o t h e r medical o r paramedi

cal specialty c a n realize these patient benefits
from r e s e a r c h only four and one-half years after
the initial introduction of a t e c h n i q u e .
T h e utilization of this orthosis m a y d e c r e a s e in
the future as t h e r m o p l a s t i c , t h e r m o f o r m e d
lower-limb o r t h o s e s gain a c c e p t a n c e . H o w e v e r ,
the U C B L foot alignment principles still apply t o
, the foot section of thermoplastic ankle-foot o r t h o
ses and knee-ankle-foot o r t h o s e s , and should be
used w h e n e v e r possible.
REFERENCES
1. American Board for Certification in Orthotics &
Prosthetics, Inc., 1974 Registry of Accredited
and Certified Individuals in Orthotics and

Facilities
Prosthetics,

Washington, D.C., 1974.

2. Committee on Prosthetics Research and De
velopment, A Clinical Evaluation

of Four

Lower-Limb

Orthoses, National Academy of Sciences, Washington,

D.C., 1971.
3. Henderson, W . H . , and J. W. Campbell, UC-BL
shoe insert: casting and fabrication. Bull. Pros. Res.
10-11:215-235, Spring 1969.
4. LeBlanc, Maurice A., Aclinical evaluation offour
lower-limb orthoses. Orth. and Pros. 26:1:27-47,
March 1972.
5. Mereday, C., C.M.E. Dolan, and R. Lusskin,
Evaluation

Planus.

of the UCBL Shoe Insert in "Flexible"

New York University, September 1969.

Pes

APPENDIX A
COMMITTEE ON PROSTHETICS RESEARCH AND DEVELOPMENT
DIVISION OF MEDICAL SCIENCESNATIONAL RESEARCH COUNCIL

NEW PUBLICATIONS

PROCEEDINGS, FIRST INTERNATIONAL

CONGRESS ON PROSTHETICS TECH
NIQUES AND FUNCTIONAL REHABILI
T A T I O N , sponsored by the World Veterans
Federation, with the cooperation of the Inter
national Society for Prosthetics and O r t h o t i c s ,
March 19-24, 1973, Vienna, Austria, 4 Vol
u m e s , 1157 p p . , 300 Austrian Schillings, Avail
able from W e i n e r M e d i z i n i s c h e A k a d e m i e ,
Stadiongasse 6-8, A1010 Vienna, Austria.

pathogenesis and pathological physiology, the

authors have clinical problems primarily in view,
and therefore c o n c e n t r a t e on the possibilities a n d
n e c e s s i t i e s for p r o v i s i o n of o r t h o s e s for t h e
hemophilic patient. F u r t h e r m o r e , the authors de
scribe the possibilities of surgical proceedings in
c a s e of deformities and severe arthrosis defor
m a n s occurring because of intra-articular bleed
ing. It also refers to s y n o v e c t o m y w h e n conser
vative t r e a t m e n t has failed.
In conclusion, one finds directions of manage
ment which are valuable in c a s e of planning a
hemophilia center. The actual problems are
clearly described in this b o o k , and while reading
the papers thoroughly, one can find multiple im
pulses for further r e s e a r c h in this field.

This report contains more than 200 papers pre

sented at the First International C o n g r e s s on
Prosthetics T e c h n i q u e s and Functional Rehabili
tation. Although the papers are short, averaging
about five pages e a c h , and most, therefore, d o
not go into detail, nearly every a s p e c t of research
and practice in limb prosthetics and orthotics is
touched upon. Most of the presentations are con
cerned with p r o s t h e t i c s , and are in English, al
though a few are in G e r m a n and F r e n c h . Al
though few of the articles are well illustrated, this
4-volume publication is an excellent reference
source and should be available to e v e r y o n e in
volved in research in prosthetics and orthotics. It
will be also of t r e m e n d o u s interest to clinicians
w h o want to k e e p up to date by introducing into
their practice the latest findings from research.

F. K o c h (Heidelberg)

A D V A N C E S IN E X T E R N A L C O N T R O L O F
H U M A N E X T R E M I T I E S , Proceedings of the
F o u r t h International S y m p o s i u m o n External
Control of H u m a n E x t r e m i t i e s , D u b r o v n i k ,
August 28-September 2, 1972; Edited by M o m cilo M. Gavrilovic and A. B e n n e t t Wilson, J r . ,
Yugoslav C o m m i t t e e for Electronics and Au
tomation ( E T A N ) , Belgrade, Yugoslavia, 803
p p . $20.
As indicated in the title, this massive volume is
c o m p o s e d of the papers p r e s e n t e d at the F o u r t h
International S y m p o s i u m on External Control of
H u m a n E x t r e m i t i e s . This series of s y m p o s i a con
t i n u e s to a t t r a c t m o r e a n d m o r e w o r k e r s
throughout t h e world w h o are engaged in re
search and d e v e l o p m e n t c o n c e r n i n g externally
p o w e r e d p r o s t h e s e s and o r t h o s e s and related
work such as the stimulation of d e n e r v a t e d m u s
cle for function. This is not a b o o k that most
clinicians will want to do more than p e r u s e , but it
is a publication that all people involved in re
habilitation engineering r e s e a r c h and d e v e l o p
ment should have b e c a u s e it contains information
concerning nearly every past and present project
in the field of externally p o w e r e d prostheses and
o r t h o s e s , plus a great deal more in allied a r e a s .

COMPREHENSIVE MANAGEMENT OF
M U S C U L O S K E L E T A L D I S O R D E R S IN
H E M O P H I L I A , ( R e p o r t of) A S y m p o s i u m
held in Miami B e a c h , Florida, O c t o b e r 12-14,
1972; edited by N e w t o n C. McCollough, III,
C o m m i t t e e on Prosthetics R e s e a r c h and De
v e l o p m e n t , National A c a d e m y of S c i e n c e s ,
W a s h i n g t o n , D . C . , U . S . A . , 214 pp, $6.25.
This book contains the lectures and following
d i s c u s s i o n s which w e r e given during a sym
posium about the m e t h o d s of treating musculo
skeletal disorders in hemophilia.
T h e result is a rather complete synopsis of the
present level of knowledge in the problems of
hemophilia. Besides a lucid and u n d e r s t a n d a b l e
representation
of q u e s t i o n s
concerning
65

66

NEW

PUBLICATIONS

THE CARE OF THE RHEUMATOID HAND,

Third Edition, by Adrian Flatt, The C. V.
M o s b y C o . , St. L o u i s , 1974, 296 p p . , $24.75.
T h e t h i r d e d i t i o n of " T h e C a r e of t h e
Rheumatoid H a n d " is a r a t h e r major revision of
the second edition of this definitive text on the
rheumatoid upper limb which was published in
1968.

REHABILITATION
AFTER
CENTRAL
N E R V O U S S Y S T E M T R A U M A , edited b y
H a r r y B o s t r o m , Tage L a r s s o n , and Nils
L j u n g s t e d t , N o r d i s k a B o k h a n d e l n s Forlag,
S t o c k h o l m , 255 p p . , 1974.
This book is a report of an international sym
posium sponsored in 1973 by the Skandia G r o u p .
Fifteen p a p e r s , and ensuing discussion, on vari
ous a s p e c t s of rehabilitation of individuals suffer
ing from central nervous system disorders are
included.

BULLETIN OF PROSTHETICS RESEARCH,

F A L L 1973, (BPR 10-20), U . S . V e t e r a n s Ad
ministration, 390 p p . , 190 illus., available from
S u p e r i n t e n d e n t of D o c u m e n t s , U . S . G o v e r n
ment Printing Office, W a s h i n g t o n , D . C . 20402;
$3.15 (payable in a d v a n c e ) .
Featured

in This

Issue:

" T h e M o r e Things C h a n g e , the M o r e T h e y Stay

the S a m e " T . J. Radley
Displacement Sensors and Their Application to
Control of Synthetically P o w e r e d P r o s t h e s e s
and O r t h o s e s C . H . Hoshall
E x p e r i m e n t a l Evaluation of Wheelchair Cush
ions: R e p o r t o f a Pilot S t u d y G . V . B . C o c h r a n
and G. Slater
Swivel Walkers for ParaplegicsConsiderations
and P r o b l e m s
in T h e i r
Design
and
ApplicationG. K. R o s e and J. T. H e n s h a w
Functional Electrical StimulationA N e w H o p e
for P a r a p l e g i c P a t i e n t s ? A . Kralj and S.
Grobelnik
Transferring L o a d to F l e s h P a r t V I . S o c k e t
Brim Radius EffectsL. B e n n e t t

1974 C O N F E R E N C E O N E N G I N E E R I N G
D E V I C E S IN R E H A B I L I T A T I O N , Biomed
ical E n g i n e e r i n g C e n t e r , Tufts U n i v e r s i t y ,
B o s t o n , M a s s a c h u s e t t s , Richard A. Foulds
and B r e n d a L. L u n d , e d s . , 150 p p . , $20.
This is a collection of 36 papers given at the
1974 Conference on Engineering Devices in Re
habilitation, held May 2-3, and sponsored by the
Biomedical Engineering Center, Tufts-New En
gland Medical C e n t e r , Medical Rehabilitation
R e s e a r c h and Training C e n t e r , Tufts University,
the D e p a r t m e n t of Physical and Rehabilitation
Medicine, Tufts University, and the Rehabilita
tion Institute of the N e w England Medical C e n t e r
Hospital. Included are papers on " S e n s o r y Im
p a i r m e n t , " " B l i n d n e s s and Low V i s i o n s , "
" T e l e p h o n e A i d s , " " S e n s o r y Control and Feed
b a c k , " " L o c o m o t i o n and M o b i l i t y , " " I n n o v a
tive P r o g r a m s , " and " D e a f n e s s . " Because the
papers were presented voluntarily, this report by
no m e a n s c o v e r s the fields.
N e v e r t h e l e s s , s o m e relatively new c o n c e p t s
are offered in this well-edited and nicely pre
sented publication, and though the price seems
e x c e s s i v e , it should be included in e v e r y library
collection o n rehabilitation r e s e a r c h .

A Method of Recording Pressure Distribution

U n d e r the Sole of the F o o t P . L e r e i m and F .
Serck-Hanssen
T h e E x t r a - A m b u l a t o r y L i m b C o n c e p t as it Ap
plies to the B e l o w - K n e e A m p u t e e SkierJ. M.
G r a v e s and E . M. Burgess
B i o e n g i n e e r i n g D e s i g n a n d D e v e l o p m e n t of
L o w e r - E x t r e m i t y O r t h o t i c D e v i c e s H . R.
L e h n e i s , W. Frisina, H . W. M a r x , a n d T a m a r a
T. Sowell
Semiflexible Body Jacket with Inflatable
PadsJ. M. M o r r i s , K. L. Markolf, and H .
Hittenberger
A b s t r a c t of a S u m m a r y Report o n R e s e a r c h and
D e v e l o p m e n t in the Field of Artificial L i m b s
(July 1973)H. A. M a u c h
Abstract of a S u m m a r y Report on the D e v e l o p
ment of a Reading Machine for the Blind (July
1973)G. C. Smith and H. A. M a u c h
C o m m i t t e e on Prosthestics Research and De
v e l o p m e n t , C o m m i t t e e on Prosthetic-Orthotic
E d u c a t i o n , D i v i s i o n of M e d i c a l S c i e n c e s
National Research Council, National
A c a d e m y of SciencesNational A c a d e m y of
E n g i n e e r i n g , Annual S u m m a r y R e p o r t A c
tivities for Y e a r E n d e d J u n e 30, 1973

NEW

VA Prosthetics Center Research

S t a r o s and E . Peizer

PUBLICATIONS

ReportA.

Highlights of O t h e r VA R e s e a r c h Programs
P r o s t h e t i c s E d i t e d by E . F . M u r p h y
S e n s o r y AidsEdited by H . Freiberger
Related Items of Interest
How to Purchase Previous
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dent of D o c u m e n t s are:
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Spring 1970
Fall 1970 at
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American countries e x c e p t Argentina, Brazil,
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m e n t s . U N E S C O c o u p o n s may also be used.
Foreign money orders and postage stamps are
not
acceptable.

THE MANAGEMENT OF
MUSCULO
SKELETAL
PROBLEMS
IN
THE
H A E M O P H I L I A S , by R. B. Duthie, J. M.
M a t t h e w s , C. R. R i z z a , a n d W . M. S t e e l ,
Blackwell Scientific Publications, Osney
M e a d , O x f o r d O X 2 O E L , E n g l a n d , 179
p p . 5. [In the U . S . and C a n a d a , o r d e r from J.
B. Lippincott C o m p a n y , P . O . Box 7, Philadel
phia, Pennsylvania 19105, $20.00]
T h e " b l e e d i n g " disease has been disastrous to
dynasties. It can also be disastrous to families.
F o r most sufferers in developed countries, the
fear of bleeding to death from minor t r a u m a has

67

b e e n largely r e m o v e d by t h e t r e a t m e n t s d e
veloped o v e r the past forty y e a r s . T h e fear of
p r o g r e s s i v e and d i s a s t r o u s crippling h a s r e
mained and indeed b e c o m e s greater with the sur
vival into adult life. T h e p r o p e r use of blood
derivatives which are n o w available should now
prevent severe musculoskeletal complications in
all but exceptional c i r c u m s t a n c e s . This n e e d s
c o n s t a n t supervision and skilled c a r e .
A recent survey (1972) by the U . S . National
H e a r t and Lung Institute s h o w e d that there are
a p p r o x i m a t e l y 25,500 m o d e r a t e to s e v e r e
haemophiliacs in the United S t a t e s . An estimated
10,800 physicians were treating these patients of
w h o m o v e r 60 percent had only o n e patient.
O t h e r countries m a y have better m a n a g e m e n t
than this; but until all sufferers from haemophilia
are under expert c a r e , it will remain a gross crip
pling disease.
Oxford has been in the forefront of r e s e a r c h
into the c a u s e and care of these d i s e a s e s . This
book is a distillate of their experience of the man
a g e m e n t of musculoskeletal sequelae in o v e r
1,000 patients.
T h e first three c h a p t e r s review the etiology a n d
medical m a n a g e m e n t . Following c h a p t e r s dis
cuss the m a n a g e m e n t of acute episodes such as
bleeding into j o i n t s , m u s c l e s , n e r v e s and the
management of fractures. A c h a p t e r o n c y s t s and
p s e u d o t u m o r s provides a bridge b e t w e e n t h e
a c u t e and c h r o n i c . C h a p t e r s o n c h r o n i c ar
t h r o p a t h y and reconstructive surgery follow. Fi
nally, there is a chapter on p h y s i o t h e r a p y .
T h e r e will be minor differences of opinion
about s o m e a s p e c t s of t r e a t m e n t such as t h e u s e
o r a b u s e of b l o o d d e r i v a t i v e s in l o n g - t e r m
prophylaxis, particularly self-administered in the
h o m e . There are those w h o would not agree with
the policy of aspiration of h a e m a r t h r o s i s .
T h e r e is no reference to orthotics principles,
either of a t e m p o r a r y or p e r m a n e n t material or
for intermittent or prolonged use. T h e index gives
two references to calipers and a n u m b e r of refer
ences to splints, but the text gives no detail of fit
or structure.
The layout and printing are of high quality. T h e
illustrations are well r e p r o d u c e d and opposite to
the text. T h e uninformed should not be treating
haemophilia. T h e informed will find much in this
book to s u p p l e m e n t their k n o w l e d g e , and it will
surely find a place in their libraries.
E. E. Harris. M . R . C . S .

68

NEW

PUBLICATIONS

PUBLICATIONS AVAILABLE
FROM CPRD/CPOE
T h e following is a partial list of reports of
w o r k s h o p s , symposia, e t c . , s p o n s o r e d by the
C o m m i t t e e s on Prosthetics R e s e a r c h and De
velopment and P r o s t h e t i c - O r t h o t i c E d u c a t i o n
(CPRD-CPOE),
National
Academy
of
SciencesNational Research Council, which are
currently available.
Individual copies of these reports are available
as long as the supply lasts without charge unless
o t h e r w i s e indicated. A d d r e s s requests to C o m
mittee on Prosthetics R e s e a r c h and D e v e l o p
m e n t , National A c a d e m y of S c i e n c e s , 2101 Con
stitution A v e n u e , N . W . , Washington, D.C.
20418.
Annual summary report, activities for year end
ing J u n e 30, 1973, C o m m i t t e e o n Prosthetics
Research and Development,
National
A c a d e m y of S c i e n c e s .
Below-knee and above-knee prostheses, report of
a w o r k s h o p held J a n u a r y 27-29, 1973, in Seat
tle, W a s h i n g t o n .
Below-knee prosthetics,
report of a s y m p o s i u m
held D e c e m b e r 16-18,1968, in N e w Y o r k C i t y .
Bracing of children with paraplegia
resulting
from spina bifida and cerebral palsy, report of
a w o r k s h o p held O c t o b e r 2-4, 1969, in Char
lottesville, Virginia.
The cane as a mobility aid for the blind, report of
a c o n f e r e n c e held S e p t e m b e r 10-11, 1971,
Washington, D.C.
Cast-bracing of fractures, report of a w o r k s h o p
held J a n u a r y 27-28,1971, in Denver, C o l o r a d o .
The child with an acquired amputation, report of
a s y m p o s i u m held J u n e 9-11, 1970, in T o r o n t o ,
O n t a r i o , C a n a d a . Available from: N a t i o n a l
A c a d e m y of S c i e n c e s , Printing and Publishing
Office, 2101 C o n s t i t u t i o n A v e n u e , N . W . ,
W a s h i n g t o n , D. C. 20418. Price $5.50.
Clinical evaluation of the Ljubljana
functional
electrical peroneal brace, R e p o r t E-7, 1973.
Clinical evaluation of a comprehensive
approach
to below-knee orthotics, Report E-6, 1972.
Comprehensive
management of
musculoskeletal
disorders
in hemophilia,
r e p o r t of a s y m
posium held O c t o b e r 12-14, 1972, in Miami
B e a c h , F l o r i d a . A v a i l a b l e from: N a t i o n a l
A c a d e m y of S c i e n c e s , Printing and Publishing
Office, 2101 C o n s t i t u t i o n A v e n u e , N . W . ,
Washington, D . C . 20418. Price $6.25.

Cosmesis and modular limb prostheses,

a report
of a conference held M a r c h 3-7, 1971, in San
F r a n c i s c o , California.
The effect of pressure on soft tissues, a report on
a w o r k s h o p held S e p t e m b e r 21-22, 1971, in
Houston, Texas.
Eighth workshop
panel on
lower-extremity
prosthetics fitting of the S u b c o m m i t t e e o n D e
sign and D e v e l o p m e n t , D e c e m b e r 14, 1964,
Miami B e a c h , Florida.
Evaluation
of sensory
aids for the
visually
handicapped,
a report on a conference held
N o v e m b e r 11-12, 1971, in W a s h i n g t o n , D . C .
Evaluation of synthetic balata for
fabricating
sockets for below-knee
amputation
stumps,
Report E - 3 , 1970.
Functional neuromuscular stimulation,
a w o r k s h o p held April 27-28,
B e t h e s d a , Maryland.

report of
1972, at

The geriatric amputee: principles of manage

ment, proceedings of a w o r k s h o p held J u n e 9-10,
1969, in W a s h i n g t o n , D . C . Available from: Na
tional A c a d e m y of S c i e n c e s , Printing and P u b
lishing Office, 2101 Constitution A v e n u e , N . W . ,
W a s h i n g t o n , D . C . 20418. Price $3.50.
Internal structural prostheses,
report of a work
s h o p held April 13-15, 1972 in Charlottesville,
Virginia.
A preliminary
evaluation
Instruments
Veterans
S e p t e m b e r 1973.

of

the
Bionic
Administration,

Pressure and force measurement,

r e p o r t of a
w o r k s h o p held May 27-28, 1968, in N e w York
City.
Rehabilitation
engineering: a plan for continued
progress,
April 1971, Washington, D . C .
Selected
lower-limb
anomaliessurgical
and
prosthetics
management,
r e p o r t of a sym
posium held May 8-9, 1969, in Washington, D.
C . Available from National A c a d e m y of Sci
e n c e s , Printing and Publishing Office. 2101
Constitution Avenue, N . W . , Washington,
D . C , 20418. Price $2.95.
Seventh
workshop
panel on
lower-extremity
orthotics of the S u b c o m m i t t e e of Design and
D e v e l o p m e n t , M a r c h 9-12, 1970, D o w n e y ,
California.

Seventh workshop
panel on
upper-extremity
prosthetics of the Subcommittee on Design and
Development, Externally Powered Terminal
D e v i c e s July 3 0 - 3 1 , 1969, Santa M o n i c a ,
California.
Spinal orthotics,
report of a w o r k s h o p held
March 28-29, 1969, in San Francisco, Califor
nia.

The Veterans Administration

Prosthetics
Center
patellar-tendon-bearing
brace-clinical
applications,
Report E-2, 1970.
Workshop on knee-disarticulation
prosthetics
of
the Subcommittee on Design and D e v e l o p
ment, held June 22-23, 1970, San Francisco,
California.

70

INFORMATION FOR AUTHORS

O R T H O T I C S AND P R O S T H E T I C S
INVITES THE SUBMISSION O F ALL ARTICLES AND M A N U S C R I P T S
WHICH CONTRIBUTE T O ORTHOTIC AND
P R O S T H E T I C PRACTICE, R E S E A R C H , AND
EDUCATION
All s u b m i t t e d m a n u s c r i p t s s h o u l d i n c l u d e :
1. THE ORIGINAL MANUSCRIPT AND T W O C O P I E S . If p o s s i b l e , t h e d u p l i c a t e m a n u s c r i p t s
s h o u l d b e c o m p l e t e with i l l u s t r a t i o n s t o facilitate review a n d a p p r o v a l .
2. BIBLIOGRAPHY. T h i s s h o u l d b e a r r a n g e d a l p h a b e t i c a l l y a n d c o v e r only r e f e r e n c e s m a d e in
t h e b o d y of t h e t e x t .
3. L E G E N D S . Listall illustration l e g e n d s in o r d e r , a n d n u m b e r t o a g r e e with i l l u s t r a t i o n s .
4. ILLUSTRATIONS. P r o v i d e a n y o r all of t h e following:
a. B l a c k a n d w h i t e g l o s s y p r i n t s
b. Original d r a w i n g s o r c h a r t s
Donot s u b m i t :
a. S l i d e s ( c o l o r e d o r b l a c k & white)
b. P h o t o c o p i e s
PREPARATION O F MANUSCRIPT
1.
2.
3.
4.
5.
6.

M a n u s c r i p t s m u s t b e TYPEWRITTEN, D O U B L E - S P A C E D a n d h a v e WIDE MARGINS.

I n d i c a t e F O O T N O T E S by m e a n s of s t a n d a r d s y m b o l s (*).
I n d i c a t e BIBLIOGRAPHICAL R E F E R E N C E S by m e a n s of A r a b i c n u m e r a l s in p a r e n t h e s e s (6).
Write o u t n u m b e r s l e s s t h a n t e n .
Do n o t n u m b e r s u b h e a d i n g s .
U s e t h e w o r d " F i g u r e " a b b r e v i a t e d to i n d i c a t e r e f e r e n c e s t o i l l u s t r a t i o n s in t h e text (. . . a s
s h o w n in Fig. 14)
PREPARATION O F ILLUSTRATIONS

1.
2.
3.
4.
5.
6.
7.

N u m b e r all i l l u s t r a t i o n s .
On t h e b a c k i n d i c a t e t h e t o p of e a c h p h o t o or c h a r t .
Write t h e a u t h o r ' s n a m e o n t h e b a c k of e a c h illustration.
Do n o t m o u n t p r i n t s e x c e p t with r u b b e r c e m e n t .
U s e c a r e with p a p e r c l i p s ; i n d e n t a t i o n s c a n c r e a t e m a r k s .
Do n o t write o n p r i n t s ; i n d i c a t e n u m b e r , l e t t e r s , o r c a p t i o n s o n a n overlay.
If t h e illustration h a s b e e n p u b l i s h e d p r e v i o u s l y , p r o v i d e a c r e d i t line a n d i n d i c a t e r e p r i n t
permission granted.

NOTES:
M a n u s c r i p t s a r e a c c e p t e d for e x c l u s i v e p u b l i c a t i o n in O R T H O T I C S AND P R O S T H E T I C S .
A r t i c l e s a n d i l l u s t r a t i o n s a c c e p t e d for p u b l i c a t i o n b e c o m e t h e p r o p e r t y of O R T H O T I C S AND
PROSTHETICS.
R e j e c t e d m a n u s c r i p t s will b e r e t u r n e d within 6 0 d a y s .
P u b l i c a t i o n of a r t i c l e s d o e s n o t c o n s t i t u t e e n d o r s e m e n t of o p i n i o n s a n d t e c h n i q u e s .
All m a t e r i a l s p u b l i s h e d a r e c o p y r i g h t e d by t h e A m e r i c a n O r t h o t i c a n d P r o s t h e t i c A s s o c i a
tion.
P e r m i s s i o n t o r e p r i n t is u s u a l l y g r a n t e d p r o v i d e d t h a t a p p r o p r i a t e c r e d i t s a r e g i v e n .
A u t h o r s will b e s u p p l i e d with 2 5 r e p r i n t s .

RESOLUTION CONCERNING THE METRIC SYSTEM

T h e following resolution w a s adopted by the Board of Directors of the American
O r t h o t i c and P r o s t h e t i c A s s o c i a t i o n at its m e e t i n g in S a n D i e g o O c t o b e r 3 , 1973:
W H E R E A S b y A c t o f C o n g r e s s it h a s b e e n d e t e r m i n e d that the U n i t e d
S t a t e s s h o u l d p r o c e e d t o w a r d s a d o p t i o n o f t h e m e t r i c s y s t e m as u s e d
a l m o s t u n i v e r s a l l y t h r o u g h o u t the rest o f the w o r l d , and
W H E R E A S t h e t e c h n o l o g i c a l p r o f e s s i o n s and m a n y s e g m e n t s o f t h e
health p r o f e s s i o n s h a v e c o m m o n l y u s e d t h e m e t r i c s y s t e m o v e r an e x
tended period of time, and
W H F R E A S it is i m p o r t a n t for m e m b e r s o f the o r t h o t i c / p r o s t h e t i c pro
f e s s i o n s to interact w i t h their c o l l e a g u e s in the m e d i c a l and t e c h n o l o g i
cal c o m m u n i t i e s for o p t i m u m patient s e r v i c e b e it h e r e b y
R E S O L V E D that t h e A m e r i c a n O r t h o t i c and P r o s t h e t i c A s s o c i a t i o n
e n d o r s e s the u s e o f t h e m e t r i c s y s t e m b y its m e m b e r s and o t h e r o r t h o t i c
and p r o s t h e t i c p r a c t i t i o n e r s in t h e U n i t e d S t a t e s , a n d in w i t n e s s o f this
e n d o r s e m e n t and A s s o c i a t i o n u r g e s the e d i t o r s o f its j o u r n a l
Orthotics
and Prosthetics
to c o m m e n c e the dual r e p o r t i n g o f w e i g h t s and
m e a s u r e m e n t s in b o t h t h e E n g l i s h and m e t r i c s y s t e m s at the earliest
possible date with the objective o f e m p l o y i n g the metric s y s t e m solely
by t h e t i m e o f t h e 29th V o l u m e in 1975.

72

METRIC SYSTEM
Conversion Factors

LENGTH
Equivalencies
1 x 1 0 - meter ( 0 . 0 0 0 0 0 0 0 0 0 1 m)
angstrom
) x 1 0 - meter ( 0 . 0 0 0 0 0 0 0 0 1 m)
millimicron*
micron (micrometer) = 1 x 1 0 - meter ( 0 . 0 0 0 0 0 1 m)
1 0

To Convert from
inches
feet
yards
miles

To

Multiply by

meters
meters
meters
kilometers

0.0254+
0.30480+
0.91440+
1.6093

square meters
square meters

.092903

AREA

To convert from
square inches
square feet

0.00063616+

VOLUME
Definition
3

1 liter = O.OOlt cubic meter or one cubic decimeter ( d m )

(1 milliliter = I t cubic centimeter)

To convert from

To

cubic inches
ounces (U.S. fluid)
ounces (Brit, fluid)
pints ( U . S . fluid)
pints (Brit, fluid)
cubic feet

cubic
cubic
cubic
cubic
cubic
cubic

MASS
To convert from
pounds (avdp.)
slugs*
FORCE
To convert from

Multiply by
16.387
29.574
28.413
473.18
568.26
0.028317

centimeters
centimeters
centimeters
centimeters
centimeters
meters

To
kilograms

Multiply by
0.45359
14.594

kilograms

Multiply by

To

ounces-force (ozf)
0.27802
newtons
ounces-force (ozf)
0.028350
kilogram-force
pounds-force (lbf)
4.4732
newtons
pounds-force (lbf)
0.45359
kilogram-force
This double-prefix usage is not desirable. This unit is actually a nanometer (10- meter = 10- centimeter).
+ For practical purposes all subsequent digits are zeros.
9

73

STRESS (OR PRESSURE)

To convert from

To

Multiply by

newton/square meter
newton/square centimeter
kilogram-force/square centimeter

6894.8
0.68948
0.070307

To

Multiply by

newton meter
kilogram-force meters

1.3559
0.13826

pounds-force/square inch (psi)

pounds-force/square inch (psi)
pounds-force/square inch (psi)
TORQUE (OR MOMENT)
To convert from
pound-force-feet
pound-force-feet
ENERGY (OR WORK)

Definition
One joule (J) is the work done by a one-newton force moving through a
displacement o f one meter in the direction of the force.
1 cal ( g m ) = 4 . 1 8 4 0 joules
To convert from
foot-pounds-force
foot-pounds-force
ergs
b.t u.
foot-pounds-force

To

Multiply by

joules
meter-kilogram-force
joules
cal (gm)
cal (gm)

1.3559
0.13826
1 x 10- f
252.00
0.32405
7

TEMPERATURE CONVERSION TABLE

T o convert F to C
1.8
F
98.6
99
99.5
100
100.5
101
101.5
102
102.5
103
103.5
104

C
37
37.2
37.5
37.8
38.1
38.3
38.6
38.9
39.2
39.4
39.7
40.0

*A slug .is a unit of mass which if acted o n b y a force of o n e p o u n d will have an acceleration of o n e foot per
second per second.

74

NEW ABC CERTIFIED PRACTITIONERS

T h e following c a n d i d a t e s successfully participated in the 1974 practitioner examinations of the
American B o a r d for Certification in Orthotics and P r o s t h e t i c s , Inc. and have been a w a r d e d certifica
tion in t h e indicated discipline.
Certified Orthotist

Certified Prosthetist

Barney, James A.
Blommaerts, Frank J.
Boles, Marvin L.
Bostock, Frank H.
Burgess, Morgan L.
Butler, Vernon H.
Campbell, John W.
Cash, Lewis W., Jr.
Craig, John G.
Daniels, Frank S.
Dettmer, Mark S.
Erskine, Stevan A.
Finger, Joe M.
Griffith, Steven T.
Guenther, Galen G.
Hall, Michael T.
Hardcastle, David D.
Hooper, Clarence R.
Kincer, Richard D.
Koch, Larry D.
Lamberty, Eugenio A.
Long, Danny E.
Luri, Alan E.
Mattingly, Leslie G.
McCulloch, Robert S.
Newton, Timothy J.
Palumbo, Robert L.
Pascavage, Joseph L.
Quirantes, Alberto
Ramcharran, Sooklall
Roman, Donald A.
Sanchez, Teofilo
Schulte, John F.
Showers, David C.
Sims, Terry T.
Strasser, Jarl V.
Supan, Terry J.
Tazawa, Eiji
Thompson, Harold E., Jr.
Topolewski, Ralph T.
Tosoonian, Ronald F.
Trexler, Gary S.
Tucker, Lonnie B.
Weintrob, Joan C.
Whiteside, Steven R.

Arthur, Robert W.
Barnhart, David W.
Barton, Calvin C.
Berman, Kenneth M.
Byers, James L.
Chadwell, Benjamin E.
Chagnon, Kenneth L.
Chang, Chung-Woo S.
Chang, Thomas C.
Cummings, William L.
Dillard, John C.
DiPompo, Michael
DiSanto, Anthony R.
Doran, Robert E.
Douglas, Roy D.
Dralle, Alan J.
Ellepola, Wijegupta M.B.
Elliott, Gene
England, Michael F.
Floyd, F. Michael
Garcia, Manuel R.
Garrett, James A.
Goff, James B.
Goodman, Donald O.
Guth, Thomas
Gruman, Gregory S.
Hall, Larry J.
Hall, Robert C.
Hansford, David P.
Harshberger, Jerald J.
Henson, Rodney D.
Janulaitis, Erdvilis
Jiuiden, Roger L.
Kegg, Larry O.
Kidd, Ronald L.
Klotz, John S.
Konigismann, Gunter
Leimkuehler, Robert V.
Lessar, John J.
Logos, James F.
Love, Jerry E.
McMorris, J. R.
Mitchell, Walter R.
Nederveld, Douglas A.
Potter, Gordon J.
Racette, Walter L.
Reger, Steven I.
Rodriguez, Jose R.
Ross, Ralph J.
Ruzich, John W.

Sandberg, Daryl W.
Shamp, N. Joseph
Sosnoff, Harvey
Tempfel, Ernest F.
Tindall, David N.
Tirimacco, Philip S.
Wake, Charles F.
Warren, Jonathan P.
Wooten, Jan L.
Ybarra, Robert
Yennie, Marvin D.
Certified Prosthetist/Orthotist
Booden, Jack, Jr.
Brace, David A.
Brelsford, Bill B.
Brown, Robert N.
Caspers, Carl A.
Conner, Roger D.
Doyle, William
Filippis, Eugene D.
Fullerton, Jerry D.
Goller, Herbert
Green, Kenneth D.
Kintz, John J.
Kramer, Herbert E.
Lane, L. D., Jr.
Lindberg, Paul T.
Marvin, Raymond W.
Mereday, Clifton S.
Meyers, Gerald G.
McManamon, Patrick J.
Morris, Louis C.
Neumann, William C.
Panton, Hugh J.
Parmley, Andrew J.
Prince, Marvin M.
Schumacher, Paul
Shallow, Steven C.
Silver, Eugene P.
Sima, Francis R.
Simons, Bernard C.
Stubbs, William V.
Thranhardt, Howard E.
Tippy, Leo V.
Trautman, Paul A.
Truesdale, Donald C.
Vinnecour, Keith E.
Wunder, Kenneth E.
Yanke, Mark J.
Yocham, Johnie L.

READY TO FIT HAND, WRIST AND FINGER BRACES,

CERVICAL BRACES, TRAINING AIDS AND SPECIAL
APPLIANCES - PLUS A COMPLETE LINE OF SPINAL
AND LEG BRACES CUSTOM MANUFACTURED TO
YOUR MEASUREMENTS.
COMPLETE CATALOG AVAILABLE ON REQUEST

C. D. DENISON ORTHOPEDIC APPLIANCE CORP.

220 W. 28th Street - Baltimore, Md. 21211

XIII

SUPPLIERS TO
PROSTHETIC & ORTHOTIC FACILITIES
Complete Line Of
Components & Supplies
For
Immediate Post Operative
Prosthetic Fittings
FOR IMMEDIATE

dm

ORLON LYCRA STUMP SOCKS

Rotted
Ready For
Application

4 Par Carton

Write

for

Complete

Information

Post O p e r a t i v e P r o s t h e t i c

Fitting!

COMFORT Alt
CURITY
LAMBS
WOOL

AMPUTALC
AMP-AID
STUMP-SPRAY
AMPU-BALM
'

1 oz.

MANNEQUIN

MARATHON
SE'SALVE

Packages

FINISH

FOR A R T I F I C I A L LIMBS
FIVE COLORS TO CHOOSE
FROM

CANE & CRUTCH

TIPS

DENIS BROWNE

PILLOW & SPLINTS

FOR HIP ABDUCTION

NIGHT

SPLINTS

KNIT-RITE, I N C
1121 G R A N D AVENUE K A N S A S CITV. MISSOURI 6 4 1 0 6
PHONE: 8 1 6 - 2 2 1 - 0 2 0 6

XIV

TORONTO

TRILATERAL

ORTHOLEN

* PELITE

ARCH SUPPORTS
POSTERIOR SPLINTS
SHEETS

P. O. BOX 1 6 7 8

SOFT, MED., & FIRM

POLYETHYLENE
FOAM
PADDING

ORTHOPEDIC
Established 1914
CHATTANOOGA. TENN.

XV

37401

Riaidlv
spinal

Spinal appliances a r e our only

p r o d u c t . T h e y ' r e sold only through
ethical dispensing o r t h o t i s t s . So
we t r y t o m a k e each of our collars a n d
braces t h e best of its kind - like
our new T w o - P o s t Cervical Brace -

im'I f

m a x i m u m a c c e p t a n c e by your
doctors and p a t i e n t s . And we
back t h e m u p with service t o you.
Service like 24-hour delivery of
prescription braces a n y w h e r e
in t h e c o u n t r y . P l u s a price
s t r u c t u r e t h a t can m a k e
!
our service your m o s t
profitable w a y - t o fill spinal
appliance prescriptions.
F o r m o r e information,
write P . 0 . Box 1299,
W i n t e r P a r k , F l o r i d a 32789.

or

Florida Brace Corporation

XVI

T h e Kingslcy S a c h Foot

For men, women, and children,

the Kingsley S a c h Foot is
a union of durable Medathane
and natural carved hardwood.
The Kingsley process
features three densities
of Medathane in one mold,
curing simultaneously.
The entire length
of the sole is reinforced
with two-ply nylon fabric
for long term durability.
The Kingsley S a c h Foot offers
every patient the essential security
which leads to maximum independence.
Write for complete

catalog.

1984 PLACENTIA AVENUE COSTA MESA, CALIFORNIA 92627 (714) 548

XVII

Sutton's SJ/4 Jack Sander.. .

YOU'LL HAVE AN ATTACHMENT FOR IT!
Or maybe 23 optional attachments. Sutton is an old pro at
making jack sanders. They know what limb & brace makers
want and need, and you can get it all in the SJ/4. Two 4" x
60" fast cutting, quick-change belts; a great dust collector;
front-opening dust drawer; iy hp motor; big shelf. Use full
belt width for faster leveling. Three other models available.
Write today!
2

<

5
Sure w e
take trades
Financing may
be a r r a n g e d
MADE IN USA

f t

n S4ee "7fCc&*vuf

P. O. OX 99*0 SI. IOUIS, MO. 63122 1314) 22S-535S

Send dope on SJ/4 and other jack sanders

Send complete Sutton catalog
Name
Shop
Address
.State.
Telephone.
City

-Zip_

Reman
Supports
'Dealer
^equiiements
from head
to toe
Dealers count on Freeman for a complete line of
Surgical Support garments , . , and wc don't disappoint
them. If it's a body support item from elastic hose
to cervical collars, chances are that Freeman makes it; at
reasonable cost. To insure prompt delivery Freeman
established four warehouses across the country. Dealers
call their nearest warehouse (collect) and receive shipment
within 24 h o u r s . . . less transportation charge; less dealer
inventory required. Complete, high quality line and
fast service . . . just a few ways in which Freeman supports
dealer needs. Write for free catalog and complete
information on Freeman products.

Modti use
Chair Baca Biaca
Knlohttyp, AOov,
right. Modal Ml,

Aaoman
FREEMAN MFG CO
Box J, Slurgis, Mich 49091

FREEMAN WAREHOUSES:
Ephrata, Pennsylvania 17522, P.O. Box 277, phone 717-733-4261
Sturgis, Michigan 49091, P.O. Box J, phone 616-651-2371
Anniston, Alabama 36201, P.O. Box 1791, phone 205-237-0611
West Covina, California 91790, 1148 E. Garvey, phone 213-338-1618

XIX

Cut it. Mold it. Bend it. Shape it.

No other splint material works so easily.
Wrap around any contour Lena support to any injured
body pari With attractive ORTHOPLAST* Splints, the
most versatile splinting material available
A lightweighl low-heat thermoplastic featunng maxi
mum ability lo be molded
Strong, cohesive, can be made to adhere to itself
without glue, simply by heating.
Can bo riveted, strapped, braced, hinged, bonded,
butt-bonded to suit all your splinl-ongineenng needs.

xx

(Can also be reheated and remolded to retil an improv

ing patient whose splint needs have changed)
Educational literature, medical reprints, splint palterns and samples may be obtained by writing to De
partment J-235, Johnson & Johnson, New Brunswick,
New Jersey 08903

ORTHOPLAST Splints

Sabel gets
all the breaks..

S l o p i n g , p a d d e d , n o - c h a f e t o p line.
E x t r a w i d e , 7" p a d d e d t o n g u e
accommodates swellings and bandaging.

Heavy foam
interlining w i t h
soft, g l o v e
l e a t h e r lining
throughout.

Pre-drilled holes
in s t e e l s h a n k
are marked and
l o c a t e d on
l e a t h e r insole.

with the all-purpose

AM-BOOT!
T h e m o s t versatile a n d a c c o m m o d a t i n g b o o t
e v e r d e s i g n e d t h r o u g h clinical e x p e r i e n c e s
a n d m e d i c a l r e q u i r e m e n t s . H e l p s put a p o s t
s u r g i c a l p a t i e n t b a c k on
his feet . . . m a k e s him
a m b u l a t o r y by providing
custom features that
a n t i c i p a t e practically
all p o s t s u r g i c a l
problems.
Write: E. J . S a b e l Co., Box 644, J e n k i n t o w n , Pa. 19046

XXI

N a t u r a l last with full,

squared-off toe. Neither
right nor left E l o n g a t e d
heel.
S t e e l s h a n k is p r e d r i l l e d for e a s y b r a c e
a t t a c h m e n t . H e e l is
e x t r a long to a c c e p t
angular bracework.

W A S H I N G T O N PROSTHETIC
SUPPLIES
WHY S P E N D YOUR VALUABLE T I M E

T-STRAP

CEREBRAL

PALSY T Y P E

B/K

MANUFACTURING

PROSTHETIC

LEATHER

40 Patterson Street, N.E.

Telephone

Washington, D.C. 20002

(202) 628-1037

XXII

SPINAL

COMPONENTS

ORTHOSES,

You Just Can't Beat Our Rover

For Fit And Comfort
Excellent For Brace Work
L o o k a t s o m e f e a t u r e s of o u r f a m o u s
"Brace S h o e "
Leather Sole & Heel L o n g Counter
E x t r a Strong Steel Shank

Y o u can use this shoe w i t h c o m p l e t e

confidence.
Sizes 4 - 1 3 in varying w i d t h s . Extra
large size range also available.
Colors:
Black, White Brown,
S m o k e , Blue Green, T a u p e , Mism a t e Service on Black O n l y .
Write For Free Catalog.

The

Irving

Orew

Corporation

Lancaster, O h i o 4 3 1 3 0
DREW

D R . HISS - C A N T I L E V E R G R O U N D GRIPPER - D I C K E R S O N

XXIII

CLASSIFIED

ADVERTISEMENTS

Advertising Rates
RegularFirst 3 5 words, $ 2 4 . 0 0 (minimum). Additional words $1.00 e a c h . Situations
wanted advertisements half rate. S p a c e rate additional: 13 X 13 p i c a s - $ 1 0 5 . 0 0 ; 13 X 18 p i c a s $180.00.
S p e c i a l M e m b e r s of the American A c a d e m y of Orthotists a n d Prosthetists who wish to
advertise their availability on a signed or unsigned basis are entitled to d o s o at the special rate
of $5.00 per five line insertion per issue. Each additional line, $1.00.
Mail a d d r e s s e d to National Office forwarded u n o p e n e d at n o c h a r g e . Classified Adver
tisements a r e to be paid in a d v a n c e ; c h e c k s should b e m a d e p a y a b l e to "Orthotics and Prosthetics".
S e n d to: Editor, Orthotics a n d Prosthetics, 1444 N St., N.W., Washington, D.C. 2 0 0 0 5 .

CERTIFIED

CANADA
PROSTHETIST-ORTHOTIST

PROSTHETIST-ORTHOTIST

E x p a n d i n g university m e d i c a l c e n t e r in a
c h a r m i n g S o u t h e a s t l o c a t i o n is s e e k i n g a
qualified individual to a s s u m e d e p a r t m e n
tal d i r e c t o r s h i p . C o m p l e t e line of fringe
benefits available, including e d u c a t i o n a l
opportunities; salary negotiable. Please
reply, in c o n f i d e n c e , t o :

C e r t i f i e d o r e l i g i b l e for c e r t i f i c a t i o n t o
w o r k in a c o m p r e h e n s i v e P r o s t h e t i c a n d
O r t h o t i c D e p a r t m e n t s e r v i n g p a t i e n t s of all
a g e s within a Regional Rehabilitation
C e n t e r affiliated with M c M a s t e r University.
Salary c o m m e n s u r a t e with
E x c e l l e n t fringe b e n e f i t s .

Staff P l a n n i n g S u p e r v i s o r
T h e N.C. M e m o r i a l Hospital
C h a p e l Hill, N.C. 2 7 5 1 4

experience.

Apply t o :
P e r s o n n e l Director,
C h e d o k e Hospitals,
P o s t Office Box 590,
Hamilton, O n t a r i o ,
Canada.
L8N 3L6.

AN EQUAL OPPORTUNITY E M P L O Y E R

ORTHOTIST OR ORTHOTIST
PROSTHETIST

O u r b u s i n e s s is g r o w i n g s o w e n e e d to
g r o w a l s o . O u r p r e f e r e n c e is for a n e x p e r i
e n c e d m a n a n d certification is n o t n e c e s
sary. S a l a r y c o m m e n s u r a t e w i t h e x p e r i
e n c e . Benefits.

CERTIFIED PROSTHETIST
AND/OR ORTHOTIST

D e l g a d o C o l l e g e offers a faculty p o s i t i o n
in its g r o w i n g O & P D e p a r t m e n t . M a k e
t e a c h i n g your satisfying and r e w a r d i n g
c a r e e r . R e s u m e will b e c o n f i d e n t i a l .

B u r g e - L l o y d S u r g i c a l Co., Inc.
4 6 0 California A v e n u e
Reno, Nevada 89502
phone322-3488 (area code-702)

PROSTHETIST AND/OR

C h a r l e s R. G o l d s t i n e
Delgado Junior College
6 1 5 City P a r k A v e n u e
New O r l e a n s , LA 7 0 1 1 9

ORTHOTIST

ORTHOTICS CHIEF

Major h o s p i t a l s y s t e m in N o r t h e r n Virginia
( m e t r o p o l i t a n W a s h i n g t o n ) is staffing its
n e w O r t h o t i c s - P r o s t h e t i c s L a b o r a t o r y . De
sire certified or e x p e r i e n c e d p e r s o n with
real i n t e r e s t in a d v a n c e d p l a s t i c s a n d e l e c
tronics technologies. Contact Personnel
Dept., T h e Fairfax Hospital, 3 3 0 0 G a l l o w s
R o a d , Falls C h u r c h , Virginia, 2 2 0 4 6 . (703)
6 9 8 - 3 1 5 6 E.O.E.

XXIV

Certified O r t h o t i c s Chief for p i o n e e r i n g or

t h o t i c s division of t h i s m a j o r c h r o n i c d i s
e a s e h o s p i t a l . M u s t b e e x p e r i e n c e d in
l o w e r a n d u p p e r e x t r e m i t y o r t h o t i c s , in
c l u d i n g e x t e r n a l p o w e r a n d p l a s t i c s . Ap
p l i c a t i o n s t o Dr. C h a r l e s L o n g , II, C o D i r e c t o r , P.M. & R., C u y a h o g a C o u n t y
Hospital, H i g h l a n d View Hospital, C l e v e
land, O h i o 4 4 1 2 2

PROSTHETIST AND ORTHOTIST

CANADA
PROSTHETIC-ORTHOTIC
TECHNICIAN

Wanted: Prosthetist and orthotist, cer

tified. Community where the quality of life
and quality of practice are not exclusive.
Outstanding opportunity exists in a com
munity in the Upper Peninsula of
Michigan. Base population 300,000. Spe
cialty group of 45 board certified physi
cians including 6 orthopedists, 1 physiatrist and 1 neurosurgeon and a Crippled
Children's Clinic.

To perform duties of a technical nature in a

well-equipped Prosthetic and Orthotic De
partment within a Regional Rehabilitation
Center affiliated with McMaster University.
Salary commensurate with experience.
Excellent fringe benefits.
Apply to:

An outstanding place to live and raise chil

dren, along with excellent opportunities
for hunting, fishing, skiing, sailing and cul
ture. If interested, please contact:

Personnel Director,
Chedoke Hospitals,
Post Office Box 590,
Hamilton, Ontario,
Canada, L8N 3L6.

J. Michael Coyne, M.D.

Medical Center
1414 W. Fair Avenue
Marquette, Michigan 49855

PROSTHETIST AND ORTHOTIST

AND
PRESCRIPTION SHOE FITTER

MANAGER ORTHOTICPROSTHETIC FACILITY

New York City facility has above positions

available. Certification not required. Salary
negotiable.

NeededOrthotist or Prosthetist to man

age complete O/P Facility. Staff of 7 in
cludes orthotists, prosthetists, fabrication
technicians and office personnel. Facility
located in the Southwest. Management Ex
perience Required. Salary commensurate
with ability. Bonus based on performance.

Eschen
Prosthetic
and
Orthotic
Laboratories, Inc., 156 E. 116th Street, N.Y.,
N.Y. 10029 (212) 369-7575.

ORTHOTISTS-PROSTHETISTS
ORTHOPEDIC

BUSINESS

NeededOrthotists and Prosthetists in

terested in advancement to management of
O/P patient care facilities. Should be Board
Certified or Eligible. Salary commensurate
with ability. Bonus based on performance.

Established Orthopedic/Surgical appliance

business. Eastern & Southern states. Send
information to:
T. K. Hastings, CO.
Certified Orthopedic Co.
1904 Flatbush Ave.
Brooklyn, N.Y. 11210

Orthomedics is a leader in the orthoticprosthetic field. We have 8 patient care

facilities. Generous company benefits are
provided. Continuing education oppor
tunities in the profession are provided, as
well as training in business management,
personnel relations and supervision.

ORTHOTIST

All communications are confidential. Write

or call:
Sam E. Hamontree, CP.
Executive Vice President
Orthomedics, Inc.
8332 Iowa Street
Downey, California 90241
(213) 862-2117

Experienced Orthotist needed, not neces

sarily certified. Profit-sharing, retirement
plan, and other fringe benefits. Contact:
Danforth Orthopedic Brace
1820 N. Orange Ave.
Orlando, Flotida 32804
(305) 898-4251
XXV

AMERICAN BOARD FOR CERTIFICATION IN

ORTHOTICS AND PROSTHETICS, INC.
Eligibility Requirements for Practitioner
Examination
Valid Through
Exam Year

Education

Experience

1975

H . S . + 3 short c o u r s e s

4 years

1975

H . S . or less for e x t e n s i o n
o f title*

Not a p p l i c a b l e

1975

A . A . in Orthotics or Prosthetics
from all schools e x c e p t Northwestern
University

3 years

1977

H . S . + 3 short courses for

e x t e n s i o n o f title

Not applicable

1979

A . A . in Orthotics or Prosthetics
via Northwestern University

2 years

1979

A . A . in Orthotics a n d / o r
Prosthetics from all other
s c h o o l s + 3 short courses

3 years

1979

2 years o f college training,

i n c l u d i n g prescribed c o u r s e s * *
+ 3 short courses

3 years

1979

M i n i m u m o f b a c c a l a u r e a t e in other
field, i n c l u d i n g prescribed c o u r s e s * *
+ 3 short courses

2 years

1980+

Bachelors degree in Orthotics

a n d Prosthetics

1 year

* Must meet educational qualifications in effect at time of original certification.

Prescribed course work consists of at least 32 semester hours (48 quarter hours)
in the following courses, to include, however, no more than 8 semester hours
(12 quarter hours) in any one subject area: English and speech, biological
sciences, physics and engineering, chemistry, mathematics, psychology, and shop
training.
As approved by Board of Directors, August 3,1974

XXVI

A M E R I C A N ORTHOTIC A N D PROSTHETIC ASSOCIATION

1 4 4 0 N STREET, N.W.
WASHINGTON, DC. 20005