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Physical Rehabilitation Programme

 ankle-Foot orthosis

 Manufacturing guidelines 

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International Committee of the Red Cross

19 Avenue de la Paix

1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57

E-mail: icrc.gva@icrc.org

www.icrc.org

© ICRC, September 2006

All photographs: ICRC/PRP

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Tae o contents

Foreword 2

Introduction 4

Choosingbetweendierentdesigns 4

Castingandrectication 5

1.FlexibleAFO 6

1.1MouldingoEVA 6

1.2Orthosistrimline 6

1.3Vacuummouldingothepolypropylene 6

1.4Preparationothepolypropyleneshell 7

1.5Preparationothestraps 8

1.6Initialttingandnishing 8

2.RigidAFO 82.1MouldingoEVA 8

2.2Orthosistrimline 9

2.3Plasticreinorcement 12

2.4Vacuummouldingothepolypropylene 13

2.5Preparationothepolypropyleneshell 14

2.6Proximalstrap 14

2.7Distalstrap 15

2.8Instepstrap 16

2.9Initialttingandnishing 183.AFOwithamarackFlexureJointM 18

3.1MouldingoEVA 18

3.2Orthosistrimline 18

3.3Plasticreinorcement 18

3.4InstallationoamarackFlexureJoint M 19

3.5Vacuummouldingothepolypropylene 19

3.6Preparationothepolypropyleneshell 20

3.7Preparationothestraps 22

3.8Initialttingandnishing 224.AFOanti-talus(anteriorshell) 22

4.1MouldingoEVA 22

4.2Orthosistrimline 23

4.3Plasticreinorcement 24

4.4Vacuummouldingothepolypropylene 24

4.5Preparationothepolypropyleneshell 25

4.6Preparationothestraps 26

4.7Initialtting 26

4.8Finishing 26

Listomanuacturingmaterials 27

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Foreor

Te ICRC poypropyene tecnooy

Sinceitsinceptionin1979,theICRC’sPhysicalRehabilitationProgrammehaspromotedtheuseotechnologythatisappropriatetothespeciccontextsinwhichtheorganizationoperates,i.e.,countriesaectedbywarandlow-incomeordevelopingcountries.

Tetechnologymustalsobetailoredtomeettheneedsothephysicallydisabledinthecountriesconcerned.

Tetechnologyadoptedmustthereorebe:

• durable,comortable,easyorpatientstouseandmaintain;• easyortechnicianstolearn,useandrepair;• standardizedbutcompatiblewiththeclimateindierentregionsotheworld;• low-costbutmodernandconsistentwithinternationallyacceptedstandards;• easilyavailable.

Techoiceotechnologyisogreatimportanceorpromotingsustainablephysicalrehabilitationservices.

Forallthesereasons,theICRCpreerredtodevelopitsowntechniqueinsteadobuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.TecostothematerialsusedinICRCprostheticandorthoticdevices

islowerthanthatothematerialsusedinappliancesassembledromcommercialready-madecomponents.

WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanuacturedlocally.Intheearly1990stheICRCstartedtheprocessostandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,orthesakeoharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityoservicestopatients.

Polypropylene(PP)wasintroducedintoICRCprojectsin1988orthemanuactureoprostheticsockets.Terstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents

suchasvariousalignmentsystemswererstdevelopedinColombiaandgraduallyimproved.Inparallel,adurableoot,madeinitiallyopolypropyleneandEthylVinylAcetate(EVA),andnowopolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberoot.

In1998,aercareulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertoocusonpatientcareandtrainingopersonnelatcountrylevel.

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Ojective o te manas

TeICRC’s“ManuacturingGuidelines”aredesignedtoprovidetheinormationnecessaryorproductionohigh-qualityassistivedevices.

Temainaimsotheseinormativemanualsareasollows:

• opromoteandenhancestandardizationoICRCpolypropylenetechnology;• oprovidesupportortrainingintheuseothistechnology;• opromotegoodpractice.

Tisisanothersteporwardintheeorttoensurethatpatientshaveaccesstohigh-qualityservices.

ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme

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Coosin eteen ierent esins

Withoutgoingintodetails,someeaturesodierenttypesoAFOaresetoutbelowtoassistinthechoiceodesign.

Feie AFO

• Dorsiexionassistance• Poormedio-lateralstabilizationothesubtalarjoint

Rii AFO

• Blocksanklemovements• Mediolateralstabilizationothesubtalarjoint• Possibilityocontrollingoreootadduction/abduction

AFO it Tamarac Fere Joint TM

• Mediolateralstabilizationothesubtalarjoint• Freeankledorsiexion• Freeorrestrictedankleplantarexion

AFO antitas

• Blocksanklemovements.Particularlyefcientorpreventingankledorsiexion

• Poormediolateralstabilizationothesubtalarjoint

Introction

Teaimothisdocumentistodescribeseveralmethodsormanuacturingankle-foot orthoses

(AFO),workingwiththepolypropylenetechnologyusedattheICRC’sphysicalrehabilitation

centres.

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Castin an rectifcation

Patientassessment,castingandrecticationopositivecastimpressionsareperormedinaccordancewithprostheticandorthotic(P&O)standards.

ForexibleAFO,thecastcanbetakenwith5degreesodorsiexionsoastoprovideapreloadandensuresomespringaction.

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1.1 Moin o EVA

AexibleAFOdoesnotusuallyrequireanyEVA.However,incaseswhereitisnecessarythe

proceduredescribedinsection2.1(page8)shouldbeollowed.

1.2 Ortosis trim ine

oachievethegoaloallowingdorsiexionotheanklewhilepreventingpassiveplantarexion,thereareanumberodesignoptions.

FlExIblE AFO1

4Markthetrimlineasollows:

A Tetopishorizontal,2cmbelowthe

bulahead.

B Attheankle,pass2cmbehindthetipothemalleolitoallowexionothepolypropylene.

C Attheoreoot,leavethesidesothetoesandtheheadothemetatarsuscompletelyclearandpassthetrimlinebelowthem.Tis will allow the

 polypropylene to ollow the movement o the metatarso-phalangeal joints.

Pullastockingovertheplastermodel.

1.3 Vacm moin o te poypropyene

Dustthestockingwithtalcumpowder.

Measurementothepolypropylenesheet:

Calcircumerence+10cm. Instepcircumerence+10cm. Legandootlength+10cm.(Seenextpicture.)

Tickness3mm,4mmor5mm,dependingonthepatient’sweight.

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2

1

3

Manufact uring Guid el ines Ankle-Foot Ort hosis

Heatthepolypropyleneat180°or20to25minutes,dependingonthethicknessothepolypropyleneandtheefciencyotheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheanteriorside.

ightenthepolypropylenearoundthesuctionconebymeansoaropeorsomethingsimilar.

Openthevacuumvalve.

4

CutotheexcessPPwithapairoscissorswhileitisstillhot.

Keepthevacuumonuntilthepolypropylenecoolsdown.

1.4 Preparation o te poypropyene se

Drawthetrimlineonthepolypropyleneasdescribedinsection1.2(page6).

Followingtheoutline,cuttheorthosiswithanoscillatingsaw.

Removetheplasticshellromtheplastermodel.

RemovethestockingrominsidetheAFO.

Grindtheorthosistrimlineandsmoothit.

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IanEVAhasbeenmoulded,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

1.5 Preparation o te straps

Fortheproximalstrap,ollowtheproceduredescribedinsection2.6(page14).

Adistalstrapmightbeneeded,dependingonthecapacityothepatient’sshoetoholdtheootinsidetheorthosis.Ithisisneeded,ollowtheproceduredescribedinsection2.7(page15).

1.6 Initia fttin an fnisin

IEVAisused,glueitpartiallyinsidetheorthosis.

TeinitialttingisperormedaccordingtoP&Ostandards.

Carryouttherequiredmodicationonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutothesurplusandsmooththetrimline.

RIgId AFO2

2.1 Moin o EVA

EVA(6mm)maybemouldedpriortothedrapingothepolypropylene,ortheollowingreasons:• toimprovecomort;• topreventskinbreakageinpatientswithsensationloss;• ororthosesusedatnight.

Followtheproceduredescribedbelowor,ithecasedoesnotrequireEVA,goontothenextsection.

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4Positiontheplastermodelwiththeoreootpointingdownwards.

MeasurementotheEVAsheet:• width,instepcircumerence;• length,thatotheplastermodel

(leg+oot);• thickness,6mm.

HeattheEVAat120°or3to5minutes,dependingontheefciencyotheoven.

DrapetheEVAmanuallyovertheplastermodelandholditinplaceuntilithascooledcompletely.

4Cutotheexcesswithacutterorapairoscissors.

StapletheEVAontotherontotheplastermodel.

2.2 Ortosis trim ine

2.2.1 “Stanar” trim ine

4Markthetrimlineasollows:

A Tetopmustbehorizontal,2cmbelow

thebulahead.

B Attheankle,passtheline1cmanteriortothetipothemalleoli.

C Attheoreoot,leavethesidesothetoesandtheheadothemetatarsuscompletelyclearandpassthetrimlinebelowthem.Tis will allow the

 polypropylene to ollow the movement o the metatarso-phalangeal joints.

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2.2.2 Trim ine to correct oreoot action

Foreootadductioniscommonincasesocluboot.

4Markthetrimlineasollows:

A Tetopmustbehorizontal,2cmbelowthebulahead.

B Increasecoverageothelateralmid-oot,passinginrontothecuboid,to enlarge the area o pressure.

C Attheoreoot,thelinemustbeproximaltothe5thmetatarsalhead.

D Decreasecoverageothemedialmid-ootatthenavicular/malleoli,

to acilitate donning.

E Attheoreoot,coverthemedialsideothemetatarsalheadandtoe,to correct 

 oreoot adduction.

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2.2.3 Trim ine to correct oreoot action

Foreootabductionisoenseenincasesocerebralpalsy.

4Markthetrimlineasollows:

A Tetopmustbehorizontal,2cmbelowthebulahead.

B Decreasecoverageatthelevelothelateralmalleoli,to ease donning.

C Attheoreoot,thelinemustbedistaltothe5thmetatarsalhead,to avoid metatarsus abductus.

D Increasecoverageothemedialmid-ootatthelevelothenavicular,

to increase mid-oot support.

E Attheoreoot,thelinemustbeproximaltothe1stmetatarsalhead.

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2.3 Pastic reinorcement

TeAFOmayneedreinorcement,especiallyatanklelevel.Inecessary,useoneotheollowingmethods;otherwisegoontothenextsection.

2.3.1 doe ayer o poypropyene

4Asecondlayeropolypropylenecoveringtheankleandtheootismouldedatthesametimeasthemainlayer.

Cutapieceopolypropylene:• thickness,3mm;• width,instepcircumerence;

• length,ootlength+10cm

Grindthelast3cmattheproximalendtograduallyreducethethicknessothepolypropylene.

4Tetwolayersareheatedatthesame

time.

Tereinorcementisplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelytoobtainaperectsealbetweenthetwo.

 A double layer o polypropylene has the disadvantage o reducing exibility o the oreoot in relation tothe metatarso-phalangeal joint.

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2.3.2 Cannes in te poypropyene

Tepresenceochannelsintheplasticsignicantlyimprovesitsstrength.Tereareseveralwaysomakingthesechannels.

4CuttwostripsoEVA:• thickness,6mm;• width,7mm;• length,15cm.

GrindbothdistalandproximalendstograduallyreducethethicknessotheEVA.

Pullastockingovertheplastermodel.

Gluethestriplightlyontothestocking.

Te more anterior the position o the channel, the more the AFO will resist dorsiexion o the ankle.

Reinorcements prolonged along the side o the mid-oot increase the volume o the orthosis so that it may no longer t into the patient’s shoe.

2.4 Vacm moin o te poypropyene

Ithishasnotyetbeendone,pullastockingovertheplastermodel.For maximum eciency, the EVA

used to make channels in the polypropylene must not be covered with a stocking.

Followtheproceduredescribedinsection1.3(page6),takingintoaccountthepresenceorabsenceoadoublelayeropolypropylene(section2.3.1,page12).

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2.6 Proima strap

Useaready-madeVelcrostrap40mmwide,ormakeastrapwithPerlonwebbingorsomeotherstrongmaterial.

4Withalargetubularrivet,xthebeltholdingthelooponthemedialside,1.5cmbelowtheproximaltrimline.

Teloopshouldbeplacedonthepolypropyleneandnotbeincontactwiththepatient’sleg.

2.5 Preparation o te poypropyene se

Drawthetrimlineonthepolypropyleneasdescribedinsection2.2(page9).

Cuttheorthosiswithanoscillatingsaw,ollowingtheoutline.

Removetheplasticshellromtheplastermodel.

RemovethestockingrominsidetheAFO.

Grindtheorthosistrimlineandsmoothit.

IEVAhasbeenmouldedbeorehand,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

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4Insertthebeltthroughthelooptomeasuretherequiredlength.

Fixthestrapwithalargetubularrivetonthelateralside.Makesurethestrapisperectlyhorizontalbeorexingit.

Coverthesuraceothestrapincontactwiththepatient’slegwith3mmEVA.

4Fixthestrapwithalargetubularrivetonthe

lateralside.Makesurethestrapisperectlyhorizontalbeorexingit.

Coverthesuraceothestrapincontactwiththepatient’slegwith3mmEVA.

2.7 dista strap

Youmustchoosebetweenadistalstrapandaninstepstrap.Telatterhastheadvantageoholdingthecalcaneumrmlyinsidetheorthosis(equinuscorrection).

UseaVelcrostrap25mmwide.

4Withalargetubularrivet,xthebeltholdingthelooponthemedialside,4cmabovethemalleoli.

Teloopshouldbeplacedoverthe

polypropyleneandnotbeincontactwiththepatient’sleg.

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2.8 Instep strap

UseaVelcrostrap25mmwide.

wotechniquesarepresented,dependingonwhetherthebackotheootisinaneutralpositionorneedsavalgus/varuscorrection.

2.8.1 Netra position

4Withalargetubularrivet,xthebeltholdingthelooponthemedialside,atanangleo45°passingthroughtheposteriordistaltipothecalcaneum.

Teloopshouldbeplacedoverthepolypropyleneandnotbeincontactwith

thepatient’sleg.

4Insertthebeltthroughthelooptomeasuretherequiredlength.

Fixthestrapwithalargetubularriveton

thelateralside,atthesameangleo45°. Coverthesuraceothestrapincontactwiththepatient’slegwith3mmEVA.

2.8.2 Vars/vas correction

Testrapwillpassthroughaslotcutinthepolypropylene.

4Teslotiscutonthelateralsideorvaruscorrectionandonthemedialsideor valguscorrection.

Markthepositionotheslot40mmromthebackotheootandperpendiculartoalinedrawnatanangleo45°passingthroughtheposteriordistaltipothecalcaneum.

Teslotshouldbe30mmlong.

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4Makeholesalongtheslotaxiswithadrillttedwitha4mmbit.

4Withacutter,connecttheholeswitheachother.

Finally,smooththetrimlinewithale.

4Teloopisplacedonthemedialsideor varuscorrectionandonthelateralsideorvalguscorrection.

Fixthebeltholdingtheloopwithalargetubularrivet,atanangleo45°passingthroughtheposteriordistaltipothecalcaneum.

Teloopshouldbeplacedoverthepolypropyleneandnotbeincontactwith

thepatient’sleg.

4Insertthebeltthroughtheslotononesideandthroughtheloopontheothersidetomeasuretherequiredlength.

Fixthestrapwithalargetubularrivetjustoutsidetheslot.

Coverthesuraceothestrapincontactwiththepatient’slegwith3mmEVA.

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AFO wITh TAMARACk FlExuRE JO INT TM3

2.9 Initia fttin an fnisin

IEVAoamisused,glueittemporarilyinsidetheorthosis.

TeinitialttingisperormedinaccordancewithP&Ostandards.

Carryouttherequiredmodicationsonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutothesurplusandsmooththetrimline.

3.1 Moin o EVA

Followtheproceduredescribedinsection2.1(page8),orgoontothenextsectioniEVAisnotrequired.

3.2 Ortosis trim ine

Followtheproceduredescribedinsection2.2.1(page9).

3.3 Pastic reinorcement

Posteriorreinorcementorgreaterplantarexioncontrolisrequiredwhentheorthosisisintendedtopreventplantarexion(notullydescribedbelow).

Followtheproceduredescribedbelow,orgoontothenextsectioniplantarexionisleree.

AsecondlayeropolypropyleneorpositioningatthelevelotheAchillestendonismouldedatthesametimeasthemainlayer.

4Cutapieceopolypropylene:• thickness,5mm;• width,2cm;• length,7cm.

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4Firstthereinorcement(heatedatthesametimeasthepolypropylene)isplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelytoobtainaperectsealbetweenthetwolayers.

4Usethemouldingdummiestoormasnuglyttingcavityortheamarack

FlexureJointM.

Nailthemverticallyontotheplastermodelsothatthemidpointislocatedontheankleaxis.

3.4 Instaation o Tamarac Fere JointTM

Ontheplastermodel,markthepositionothejointaxis:• laterally,attheapexothemalleoli;• medially,slightlyposteriortothedistaltipothemalleoli.

Makesurethatthejointsareatthesamelevelonbothsides.

3.5 Vacm moin o te poypropyene

Followtheproceduredescribedinsection1.3(page6),takingintoaccountthepresenceorabsence

oaposteriorreinorcement(section3.3,page18).

Pullastocking(cottonstockinetistoothick)overtheplastermodel.

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3.6 Preparation o te poypropyene se

Drawthetrimlineonthepolypropyleneasexplainedinsection3.2(page18).

Cutonlythecontourotheorthosiswithanoscillatingsaw.Donotcutalongtheseparationbetweenootsectionandcalsection.

Removetheplasticshellromtheplastermodel.

ExtractthemouldingdummiesandthestockingrominsidetheAFO.

4Drawtheseparationlinebetweentheootsectionandthecalsection:• Markthemiddleothecavitiescreatedbythedummies.

• Drawa“V”anteriortothemidlineo

eachcavity.Ensurethatthe“V”doesnotextendbackwardspastthecentreothecavity.

4ForAFOwith plantar exion control ,

drawahorizontallineposteriortothemarksjoiningthetwosides.

4ForAFOwith ree plantar exion,drawa“V”posteriortothemidlineoeachcavity.Ensurethatthe“V”doesnotextendorwardpastthecentreothecavity.

Correct Incorrect

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4Drillholesatthedimpleslebytheholesinthemouldingdummies:• 5mmorlargesize;• 4.5mmorsmallsize.

4Useathin-bladed saw(1/16’’bladekerorless)toseparatetheootsectionromthecalsection.

Do not use an oscillating saw because toomuch material is lost along a ragged, widecut line.

Smooththetrimlineedgewithahanddeburringtoolorapieceoglass.Do not grind the trim linebecause this will reduce exure coverage and reduce the ability o the cavity to anchor and control the

 exure efectively.

4

InserttheamarackFlexureJointM

andsecurewithmetalastenersandanchoringscrews.

Dependingonthethicknessothepolypropylene,itmaybenecessarytoadjustthelengthothescrewsitheendsprotrudeinsidetheAFO.

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3.7 Preparation o te straps

Fortheproximalstrap,ollowtheproceduredescribedinsection2.6(page14).

Insomecasesthepatientmightneedadistalstrap.Iso,ollowtheproceduredescribedinsection2.7(page15).

3.8 Initia fttin an fnisin

IEVAoamisused,glueittemporarilyinsidetheorthosis.

TeinitialttingisperormedinaccordancewithP&Ostandards.

Carryouttherequiredmodicationsonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutotheexcessandsmooththetrimline.

Gluetheexureanchoringscrewswitharemovablethread-lockingcompound(Loctite).

AFO ANTI-TAluS (ANTERIOR S hEll)4

4.1 Moin o EVA

EVA(6mm)maybemouldedpriortodrapingothepolypropylene:

• toimprovecomort;• topreventskinbreakageorpatientswithsensationloss.

Do not cover the oot, to avoid an increase o volume which may prevent the patient rom wearing normal shoes.

Followtheproceduredescribedbelow,orgoontothenextsectionithecasedoesnotrequireEVA.

Positiontheplastermodelwiththeoreootpointingupwards.

4CutapieceoEVA:• width,calcircumerence;• length,leglength;• thickness,6mm.

HeattheEVAat120°or3to5minutes,dependingontheefciencyotheoven.

DrapetheEVAovertheplaster

modelmanuallyandholditinplaceuntilithascooledcompletely.

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4Cutotheexcesswithacutterorapairoscissors.

Grindthedistaltrimlinetograduallyreduceitsthickness.

StapletheEVAontothebackotheplastermodel.

4Marktheorthosistrimlineasollows:

A Tetopmustbehorizontal,2cmbelowthetibialtubercle.

B Ontheleg,1cmposteriortothemid-line.

C Ontheankle,atthetopothemalleoli

toacilitatedonning.

D Ontheoreoot,clearthesidesandtopothetoesandtheheadothemetatarsuscompletely,passingbelowthem.Tis will allow the polypropyleneto ollow the movement o the metatarso-

 phalangeal joints.

4.2 Ortosis trim ine

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2

1

3

ICRC P hysical Rehab i l i t at ion P rog ramme

4.3 Pastic reinorcement

Tepresenceochannelsintheplasticsignicantlyimprovesitsstrength.Tereareseveralwaysomakingthesechannels.

4CuttwostripsoEVA:

• thickness,6mm;• width,10mm;• length,20cm.

Grindbothdistalandproximalendstograduallyreducetheirthickness.

Gluethestripsontotheplastermodel,1cmanteriortothelateralandmediallongitudinalaxes.

Reinorcements prolonged along the side o the

mid-oot increase the volume o the orthosis so that it may no longer t into the patient’s shoe.

4.4 Vacm moin o te poypropyene

Te procedure described below ensures uniorm thickness o the polypropylene all over the orthosis. Donot try to make a single seam on the anterior side, because the creases gathering at the ankle will makeit necessary to stretch the polypropylene too thinly.

Ithishasnotyetbeendone,pullastockingovertheplastermodel.For maximum eciency the EVAused to channel the polypropylene must not be covered with a stocking.

Dustthestockingwithtalcumpowder.

Measurementothepolypropylenesheet:

Calcircumerence+10cm. Instepcircumerence+10cm. Legandootlength+10cm.

PPthickness:4mmor5mm,dependingonthepatient’sweight.

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Heatthepolypropyleneat180°or20to25minutes,dependingonthethicknessothepolypropyleneandtheefciencyotheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheposteriorsideandundertheoot.

ightenthepolypropylenearoundthesuctionconewitharopeorsomethingsimilar.

Openthevacuumvalve.

4Cutotheexcesswithapairoscissorswhilethepolypropyleneisstillhot.

Keepthevacuumonuntilthepolypropylenecoolsdown.

4.5 Preparation o te poypropyene se

Drawthetrimlineonthepolypropyleneasexplainedinsection4.2(page23).

Cuttheorthosiswithanoscillatingsaw,ollowingtheoutline.

Removetheplasticshellromtheplastermodel.

RemovethestockingrominsidetheAFO.

Grindtheorthosistrimlineandsmoothit.

IEVAhasbeenmouldedbeorehand,transerthetrimlinetotheEVAandcutotheexcesswithapairoscissors.

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4.7 Initia fttin

IEVAoamisused,glueittemporarilyinsidetheorthosis.

TeinitialttingisperormedinaccordancewithP&Ostandards.

4Itisoennecessarytoarethepolypropyleneattheposteriorpartotheheelinordertoacilitatedonningandtoavoidpainulcontactwiththeedgeotheplastic.

4.6 Preparation o te straps

Fortheproximalstrap,ollowtheproceduredescribedinsection2.6(page14).

Insomecasesthepatientmightneedadistalstrap.

Iso,ollowtheproceduredescribedinsection2.7(page15).

4.8 Finisin

Carryouttherequiredmodicationsonthepolypropyleneandsmooththetrimline.

GluetheEVAinsidethepolypropylene,cutothesurplusandsmooththetrimline.

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ICRC Code DescriptionUnit of measure

Quantity

For negative and positive cast :

ODROSTOCOT60 Tubular stockinet, 60 cm cm 70

According to size:• MDREBANDP10• MDREBANDP12• MDREBANDP15

Plaster of Paris bandages10, 12 or 15 cm x 3 m

Piece 3

OTOOPLASPW40 Plaster of Paris powder Each As required

For EVA and plastic moulding :

If required, according tocolour:• OPLAEVAFERA06• OPLAEVAFLIV06• OPLAEVAFKIN06

EVA 6 mmTerra, olive or beige colour

Each As required

None Nylon stockinet Piece 1

According to colour andthickness:• OPLAPOLYCHOC03• OPLAPOLYCHOC04• OPLAPOLYCHOC05• OPLAPOLYLIV03• OPLAPOLYLIV04• OPLAPOLYLIV05• OPLAPOLYSKIN03• OPLAPOLYSKIN04• OPLAPOLYSKIN05

HomopolymerTerra, olive or beige colour3, 4 or 5 mm thickness

Each As required

For the TAMARACK Flexure JointTM

:According to size:• OCPOSOOTTAL• OCPOSOOTTAS

Large size (740L)Small size (740S)

Piece 1

EHDWGLUEL243 Glue, Loctite 243, blue, threadlock, 50-ml bottle As required 4

For the proximal strap:

OSBOSTRVP440 Strap, Velcro, PVC, with loop, brown, 400 x 40 mm Piece 1

OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

or 

OSBOVSBO30 Strap, polyester, black, 40 mm cm 25

None Strap, Velcro, 40 mm cm 20

None Loop, 40 mm x 100 pieces Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

For distal/instep strap:

OSBOSTRVP325 Strap, Velcro, PVC, with loop, brown, 300 mm x 25 mm Piece 1

OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

or 

OSBOVSBO24 Strap, Perlon webbing, 25 mm cm 20

None Strap, Velcro, 25 mm cm 15

OSBOVSBO35 Loop, 25 mm x 100 pieces Piece 1

OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

list o manactrin materias

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MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral andindependent organization whose exclusively humanitarian mission is to protect thelives and dignity of victims of war and internal violence and to provide them withassistance. It directs and coordinates the international relief activities conductedby the Movement in situations of conict. It also endeavours to prevent suffering

by promoting and strengthening humanitarian law and universal humanitarianprinciples. Established in 1863, the ICRC is at the origin of the International RedCross and Red Crescent Movement.

Acknowledgements:

Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard Matagne

Joel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan 

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.

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