Prosthetics and Orthotics Manufacturing Guidelines - 3 ... · foot, passing in front of the cuboid, to enlarge the area of pressure. C At the forefoot, the line must be proximal to

Physical Rehabilitation Programmeankle-Foot orthosis

Manufacturing guidelines

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MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

Acknowledgements:

Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoestmaHmayak Tarakhchyan

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

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP

�Manufac tur ing Guidel ines Ankle -Foot O r thosis

Table of contents

Foreword 2Introduction 4Choosingbetweendifferentdesigns 4Castingandrectification 51.FlexibleAFO 6

1.1MouldingofEVA 61.2Orthosistrimline 61.3Vacuummouldingofthepolypropylene 61.4Preparationofthepolypropyleneshell 71.5Preparationofthestraps 81.6Initialfittingandfinishing 8

2.RigidAFO 82.1MouldingofEVA 82.2Orthosistrimline 92.3Plasticreinforcement 122.4Vacuummouldingofthepolypropylene 132.5Preparationofthepolypropyleneshell 142.6Proximalstrap 142.7Distalstrap 152.8Instepstrap 162.9Initialfittingandfinishing 18

3.AFOwithTamarackFlexureJointTM 183.1MouldingofEVA 183.2Orthosistrimline 183.3Plasticreinforcement 183.4InstallationofTamarackFlexureJointTM 193.5Vacuummouldingofthepolypropylene 193.6Preparationofthepolypropyleneshell 203.7Preparationofthestraps 223.8Initialfittingandfinishing 22

4.AFOanti-talus(anteriorshell) 224.1MouldingofEVA 224.2Orthosistrimline 234.3Plasticreinforcement 244.4Vacuummouldingofthepolypropylene 244.5Preparationofthepolypropyleneshell 254.6Preparationofthestraps 264.7Initialfitting 264.8Finishing 26

Listofmanufacturingmaterials 27

� ICRC Physical Rehabi l i tat ion Programme

Foreword

The ICRC polypropylene technology

Sinceitsinceptionin1979,theICRC’sPhysicalRehabilitationProgrammehaspromotedtheuseoftechnologythatisappropriatetothespecificcontextsinwhichtheorganizationoperates,i.e.,countriesaffectedbywarandlow-incomeordevelopingcountries.

Thetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountriesconcerned.

Thetechnologyadoptedmustthereforebe:

• durable,comfortable,easyforpatientstouseandmaintain;• easyfortechnicianstolearn,useandrepair;• standardizedbutcompatiblewiththeclimateindifferentregionsoftheworld;• low-costbutmodernandconsistentwithinternationallyacceptedstandards;• easilyavailable.

Thechoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitationservices.

Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.ThecostofthematerialsusedinICRCprostheticandorthoticdevicesislowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-madecomponents.

WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityofservicestopatients.

Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprostheticsockets.Thefirstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponentssuchasvariousalignmentsystemswerefirstdevelopedinColombiaandgraduallyimproved.Inparallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowofpolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.

In1998,aftercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.


Objective of the manuals

TheICRC’s“ManufacturingGuidelines”aredesignedtoprovidetheinformationnecessaryforproductionofhigh-qualityassistivedevices.

Themainaimsoftheseinformativemanualsareasfollows:

• TopromoteandenhancestandardizationofICRCpolypropylenetechnology;• Toprovidesupportfortrainingintheuseofthistechnology;• Topromotegoodpractice.

Thisisanotherstepforwardintheefforttoensurethatpatientshaveaccesstohigh-qualityservices.

ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme


Choosing between different designs

Withoutgoingintodetails,somefeaturesofdifferenttypesofAFOaresetoutbelowtoassistinthechoiceofdesign.

Flexible AFO• Dorsiflexionassistance• Poormedio-lateralstabilizationofthesubtalarjoint

Rigid AFO• Blocksanklemovements• Mediolateralstabilizationofthesubtalarjoint• Possibilityofcontrollingforefootadduction/abduction

AFO with Tamarack Flexure Joint TM

• Mediolateralstabilizationofthesubtalarjoint• Freeankledorsiflexion• Freeorrestrictedankleplantarflexion

AFO anti-talus• Blocksanklemovements.Particularlyefficientforpreventingankledorsiflexion• Poormediolateralstabilizationofthesubtalarjoint

Introduction

Theaimofthisdocumentistodescribeseveralmethodsformanufacturingankle-foot orthoses (AFO),workingwiththepolypropylenetechnologyusedattheICRC’sphysicalrehabilitationcentres.


Casting and rectification

Patientassessment,castingandrectificationofpositivecastimpressionsareperformedinaccordancewithprostheticandorthotic(P&O)standards.

ForflexibleAFO,thecastcanbetakenwith5degreesofdorsiflexionsoastoprovideapreloadandensuresomespringaction.


1.1 Moulding of EVA

AflexibleAFOdoesnotusuallyrequireanyEVA.However,incaseswhereitisnecessarytheproceduredescribedinsection2.1(page8)shouldbefollowed.

1.2 Orthosis trim line

Toachievethegoalofallowingdorsiflexionoftheanklewhilepreventingpassiveplantarflexion,thereareanumberofdesignoptions.

FlExIblE AFO1

4Markthetrimlineasfollows:

A Thetopishorizontal,2cmbelowthefibulahead.

B Attheankle,pass2cmbehindthetipofthemalleolitoallowflexionofthepolypropylene.

C Attheforefoot,leavethesidesofthetoesandtheheadofthemetatarsuscompletelyclearandpassthetrimlinebelowthem.This will allow the polypropylene to follow the movement of the metatarso-phalangeal joints.

Pullastockingovertheplastermodel.

1.3 Vacuum moulding of the polypropylene

Dustthestockingwithtalcumpowder.

Measurementofthepolypropylenesheet:

� Calfcircumference+10cm.� Instepcircumference+10cm.� Legandfootlength+10cm.(Seenextpicture.)

Thickness3mm,4mmor5mm,dependingonthepatient’sweight.

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Manufac tur ing Guidel ines Ankle -Foot O r thosis

Heatthepolypropyleneat180°for20to25minutes,dependingonthethicknessofthepolypropyleneandtheefficiencyoftheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheanteriorside.

Tightenthepolypropylenearoundthesuctionconebymeansofaropeorsomethingsimilar.

Openthevacuumvalve.

4CutofftheexcessPPwithapairofscissorswhileitisstillhot.

Keepthevacuumonuntilthepolypropylenecoolsdown.

1.4 Preparation of the polypropylene shell

Drawthetrimlineonthepolypropyleneasdescribedinsection1.2(page6).

Followingtheoutline,cuttheorthosiswithanoscillatingsaw.

Removetheplasticshellfromtheplastermodel.

RemovethestockingfrominsidetheAFO.

Grindtheorthosistrimlineandsmoothit.


IfanEVAhasbeenmoulded,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.

1.5 Preparation of the straps

Fortheproximalstrap,followtheproceduredescribedinsection2.6(page14).

Adistalstrapmightbeneeded,dependingonthecapacityofthepatient’sshoetoholdthefootinsidetheorthosis.Ifthisisneeded,followtheproceduredescribedinsection2.7(page15).

1.6 Initial fitting and finishing

IfEVAisused,glueitpartiallyinsidetheorthosis.

TheinitialfittingisperformedaccordingtoP&Ostandards.

Carryouttherequiredmodificationonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutoffthesurplusandsmooththetrimline.

RIgId AFO2

2.1 Moulding of EVA

EVA(6mm)maybemouldedpriortothedrapingofthepolypropylene,forthefollowingreasons:• toimprovecomfort;• topreventskinbreakageinpatientswithsensationloss;• fororthosesusedatnight.

Followtheproceduredescribedbelowor,ifthecasedoesnotrequireEVA,goontothenextsection.


4Positiontheplastermodelwiththeforefootpointingdownwards.

MeasurementoftheEVAsheet:• width,instepcircumference;• length,thatoftheplastermodel

(leg+foot);• thickness,6mm.

HeattheEVAat120°for3to5minutes,dependingontheefficiencyoftheoven.

DrapetheEVAmanuallyovertheplastermodelandholditinplaceuntilithascooledcompletely.

4Cutofftheexcesswithacutterorapairofscissors.

StapletheEVAontothefrontoftheplastermodel.


2.2.1 “Standard” trim line


A Thetopmustbehorizontal,2cmbelowthefibulahead.

B Attheankle,passtheline1cmanteriortothetipofthemalleoli.

C Attheforefoot,leavethesidesofthetoesandtheheadofthemetatarsuscompletelyclearandpassthetrimlinebelowthem.This will allow the polypropylene to follow the movement of the metatarso-phalangeal joints.

�0 ICRC Physical Rehabi l i tat ion Programme

2.2.2 Trim line to correct forefoot adduction

Forefootadductioniscommonincasesofclubfoot.



B Increasecoverageofthelateralmid-foot,passinginfrontofthecuboid,to enlarge the area of pressure.

C Attheforefoot,thelinemustbeproximaltothe5thmetatarsalhead.

D Decreasecoverageofthemedialmid-footatthenavicular/malleoli,to facilitate donning.

E Attheforefoot,coverthemedialsideofthemetatarsalheadandtoe,to correct forefoot adduction.

��Manufac tur ing Guidel ines Ankle -Foot O r thosis

2.2.3 Trim line to correct forefoot abduction

Forefootabductionisoftenseenincasesofcerebralpalsy.



B Decreasecoverageatthelevelofthelateralmalleoli,to ease donning.

C Attheforefoot,thelinemustbedistaltothe5thmetatarsalhead,to avoid metatarsus abductus.

D Increasecoverageofthemedialmid-footatthelevelofthenavicular,to increase mid-foot support.

E Attheforefoot,thelinemustbeproximaltothe1stmetatarsalhead.

�� ICRC Physical Rehabi l i tat ion Programme

2.3 Plastic reinforcement

TheAFOmayneedreinforcement,especiallyatanklelevel.Ifnecessary,useoneofthefollowingmethods;otherwisegoontothenextsection.

2.3.1 double layer of polypropylene

4Asecondlayerofpolypropylenecoveringtheankleandthefootismouldedatthesametimeasthemainlayer.

Cutapieceofpolypropylene:• thickness,3mm;• width,instepcircumference;• length,footlength+10cm

Grindthelast3cmattheproximalendtograduallyreducethethicknessofthepolypropylene.

4Thetwolayersareheatedatthesametime.

Thereinforcementisplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelytoobtainaperfectsealbetweenthetwo.

A double layer of polypropylene has the disadvantage of reducing flexibility of the forefoot in relation to the metatarso-phalangeal joint.


2.3.2 Channels in the polypropylene

Thepresenceofchannelsintheplasticsignificantlyimprovesitsstrength.Thereareseveralwaysofmakingthesechannels.

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

GrindbothdistalandproximalendstograduallyreducethethicknessoftheEVA.

Pullastockingovertheplastermodel.

Gluethestriplightlyontothestocking.

The more anterior the position of the channel, the more the AFO will resist dorsiflexion of the ankle.

Reinforcements prolonged along the side of the mid-foot increase the volume of the orthosis so that it may no longer fit into the patient’s shoe.


Ifthishasnotyetbeendone,pullastockingovertheplastermodel.For maximum efficiency, the EVA used to make channels in the polypropylene must not be covered with a stocking.

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


2.6 Proximal strap

Useaready-madeVelcrostrap40mmwide,ormakeastrapwithPerlonwebbingorsomeotherstrongmaterial.

4Withalargetubularrivet,fixthebeltholdingthelooponthemedialside,1.5cmbelowtheproximaltrimline.

Theloopshouldbeplacedonthepolypropyleneandnotbeincontactwiththepatient’sleg.


Drawthetrimlineonthepolypropyleneasdescribedinsection2.2(page9).

Cuttheorthosiswithanoscillatingsaw,followingtheoutline.




IfEVAhasbeenmouldedbeforehand,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.


4Insertthebeltthroughthelooptomeasuretherequiredlength.

Fixthestrapwithalargetubularrivetonthelateralside.Makesurethestrapisperfectlyhorizontalbeforefixingit.

Coverthesurfaceofthestrapincontactwiththepatient’slegwith3mmEVA.

4Fixthestrapwithalargetubularrivetonthelateralside.Makesurethestrapisperfectlyhorizontalbeforefixingit.


2.7 distal strap

Youmustchoosebetweenadistalstrapandaninstepstrap.Thelatterhastheadvantageofholdingthecalcaneumfirmlyinsidetheorthosis(equinuscorrection).

UseaVelcrostrap25mmwide.

4Withalargetubularrivet,fixthebeltholdingthelooponthemedialside,4cmabovethemalleoli.

Theloopshouldbeplacedoverthepolypropyleneandnotbeincontactwiththepatient’sleg.


2.8 Instep strap

UseaVelcrostrap25mmwide.

Twotechniquesarepresented,dependingonwhetherthebackofthefootisinaneutralpositionorneedsavalgus/varuscorrection.

2.8.1 Neutral position

4Withalargetubularrivet,fixthebeltholdingthelooponthemedialside,atanangleof45°passingthroughtheposteriordistaltipofthecalcaneum.


4Insertthebeltthroughthelooptomeasuretherequiredlength.

Fixthestrapwithalargetubularrivetonthelateralside,atthesameangleof45°.

Coverthesurfaceofthestrapincontact

withthepatient’slegwith3mmEVA.

2.8.2 Varus/valgus correction

Thestrapwillpassthroughaslotcutinthepolypropylene.

4Theslotiscutonthelateralsideforvaruscorrectionandonthemedialsideforvalguscorrection.

Markthepositionoftheslot40mmfromthebackofthefootandperpendiculartoalinedrawnatanangleof45°passingthroughtheposteriordistaltipofthecalcaneum.

Theslotshouldbe30mmlong.


4Makeholesalongtheslotaxiswithadrillfittedwitha4mmbit.

4Withacutter,connecttheholeswitheachother.

Finally,smooththetrimlinewithafile.

4Theloopisplacedonthemedialsideforvaruscorrectionandonthelateralsideforvalguscorrection.

Fixthebeltholdingtheloopwithalargetubularrivet,atanangleof45°passingthroughtheposteriordistaltipofthecalcaneum.


4Insertthebeltthroughtheslotononesideandthroughtheloopontheothersidetomeasuretherequiredlength.

Fixthestrapwithalargetubularrivetjustoutsidetheslot.



AFO wITh TAMARACk FlExuRE JOINT TM3


IfEVAfoamisused,glueittemporarilyinsidetheorthosis.

TheinitialfittingisperformedinaccordancewithP&Ostandards.

Carryouttherequiredmodificationsonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutoffthesurplusandsmooththetrimline.

3.1 Moulding of EVA

Followtheproceduredescribedinsection2.1(page8),orgoontothenextsectionifEVAisnotrequired.


Followtheproceduredescribedinsection2.2.1(page9).


Posteriorreinforcementforgreaterplantarflexioncontrolisrequiredwhentheorthosisisintendedtopreventplantarflexion(notfullydescribedbelow).

Followtheproceduredescribedbelow,orgoontothenextsectionifplantarflexionisleftfree.

AsecondlayerofpolypropyleneforpositioningattheleveloftheAchillestendonismouldedatthesametimeasthemainlayer.

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


4Firstthereinforcement(heatedatthesametimeasthepolypropylene)isplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelytoobtainaperfectsealbetweenthetwolayers.

4UsethemouldingdummiestoformasnuglyfittingcavityfortheTamarackFlexureJointTM.

Nailthemverticallyontotheplastermodelsothatthemidpointislocatedontheankleaxis.

3.4 Installation of Tamarack Flexure JointTM

Ontheplastermodel,markthepositionofthejointaxis:• laterally,attheapexofthemalleoli;• medially,slightlyposteriortothedistaltipofthemalleoli.

Makesurethatthejointsareatthesamelevelonbothsides.


Followtheproceduredescribedinsection1.3(page6),takingintoaccountthepresenceorabsenceofaposteriorreinforcement(section3.3,page18).

Pullastocking(cottonstockinetistoothick)overtheplastermodel.

�0 ICRC Physical Rehabi l i tat ion Programme


Drawthetrimlineonthepolypropyleneasexplainedinsection3.2(page18).

Cutonlythecontouroftheorthosiswithanoscillatingsaw.Donotcutalongtheseparationbetweenfootsectionandcalfsection.


ExtractthemouldingdummiesandthestockingfrominsidetheAFO.

4Drawtheseparationlinebetweenthefootsectionandthecalfsection:• Markthemiddleofthecavitiescreated

bythedummies.• Drawa“V”anteriortothemidlineof

eachcavity.Ensurethatthe“V”doesnotextendbackwardspastthecentreofthecavity.

4ForAFOwith plantar flexion control,drawahorizontallineposteriortothemarksjoiningthetwosides.

4ForAFOwith free plantar flexion,drawa“V”posteriortothemidlineofeachcavity.Ensurethatthe“V”doesnotextendforwardpastthecentreofthecavity.

Correct Incorrect


4Drillholesatthedimplesleftbytheholesinthemouldingdummies:• 5mmforlargesize;• 4.5mmforsmallsize.

4Useathin-bladedsaw(1/16’’bladekerforless)toseparatethefootsectionfromthecalfsection.

Do not use an oscillating saw because too much material is lost along a ragged, wide cut line.

Smooththetrimlineedgewithahanddeburringtoolorapieceofglass.Do not grind the trim line because this will reduce flexure coverage and reduce the ability of the cavity to anchor and control the flexure effectively.

4InserttheTamarackFlexureJointTMandsecurewithmetalfastenersandanchoringscrews.

Dependingonthethicknessofthepolypropylene,itmaybenecessarytoadjustthelengthofthescrewsiftheendsprotrudeinsidetheAFO.




Insomecasesthepatientmightneedadistalstrap.Ifso,followtheproceduredescribedinsection2.7(page15).





GluetheEVAcompletelyinsidethepolypropylene,cutofftheexcessandsmooththetrimline.

Gluetheflexureanchoringscrewswitharemovablethread-lockingcompound(Loctite).

AFO ANTI-TAluS (ANTERIOR ShEll)4

4.1 Moulding of EVA

EVA(6mm)maybemouldedpriortodrapingofthepolypropylene:• toimprovecomfort;• topreventskinbreakageforpatientswithsensationloss.

Do not cover the foot, to avoid an increase of volume which may prevent the patient from wearing normal shoes.

Followtheproceduredescribedbelow,orgoontothenextsectionifthecasedoesnotrequireEVA.

Positiontheplastermodelwiththeforefootpointingupwards.

4CutapieceofEVA:• width,calfcircumference;• length,leglength;• thickness,6mm.

HeattheEVAat120°for3to5minutes,dependingontheefficiencyoftheoven.

DrapetheEVAovertheplastermodelmanuallyandholditinplaceuntilithascooledcompletely.


4Cutofftheexcesswithacutterorapairofscissors.

Grindthedistaltrimlinetograduallyreduceitsthickness.

StapletheEVAontothebackoftheplastermodel.

4Marktheorthosistrimlineasfollows:

A Thetopmustbehorizontal,2cmbelowthetibialtubercle.

B Ontheleg,1cmposteriortothemid-line.

C Ontheankle,atthetopofthemalleolitofacilitatedonning.

D Ontheforefoot,clearthesidesandtopofthetoesandtheheadofthemetatarsuscompletely,passingbelowthem.This will allow the polypropylene to follow the movement of the metatarso-phalangeal joints.


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ICRC Physical Rehabi l i tat ion Programme


Thepresenceofchannelsintheplasticsignificantlyimprovesitsstrength.Thereareseveralwaysofmakingthesechannels.

4CuttwostripsofEVA:• thickness,6mm;• width,10mm;• length,20cm.

Grindbothdistalandproximalendstograduallyreducetheirthickness.

Gluethestripsontotheplastermodel,1cmanteriortothelateralandmediallongitudinalaxes.

Reinforcements prolonged along the side of the mid-foot increase the volume of the orthosis so that it may no longer fit into the patient’s shoe.


The procedure described below ensures uniform thickness of the polypropylene all over the orthosis. Do not try to make a single seam on the anterior side, because the creases gathering at the ankle will make it necessary to stretch the polypropylene too thinly.

Ifthishasnotyetbeendone,pullastockingovertheplastermodel.For maximum efficiency the EVA used to channel the polypropylene must not be covered with a stocking.

Dustthestockingwithtalcumpowder.

Measurementofthepolypropylenesheet:

� Calfcircumference+10cm.� Instepcircumference+10cm.� Legandfootlength+10cm.

PPthickness:4mmor5mm,dependingonthepatient’sweight.


Heatthepolypropyleneat180°for20to25minutes,dependingonthethicknessofthepolypropyleneandtheefficiencyoftheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheposteriorsideandunderthefoot.

Tightenthepolypropylenearoundthesuctionconewitharopeorsomethingsimilar.

Openthevacuumvalve.

4Cutofftheexcesswithapairofscissorswhilethepolypropyleneisstillhot.

Keepthevacuumonuntilthepolypropylenecoolsdown.


Drawthetrimlineonthepolypropyleneasexplainedinsection4.2(page23).

Cuttheorthosiswithanoscillatingsaw,followingtheoutline.




IfEVAhasbeenmouldedbeforehand,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.


4.7 Initial fitting



4Itisoftennecessarytoflarethepolypropyleneattheposteriorpartoftheheelinordertofacilitatedonningandtoavoidpainfulcontactwiththeedgeoftheplastic.



Insomecasesthepatientmightneedadistalstrap.Ifso,followtheproceduredescribedinsection2.7(page15).

4.8 Finishing


GluetheEVAinsidethepolypropylene,cutoffthesurplusandsmooththetrimline.


ICRC Code Description Unit of measure Quantity

For negative and positive cast :ODROSTOCOT60 Tubular stockinet, 60 cm cm 70According 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 requiredFor EVA and plastic moulding :If required, according to colour:• OPLAEVAFERA06• OPLAEVAFLIV06• OPLAEVAFKIN06

EVA 6 mmTerra, olive or beige colour

Each As required

None Nylon stockinet Piece 1According to colour and thickness:• 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 4For the proximal strap:OSBOSTRVP440 Strap, Velcro, PVC, with loop, brown, 400 x 40 mm Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

orOSBOVSBO30 Strap, polyester, black, 40 mm cm 25None Strap, Velcro, 40 mm cm 20None Loop, 40 mm x 100 pieces Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2For distal/instep strap:OSBOSTRVP325 Strap, Velcro, PVC, with loop, brown, 300 mm x 25 mm Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

orOSBOVSBO24 Strap, Perlon webbing, 25 mm cm 20None Strap, Velcro, 25 mm cm 15OSBOVSBO35 Loop, 25 mm x 100 pieces Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

list of manufacturing materials

MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

Acknowledgements:

Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan

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

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP

Physical Rehabilitation Programmeankle-Foot orthosis

Manufacturing guidelines

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Documents

Prosthetics and Orthotics Manufacturing Guidelines - 3 ... · foot, passing in front of the cuboid, to enlarge the area of pressure. C At the forefoot, the line must be proximal to