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How To Select: Manual Wheelchairs
Feet and Leg Support Choices
Consider what you need for your legs and feet and that will likely determine the overall choice of wheelchair.
by Jessica Pedersen

There are many different types of foot supports available.

There are many different types of foot supports available. The style you want or need might determine the specific wheelchair frame that you will order. For instance, a fixed tapered front-end cannot be ordered on a lightweight wheelchair frame.

Fixed, non-removable front ends are often found on rigid wheelchair frames and some ultralight or custom model wheelchair frames. This option provides stability to the frame and may prevent folding the frame vertically. The specific frame choice might have the bars holding the foot support come straight down, providing more foot space. Or, they could taper inward, bringing your legs and feet closer together.

Front riggings describe swing away or removable foot rests or leg rests. Swing away footrests and leg rests make it easier for you to transfer because they can be moved out of the way. They are also a good choice if you will be using one foot or both feet to propel or if you want to move the chair closer to other objects such as the bed or toilet.

Footrests are typically bilateral (left and right) pieces that have a bar on the outside of the leg and a footplate that support the foot.

Leg rests are typically bilateral (left and right) and have a bar on the outside of the leg, a footplate, AND a pad behind the calf. Because these usually can elevate, they require a pad behind the calves to prevent the calves from falling behind the wheelchair when the leg rest is elevated.

Angled Front Riggings

The bars for the footrests or leg rests might come at different angles such as 60, 70 or 90 degrees. There is also an adjustable angle option that allows changes to any angle. These numbers describe the angle at the top of the front rigging bar where the knees are when the person is sitting in the wheelchair. A 60-degree angle front rigging has a more opened angle than a 90-degree angle front rigging. The 60-degree front rigging will pull your lower leg further away from your thigh, opening up the knee angle.

Consider these points when determining what angle of front rigging to order:

  • Angle of your thigh-to-your calf
  • Overall wheelchair length
  • Functional positions of the legs when sitting
  • Thigh-to-calf angle: This is important because there may be some tightness or limitations at your knee that will not allow you to sit correctly in a wheelchair that has a 60-degree angled front rigging or an elevating leg rest. The hamstring muscle in your leg is connected to the pelvic bone and goes past the thigh to the lower leg. It is called a two-joint muscle because it crosses the hip joint and the knee joint. If the hamstring muscle is tight, it will pull at the hip and knee. This will cause the pelvic bone to tilt backward (opening the angle at the hip), and the lower leg to move inward (closing the angle of the knee). This must be accommodated for and the best way to do that is to allow the lower legs to come in more. Therefore, a 60-degree angled footrest or elevating leg rest will not be appropriate. You should consider a 70- or 90-degree footrest and bring the footrest inward toward the frame of the wheelchair.
  • Any bony contractures where the angle of the thigh-to-calf are less that 90 degrees should be accommodated for as well by ordering a 70- or 90-degree footrest. An elevating leg rest should never be used when there are tight hamstrings or orthopedic contractures because the elevating leg rest will pull on the lower leg. The lower leg will not open at the knee and the person will be pulled out of the wheelchair frame. Many elderly people have tight hamstrings. They often erroneously purchase standard style footrests (60 degrees) or think that elevating leg rests will be more comfortable. Unfortunately, this error in footrest or leg rest choice makes them slip forward in their wheelchair, causing them to feel like they are falling out of the wheelchair. That's because they are sliding out of the wheelchair!

    • Overall wheelchair length: A 60-degree footrest sticks out farther than a 70-degree footrest. This small measurement might mean less maneuverability in small spaces. A 90-degree footrest, however, might limit how much caster play there is because it brings your feet under the wheelchair frame right next to the caster housing. This might limit the turning ability of the casters. Make sure this will not be a problem when ordering wheelchair front riggings.
    • Functional positions of the legs when sitting: Sit in your existing wheelchair or in a standard chair and reach for items or perform usual activities that will be done from the chair, such as dressing, computer work, household tasks, etc. Do you feel more balanced or can you reach farther when your lower legs are positioned at various angles? For instance, most people have a greater forward reach when their knees are flexed a little (bent toward the chair) than when the legs are out further. This might determine the angle of front rigging desired.

    Tapered front riggings are offered on some wheelchair models. This brings the feet closer together. It may allow a better position of function. The tapered front riggings might also allow placement of the legs closer to the wheelchair frame without interfering with the casters. If you wear braces on your feet, the space for your feet when using tapered front edges might not be enough for comfortable foot placement.

    Footrest and Leg Rest Lengths

    The length of the footrest (from attachment to the frame down to the footplate) is usually adjustable and is a tube sliding inside another tube. However, if you order a wheelchair frame that is lower to the ground to allow foot propulsion, the length of a standard footrest or leg rest might be too long. The tube will hit the floor. A hemi leg rest or footrest must be ordered. The tubing will be shorter to allow clearance of the floor.

    Elevating leg rests are ordered if you have the knee range of motion to open the thigh to calf angle. They are used to decrease edema (swelling) in the feet, for legs that have knee contractures or tightness that prevent bending at the knee, for legs that are casted or splinted at the knee, and sometimes for a change in position or to provide comfort. Elevating leg rests may be ordered standard or articulating and also are ordered depending on the seat height.

    Standard elevating leg rests have a ratcheting device that brings the leg rest upward. The leg length stays the same. This may cause the foot to push against the footplate as the leg is raised. It might not allow the knee to straighten. An articulating leg rest will lengthen the bar as the leg rest is raised. This will provide enough length for the leg to extend and the foot will not push against the footplate.

    Custom Options for footrests/leg rests may also include:

    • A footplate that swings under to clear the wheelchair frame;
    • A leg rest or footrest that has the bars in the center rather than to the sides to allow angling for leg contractures, bringing the legs under the frame more and clearing the casters
    • Extensions to lengthen the footrests/leg rests

    Footplates support the bottom of the feet. They come in many styles. One piece footplates support both feet. They can be tubular, provide a surface to place the feet on, but minimal surface support throughout the foot or can be a footboard. They can flip up or remain in the same position. The flip up style will stabilize a wheelchair frame, but can flip up to allow the chair to be folded or to allow for clearance for transfers. A footboard also allows attachment of more custom foot supports such as foot boxes.

    Bilateral footplates on chairs with swing away front riggings can be standard, which support the foot usually to the ball of the foot. A larger footplate may be ordered that will support more of the foot. An angle adjustable footplate will allow the ankle angle to be changed. This is necessary when there are limitations at the ankle. These may be ordered with the option of flipping up to provide room for transfers, or bringing the foot to the floor.

    Jessica Pedersen, OTR, MBA, ATP, has worked in the field of rehabilitation technology for more than 20 years. Her experience includes working in mobility and seating clinics at rehab facilities, for rehab technology supply companies and for manufacturers. She's a lecturer and has contributed to books on the subject of rehab technology. She's a member of the American Occupational Therapy Association and is active in its Technology Special Interest Section. Also, she is an active member of the Rehabilitation Engineering and Assistive Technology Society of North America. Living in Chicago, she is a consultant to various agencies and is a lecturer in Governor's State University's Department of Occupational Therapy.

    January 12, 2000

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