Responses to Gait Plates

Responses to Gait Plates

Thanks to all who responded to my question on gait plates. I have also
included responses to an earlier question re: torque heels, which was what I
was thinking of anyway. My apologies for the lenght of the post.

Dear Toheck

  Gait plates are in essence very simple traditionally they are made with

materials such as aluminium sheet inserted in the shoe. In principle what

happens is that the plate extends like a sock lining until the break of the

shoe under the met heads. This is where the difference is, if you want to

promote out-toeing you extend the end of the plate distally on the lateral

side(ie in front of met heads) and cut it short on the medial side.

Conversely if you want to promote in-toeing you extend the plate distally on

the medial side and cut it short on the lateral side. Gait plates are

generally used in paediatric orthotics. Now your probably thinking that I

haven't used aluminium in this manner for a while and wouldn't this give the

shoes a bit of a hiding? Answer Correct. This is why I would recommend

that you adapt yourself to making the plate with podiatry techniques. Have

you heard of the Neutral talus Orthosis in a book by a chap called Jim

Phelps? (Common garden podiatry 'orthotics' to everyone else). Well in short

you need to take slipper cast with the foot in Subtalar joint neutral

position and do a bladder mold on the resulting cast with 1/8

Polypropylene. This can then have it's leading edge modified as you

previously would have the aluminium.

Of course you can take a UCBL cast, but as you only need to use the plantar

surface and there are problems with UCBL's in maintaining good plantar

surface reproducibilty, you may prefer to read up on or talk to your

friendly podiatrist. (I am a Orthotist gone back to podiatry school) I also

believe that some of the orthotic texts such as the one that 'Rose' wrote

cover this topic. Don't be too concerned about this the principle is quite

simple. The reason that you have not dealt with this problem, is perhaps due

to the fact that there is opinion as to wether this is a problem worth

treating, as a large portion of these problems self resolve. Please reply if

you require further information. As you are an Orthotist you are by,

definition resourceful.

Regards Leo Brown

-----Original Message-----

From: <Email Address Redacted> < <Email Address Redacted> >

To: <Email Address Redacted> < <Email Address Redacted> >

Date: Thursday, 29 October 1998 14:42

Subject: gait plates





>Hello to all. Sometime in the last few months I recall a post concerning

the

>use of gait plates to treat in-toeing or out-toeing or some other such

toeing.

>I thought it was amazing that in twenty+ years in the field and many

>rotational deformities/abnormalities seen and treated, I had never had a

>request for gait plates. I read the responses, including how to obtain gait

>plates, and then calmly trashed them. I'm sure you know where this is

going -

>today comes my first Rx ever for gait plates. Any help would be

appreciated.

>





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From: Leo Brown's Mail < <Email Address Redacted> >
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Subject: Re: gait plates
Date: Fri, 30 Oct 1998 14:43:14 +1300
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Baumsteve

Would you be so kind as to combine your gait plate responces and share them
with the O&P list subscribers? I am interested in the responses as well.
Steve Baum, CO, Menlo Park, CA

<Email Address Redacted>
I think most would consider a gait plate to be a cross between a UCB and
 standard arch supports. I do know that Bio Orthopaedic Lab in Costa Mesa,
 CA can make them for you from positive casts, negative casts or foam art
 impressions.
 Their phone number is: 1-800-234-1237
 Lab costs are about $45.00 US depending on the options you would like
 included.
 Good luck,
 Dan Selleck

Rabcped
We order premade pediatric sizes from Pedifix. phone 800-424-5561. Address 4
Columbus Ave., Mt Kisco, NY

Raymond Blasingame



-----Original Message-----

From: Ben McMurtrie < <Email Address Redacted> >

To: O&P Listserver < <Email Address Redacted> >

Date: Friday, July 24, 1998 3:30

Subject: Torque heel response





Thankyou for all the replies regarding Torque Heels, Please find the responses
listed.

General concensus say's, Give them a try , as well as having a fast wear
factor.



Answers to some questions asked are-



Pat P - Oxford scale strenght would be a 4/5 for active internal rotation

Harold A -Spasticity is low, good active movement but limited at approx 10 deg
ext rot'n, lack of ext Rot'n comes from an antiverted femoral neck, not tibial
torsion.







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Dear Colleague,

Try out the heels, don't have much to lose. Does this patient have any

active movement towards her best externally rotated position?

Pat Peick CPO





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Ben- we do use twister cable setups, preferably with the twister in the

thigh segment and connected with single uprights and a free knee joint to

either shoe or AFO for cases as you describe where the rotation seems to

be coming from the hip. I hate to put torque through inivolved joints and

run the risk of creating knee ligamentous instability. Another option is

to use commercially available elastic wraps, or Ace wraps if you can

explain how to wrap them to parents and therapists. The goal with these

things is not to influence bony growth but just fucntionally to point the

toes straighter ahead and perhaps overcome internal rotation tightness.

PT should also work on hip range and if there is differential tightness of

one hamstring over the other that can be addressed either by Botox

injection or trial of stretching with bias towards the medial or lateral

side (rotate lower leg slightly while doing the stretch with hip flexed to

90 and extending knee.)



I've never tried a torque heel and would be veryinterestedto hear about

what that does for a child with CP! Thanks,



Vikki Stefans, pediatric physiatrist (rehab doc for kids) and working

Mom of Sarah T. and Michael C., aka <Email Address Redacted>

Arkansas Children's Hospital/ U of A for Medical Sciences, Little Rock

...and EVERY mom is a working mom! (OK, dads too...)







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Torque heels are fairly inexpensive and don't do permanent damage to

shoes so, I'd say try it and let us know what your results were.

It's very difficult for me to say this will or will not work based on

what you've presented. Is there spasticity involved? Is the lack of

external ROM coming from the hip or from internal tibial torsion?

Even knowing this may not be enough to say yes or no.



I've worked with orthopedic surgeons who would put twister cables on

even a minor rotational deformity ignoring whether it comes from the

hip or tibia. However, the surgeons I've worked with who are

pediatric specialists tend to not use twister cables or bent knee

orthoses as they claim they don't get good results from them. In

severe cases, they will do osteotomies.



I'm very much interested in seeing what other practitioner's

experiences are concerning rotational deformities such as femoral

antiversion and Internal tibial torsion. Have you had documentable

success with orthotic intervention or is surgery the only effective

means of correcting these problems? I've put many bent knee orthoses

on children for ITT and many twister cables on children with problems

coming from the hip. Unfortunately, these are the cases that we

don't get to follow up on. The ones that do come back tend to be the

failures but does that mean the rest are successes? The twister

cables that I've been able to follow tend to be used to combat high

or low tone problems. The few (very few) that doctors have

prescribed for femoral (or, worse, ITT) rotational deformities have

never returned.



Back to the torque heels. I doubt that they could do any more than

address the symptom if they can do that. My experience is limited

with them and the few I've done have not been very successful. The

same goes for gait plates. When fit, some patients do very well.

Then, a week later, they return intoeing as much as without the gait

plate. One problem I see with them is that they assume fairly normal

gait. The child is supposed to have a heel/toe gait and, if they

avoid pressure on the heel, the torque heel doesn't work. If they

avoid using the toes for push off, then the gait plate doesn't work.

There are too many ways for them to get around the problem we've

introduced to their feet.



But, like I say, try it. You may have success. And let us know.



Harold Anderson, CO





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Hi Ben,

I have used the torque heels, some years ago,

They are of limited use, and dependant on the patients gait

i.e. you have to have heel strike, and have to locate the

torque thingy correctly. Also the weight and tone of the

patient has some influence. A bit like winnining the lotto really.

If you can get hold of some relatively easily they may be worth a try.

They do wear out rather quickly as you might imagine.

MArk Holian

Dir P&O

Royal Brisbane Hospital

Ph 07 3253 1080

Fx 07 3253 3500 (I am out today)







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Sir, I know this dosnt answer your question but>> I have had some success

with taping for muscle reeducation. The technique uses leucotape and pre wrap

places directly on the skin (a skin prep of milk of magnesia is used to limit

skin reactions). The tape orientation is from sacrum to anterior thigh. The

tape needs to be applied with the pt in sidelying with the leg abducted and

maximally external rotated.

Let me know if I can help

Scott Bleakley MSPT





Have you considered the OOS afo (Oregon Orthotic System). This might



****************************

Steve Strasburg C.O. e-mail: <Email Address Redacted>

Univ of Michigan PM&R O&P

313-973-2400





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    -----Original Message-----

    From: Ben McMurtrie < <Email Address Redacted> >

    To: <Email Address Redacted> < <Email Address Redacted> >

    Date: Monday, July 20, 1998 3:27 AM

    Subject: Fw: Torque Heels?







    I used torque heels all the time on children a few yaers ago. We stoped
using them because, as you said you can not change a boney condition with an
external device. However they will turn the leg out if all you want to do is
improve gait.



    Jim Butts RTO





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    We used these heels in the past, they can help. The problem that we had
was

    durability. Often they would wear out in less then 1 month.



    Dreher Jouett, CPO







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Hi Ben



I have several kids like this as well. I've used a simple 1 inch wide

cotton strap attached to a pelvic band of thin aluminum. By winding the

strap around the leg once and attaching to the band external (or internal

if so desired) rotation is achieved.



I'd be really interested though if you get replies regarding your wheeled

device. If you get any info, could you send it my way as well??



Good luck and thanks in advance for anything you may find.







Cameron Renwick, C.O.(c)

Algonquin Orthopaedics

228 Main St. W.

Huntsville, Ont., Canada

P1H 1Y1

705.787.0797(8)

705.787.0799 (fax)

<Email Address Redacted>





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Hi Ben!



I'm an Orthotic Tech at The Rehabilation Centre in Ottawa, Ont, Canada.

I've used the torque heels a few years back and they actualy worked

well. The only problem is that they wore down rather quickly(2 months

of use).





Shawn Millar







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Hi Ben,



I have used these heels for many years. They work very well.

The only problem is that they do not last well.



You could also try lateral sole wedges ?



All the best,



Errol Lishman CPO

=======================





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Thankyou all once again. Once I find out the costs etc and try them I will
post a report on their effectiveness.





Ben McMurtrie - Orthotist

Geelong Orthotics

42 Bellerine St

Geelong 3220

Ph-(03) 52 242200

Fax-(03) 52 242829

E- <Email Address Redacted>


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<DIV>&nbsp;</DIV>

<DIV>-----Original Message-----
From:

Ben McMurtrie &lt; <Email Address Redacted> &gt;
To:

O&amp;P Listserver &lt; <Email Address Redacted> &gt;
Date:

Friday, July 24, 1998 3:30
Subject: Torque heel

response