Toe Off replies, Thanks for the replies

Toe Off replies, Thanks for the replies

S. Yoshino

11/3/1999

We have used the Toe-OFF quite often for patients (mostly adult) for
drop-foot w/o m/l instability in the ankle, equinus, etc.. We've had very
good results and most don't even complain about the color, especially if
they were previous wearers of a plastic AFO. It is so much more
comfortable, lighter, and even has a little dynamic toe-off effect. The
only thing to it is making sure you accomodate the curvature of their
tibial crest with your padding material. They just came out with a
padding
kit that so far has worked well for us too. We've even experimented with
some KAFO hybrids using it. It gets a hardy thumbs up from us.

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I have tried the Toe off orthosis with several pt's which seemed to me to
be
ideal (based on the sales info and rep info) with poor results. My
concerns
were
1. protecting the skin
2. did not provide any medial lateral control ( a curiosity because the
sales rep markets the opened calcaneous as a bonus to the pt, I cant
figure
what pt that needs a AFO doesn't benefit from hindfoot control?)
3. pt's reported discomfort over anterior tib

I would be curious to hear if people are having success and what they are
doing differently
________________________________________________-
My office has fit two so far and to my knowledge, the clients have done
well
with them and liked them.
__________________________________

I have fit a few and tried on approval from the company quite a few more
than I ended up fitting. If the Toe-OFF is going to work, it seems to
work
immediately, the first time you try it on the patient. I usually get the
size blank the person measures for and take to phys therapy session and
let
the PT evaluate it at same time I do. I put temporary straps on and
usually
no padding for the trial. If it works noticeably I then pad the anterior
section, etc.

One of the biggest problems I have had with it is attachment of permanent
straps. Camp says don't drill rivet holes. They recommend using epoxy. I


live in a very cold winter climate (formerly South Dakota, now Montana).
Epoxy gets rigid and brittle in cold weather and that portioon of the
Toe-Off stays flexible so the the straps and loops stay attached approx. 2
hours in cold winter weather. I ended up having to use the industrial
strength Velcro (stickyback) that I can get at Ben Franklin craft stores
to
apply to the brace itself and then just have the velcro pile straps wrap
around the leg without being able to have the velcro go through a loop
and
double back on itself. I finally figured out how to incorporate a loop
into
the industrial strength sticky back velcro and rivet the velcro closed
around the loop so the vecro strap could pass through the loop and double
back on itself, but it is a little bulky.

I have seen the Toe-Off double the walking speed in two patients--one was
an
MS patient, the other was an elderly man who had surgery for a spinal
stenosis and had bilateral peroneal weakness as a result and had failed
standard custom AFOs. I have seen the Toe-Off produce lateral stabilty in
a
more active MS client. It has also worked well with a incomplete spinal
crod
injury (cervical injury on the job). The man was in his 40s and had been
quite active. He tried the Toe-Off and not only did it work well he also


liked it (he had rejected delviery of a custom AFO at a competitor's
office
after trying walking in the AFO). His question in regards to the Toe-Off
was
would he be able to resume jogging with it! If the Toe-Off is going to
work,
my experience at least is that it works dramatically the first time the
client tries it. I recommend always getting the brace on approval. That
way you can keep it several weeks, try it with the client and return it
with
no obligation except to cover the cost of shipping.
_____________________________________________-.


Neat idea, works well for totally flacid foot, had fitting problems with
the
distal anterior part where the plastic crosses.

_____________________________________________
Hi

My experience is that this device is not for everybody but does work well
in simple dorsiflexion weakness situations. I've had several clients who
comment that it's very light, fits most shoes and is comfortable to wear.
Cost is a factor so non insured clients may opt for less expensive devices
but overall I've been pretty pleased with the device.

___________________________________________
I like it. It is best used for patients whom only have a problem with
dorsiflexsion, and some need of knee stability when standing. The
cosmesis
is not the greatest, but the accomodation to footwear is wonderful; it
goes
under the innersole of the shoe...no need for larger footwear to
accomodate a
brace.
Try it, you'll like it to, especially for those who are already using a
AFO
and want to try something else.

Just repeat after me, prefab sucks. By the way, are you an orthotist?
And
if so, are you ABC-certified or other... The only reason I ask is that
there are always questions about prefab this & that from other
practitioners. I think the Toe Off is an interesting approach but, if you
like it, I think a better fitting and more comfortable custom alternative
can
certainly be fabricated. The more off-the-shelf crap that gets billed to
3rd
party payers the more difficult it is to seek reimbursement for custom
orthoses. If you don't believe this is a real-life phenomenon, move to
Pennsylvania and deal with their state-run medical assistance. Please
seek
custom alternatives...

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That is it for now if there are more I will foward them as well. Thanks
to those who applied. Stephanie Yoshino CPO