Cam Walker replies

Cam Walker replies

Gary A. Lamb

9/11/2000

Thanks for all the replies, I present them for your edification... now if
the patient will schedule an appointment... still waiting.....
Regards,
Gary A. Lamb C.O., FAAOP, LPO
=================================================

Gary, I would go custom and if you have time, use Otto Bocks new oven cured
laminate. It's only available as a central fab item and requires a cast.
Otherwise go metal. Rick Lehneis

Bledsoe makes an XLG open back walker with open cuffs also, I recently used
it for a similar patient.Ron Mocchia

Re: Cam walker for patient at 400+ lbs.---- I'd go with a laminated brace
with double uprights. I doubt anything else is going to hold up to the
torque
that a person of this size witha dorsi stop is going to create. Definitely a
rocker sole as well. Paul Meyer CPOI had a similar situation very recently.
Try the metal afo with a custom
black polypropylene plastic footplate trimmed like a camwalker but make it a
custom camwalker type by adhering velcro hook to the inside surface of
heavy duty uprights. Then order an X-large camwalker liner and fasten the
uprights to the liner in the same manner as fitting a camwalker boot liner
to
the device. The metal uprights should be double action and should be riveted
to a custom footplate. A rockerbottom is then added to the footplate(this
should be extra wide so you have a large base of support for your obese pt.
Any questions call me 212-879-8100. Rob CPO

Gary,
 Can I encourage you to consider using a rollover sole that would
 take away the biomechanic stresses of dorsiflexion in the metal AFO?
Respectfully,
Tony Denson CO
San Antonio

Being a big P and a little o, I would think a standard metal AFO would
require a Scott-Craig stirrup with extended steel shank in the shoe to
prevent her from dorsiflexing the system as she progressed to the third and
fourth rocker of weight bearing gait. Bill

Gary, does this individual have any other diagnosis, such as diabetes, etc.
If so, it may influence the orthotic outcome. The necrotic ulcer part of
your
e-mail gives me concern. If no other problems existed, I'd simply call the
manufacturer to inquire about weight limitations. If you do fab. a
conventional AFO, consider either a long stirrup or sole stiffener to keep
the shoe from breaking down to quickly. A well contoured foot orthotic
inside
the shoe may be nice to counteract the rigidness of the shoe bottom. Good
luck,
Steve Baum C.O.

I would recommend a metal AFO without hesitation. Anything else is risky.
Use
a reinforced long tongue stirrup, heavy duty uprights, and carefully
selected
shoe wear.
I would not use a CAM walker. Just my $.02.
Matt Bailey, CPO, LPO

Anyting OTS would likely decrease probability of success. If ROM is not a
severe issue it seems that a CRO walker (Total contact AFO, or Neuropathic
Walker) may be more appropriate. Her ankle will be immobilized at 90
degrees but a rocker on the sole portion of the orthosis would simulate
some of that ROM.
I was able to sucessfully fit one patient who was 450+ for a different
diagnosis.
Hope this helps.
Russell Dela Rosa CO

Standard metal AFO with long tongue stirrrup trimmed just prox to MT
heads
and DAAJs (1/4 X 3/4 ss sidebars).
Tom Lunsford, LOCO

Just a suggestion, but I wouldn't even fool around with the off the shelf
CAM Walkers and fab him a metal AFO w/ double action joints.
Bob

I have a couple of thoughts to discuss with you on this:
1.) I ruptured my achilles about eight years ago, and after surgery, I wore
a
walking boot plantarflexed about 30 degrees as to the Doctor's orders while
non-weight bearing using crutches. After three weeks, he dropped it to 10
degrees pf while continuing with the cruthches. As a bad patient, I put the
brace in neutral about 5 weeks out from the surgury and begin weight bearing
with the crutches. As a final follow-up, the surgeon had me use a heel lift
of about a quarter inch for a few monthes afterwards.
2.) Shortly after all this occured, I had a gentleman present to my practice
with an achilles rupture. He was a sailor and was preparing for a voyage. He
refused surgury.
He was basically sent over to see what we could do to help him out in the
meantime. I measured and fabricated a double upright metal AFO with double
action ankle joints. We set these out toaround 30 degrees of pf and built up
the shoe accordingly with a heel wedge. We then balanced the height with the
other shoe. It worked out pretty well and the man seemed to function
well-enough. I also ran this suggestion by another Orthopod who I had
developed a friendship with and he believed this was appropriate as long as
we kept the achilles shortened and positioned properly. Weight bearing on
this was not a major issue if this was done, he reiterated.
Anyways, hope this helps,
Josh Ryder, C.O.

I agree with your assessment. Tom D

Best bet for me has been reverse klanzak with ortho lace to the toe high
tops with custom molded innersole. Paul T. Webber

  Did they surgically repair the rupture ? A metal AFO may be
your only option for a person so large. Even that will be stressed an awful
lot. Good luck - S

Several thoughts. Get her GP involved. Atkins revolutionary diet is out
there. Is she a BKA potential. You mention necrosis. PVOD ? Endstage
diabetes.? Wound Sluff?? AFO Double metal upright is a good thought as
long as you have an appropiate shoe. Her weight creates a challenge!
Kenneth H. Noll