Toe Off replies

Toe Off replies

Derek Kozar

9/13/2001

Here are the responses to my request for feedback on the Toe-Off and its
durability.

One thing my clients have commented upon when I've fitted them with the
Toe-Off is how much lighter it is. In my experience your client will
either break it quickly or not at all. I have not found any way to
predict
who will and who won't break the Toe-Off. Camp will replace a broken
AFO
twice in the warranty period. It seems that if they break the first one

they will break the replacements too. The vast majority do not break
but
it does occasionally happen.

I have fitted four of these now, all patients have been very happy to
date. The heaviest male fitted was about 90Kg. No reports of failure,
fingers crossed as this is my greatest hesitationwhen fitting these,
particularly seeing they cost quite a bit.Certainly very light and good
for the mild to moderate foot drop patients, without total lack of
dorsi-flexion. ie early stages of Peripheral neuropathy
Will be interested in other responses.

Our experience has been that every high activity user over 180#s that we

have fit with this orthosis has had problems with delamination at the
junction of the vertical strut and the footplate. We tell them all, No

stooping, squatting, etc.., but they typically don't believe us and end
up
coming back in a couple or months or so anyway. We think it's a great
brace but for a narrow 'indication group' of patients. Be sure to fill
out
the warranty cards, you will likely need them.

It is very light weight. And not very durable. You might broach the
concept with him. I usually give the pros and cons and let the client
decide. Depends on his tolerance for breakage and return appointments.


 I have used about 20 of the toe off AFO's. I like them for CVA pt's
who
have slight Quad involvement and footdrop. They are very light and
adjust
for volume changes. I have had 1 delaminate (highly active 6',180#,
female
salon stylist). Camp is doing warranty of this AFO and I already have
the
pt. in a new Toe Off, the pt loves it. All the pts have been very
pleased
and satisfied. Make sure to place the footplate under a insole or
insert
and use the pad kit from Camp. Be very diligent in your pt selection.
Foot
drop, nerve palsy, mild hyperextension, and anterior tib. draw can be
easly
addressed. I also use them on diabetics with footdrop in conjunction
with
extra depth shoes and diabetic inserts for neuropathy. Do not use on pts
with
severe hyperextension problems.

I have fit probably over two dozen. The only people that had failure of
the device where
bilateral wearers. I have had laborers use them. Their biggest
complaint is losing the
ability to squat. If their job requires them to do so you might want to
steer them towards a jointed AFO with dorsi assist joints
without a plantarflexion stop.

Be afraid, durability would be a concern.
I fit a 5' 10 170 pound doctor, that eventually developed spastcity, a
known contraindication, and he fractured it in his everyday activities.
Diagnosed with MS.

We had a gentleman that probably was not as active but was 5'9 approx
250
and he had a distress fracture to the brace and Camp replaced it without
a
warranty card completed.

I have limited experience w/ the Toe-Off AFO--limited because of
durability
issues. I had a patient while I was working at Duke University Medical
Center who came in wearing one that a friend had given her. She had
been
pleased w/ it due to it's light weight and wanted another for her other
foot
(Patient: a 40+ year old woman w/ a progressive peripheral neuropathic
condition--about 5'9 and 145 pounds--bilateral foot drop) She had had
the
orthosis about 3 months. Unfortunately, the carbon braid was
delaminating
at the juncture between the footplate and the upright leaving jagged
shards
of material protruding and giving every appearance of being ready to
fail
catastrophically. When I inquired about this state of affairs, the Camp

Sales Rep gave the usual We've fit thousands in Europe and this almost
never happens litany that must be imprinted on all Sales Reps before
they
are allowed to carry a sample case. I spoke w/ the technical support
person
at Camp who, in addition to the above mantra, added the ...as good as
this
device is it is not for everybody disclaimer as well as the ..your
patient
must have gotten one of the old ones-we've redesigned the device to
solve
that problem...-my patient was horrified and opted for alternative
orthoses.
        As an aside, one of my colleagues at Duke had just finished
participating in a research project at Ranchos Los Amigos Hospital in
California using carbon Pre-preg material to make orthoses for children
w/
spina bifida. Her experience was that these pre-preg materials (the
Toe-Off
is composed of carbon and fiberglass pre-preg) are predisposed to this
type
of failure.
        All told, it's a nifty-if terribly expensive device that I would

been prone to avoid in all but those cases where the patient is so weak
that
any other device would be prohibitively heavy,. I also have other
issues
with how these devices are coded for billing in the USA, but I doubt if
you
would find those interesting. Hope this helps.