Summary: Adjustable heel height foot

Summary: Adjustable heel height foot

Paul Prusakowski

12/4/2001

Thanks for all the responses. Here is the original questions and the
summary. -Paul Prusakowski, CPO

I am currently working with a young woman who is requires a foot that is
easy to adjust for different heel heights so that she can switch between
dress shoes and boots. Does anyone have any favorable experiences with
durable feet that are easy for the user to self adjust the heel height?
Thanks in advance.
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Response Summary:
1. Total Concept by Ossur
2. Masterstep by Ossur
3. Endolite Multiflex
4. Endolite PAH Foot
5. SAFE II

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TOTAL CONCEPT BY OSSUR COMMENTS:

If your patient is under 80 Kg ( 175 pounds) you should try the Total
Concept, from Össur/Century. It's probably the easiest for the patient(
up to 5 cm adjustments) and good gait features.

I have used the adjustable heal height foot from the Century XXII (which
I think is now Flexfoot/Ossur). It worked well for adjustability
purposes. Unfortunately, it is NOT a dynamic foot. The patient uses it
for dress but prefers her more dynamic foot for everyday. I hope this
helps and if you get other suggestions I would be interested in them for
my use too.

century's total concept foot ahs worked well for one of my patients - I
haven't tried any others - the patient is a mother, an attorney, AK
amputee & wife ! - busy schedule ! - she loves it & it has served her
well for over a year now

century 22 makes a foot that is adjustable and easy to use but kind of
heavy

Hello. have recently used the century 22 total foot ,and I will not use
any more. both that I used broke with in 4 months, and it took almost
that long to get them repaired and sent back. thank you Ossur.. I have
used the masterstep and it has performed very well,also endolite makes
an adjustable foot that is very simple and durable.Hope this helps.

I have used the total concept (Narrow) for one 23 year old female. She
loved having the ability to quickly adjust the heel height from no heel
to 1. The range is greater (up to 2+, I think) but it is harder to
provide an acceptable cosmesis. The greater the plantar flexion
adjustment, the more compression of the posterior area of the foam cover
and/or skin covering; and tension (separation) anteriorly . Dorsiflexion
(less plantar flexion) provides the opposite problems for the
cover/covering.

The Total Concept from Century (Ossur, USA) is easy to adjust, and quite
durable- The foot has a button on the side that you push, allowing the
amputee to move the ankle to adjust foot height.

TheTotal Concept is a good foot. It is difficult to maintain cosmesis
while maintaining easy adjustability in the ankle area but workable.
The keel has separated from the foam foot shell on one patient and has
caused squeaking sounds but not foot failure. Flexfoot/Ossur said they
are improving this foot. I recommend it- Four stars out of five ****.
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MASTERSTEP COMMENTS:

Have you tried the Master Step from Iceross? This foot is very easy to
use by the amputee, but does have high maintenance requirements on the
part of the prosthetist. I have one out now on a 16 yr. old girl, active
in high school, dating, etc.

I do have to go in and tighten the bands every six weeks or so due to
the foot getting noisy. I have a difficult time hearing the noise but
she hears every whisper and its her ears that have to be satisfied.

My previous experience with the MasterStep was in Colorado where I used
it on 5 ranchers who adjusted heel heights between rubber boots and
cowboy boots and almost all heights in between.

Paul, I have used the Masterstep Foot from Ossur for a similar
situation. It was a woman that was not very mechanically inclined and
after trying a few feet (and you will find only a few with adjustable
heel heights) the Masterstep was the easiest foot for her to adjust. It
does not require a SACH foot bolt be loosened and subsequently torqued
again. It does however require (and comes with) two allen wrenches, a
4mm. and a 3mm.. First they use the 4mm. to loosen the set screw, then
use the 3mm. to adjust the heel, then tighten things up with the 4mm
wrench again. All this takes place at the ankle level from the rear, so
an access hole will need to be utilized that gets placed right on the
Achilles tendon area.


Ossur (Not Flex Foot) has a foot called the Masterstep they sell in
Europe. It purports to have an adjustable heel height and a tension
adjustment system based upon a system of resiliant internal bands.
It's a carbon foot, and is recommended to meet the requirements for
multiaxial function too.

I haven't seen it used personally, but I've been intrigued. Some of the
CPO's I've talked to who have tried said it was prone to failure/repair.

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ENDOLITE MULTIFLEX COMMENTS

The best foot adjustable is a MULTIFLEX from ENDOLITE It is possible to
adjust the heights of the heel himself.

It takes some patient education and perhaps some creative markings on
the foot but we have had fairly good success utilizing the endolite
dynamic response foot and their multiaxial ankle. The problem we have
seen occurs when people don't get the teeth lined up properly and end up
ruining the mating surfaces between the foot and ankle.

Paul, I have used the Endolite patient adjustable heel height the most
and have had some success with it. When the foot is adjusted so the
heel is low the toe sticks up but not too bad. I have had some problems
with noise but again not bad. The adjustablity is eazy for most
people. Of course you have it in conjunction with the multiflex ankle.
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ENDOLITE PAH FOOT COMMENTS

Endolite North America too have an adjustable heel foot, called the PAH
FOOT, This foot allows the patient to adjust the heel to differing heels
dependent on the shoes they may be wearing at the time, it is very
popular, and durable, the other feet in the Endolite range are also heel
height adjustable but this is normally carried out by the facility, as
it would require some thought into the positioning of the foot and some
specialized fitting instructions to be followed, something the patient
could not be trusted to do without the proper tooling.

I have used the Endolite foot for this purpose. The patient still uses
it for high heeled activities and finds it satisfactory. It adjusts
using an allen wrench from the posterior heel area. Draw backs are the
weight (compared to todays lighter feet) and the relative lack of
functional features. Unless the foot has been upgraded, it is at best a
first generation attempt at copying the College Park, and a weak one at
that!

I have good results with Endolite's patient adjustable foot. It is easy
to adjust and has a wide range of heel height. With the Endolite ankle
the foot has satisfactory motion. The cost is about 1/2 of the Century
22 foot.

It only comes in 25cm largest size but it is designed for ladies and
offers adjustment by supplying a 4mm hex driver. It locks in the
position after the required adjustment.
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SAFE II COMMENTS:

I find that the Safe II adjustable works well. It is not the best for
exoskeleton finishes. Once you get the heel height set use a sharpie to
mark the position so that it will make it easier for the patient to find
the right position when she changes from shoe to shoe.