AFO Question Replies
Patti Larkin
Description
Collection
Title:
AFO Question Replies
Creator:
Patti Larkin
Text:
I would like to thank everyone who responded to my AFO situation.
Question:
I am presently working with a 8 yr. old girl diagnosed with Cerebral Palsy.
This young lady presents with severe pes plano valgus (navicular on floor
and head of talus exposed upon weight bearing) on her left side coupled with
a moderate amount of crouching. However, on her right side she is quite a
bit stronger and only presents with a mild/moderate form of pes plano valgus
and very mild crouching (may be caused by a compensatory gait deviation due
to LLD and left leg deformity). Her balance is good and does not need any
assistive devices to ambulate.
I am comfortable recommending a Floor Reaction AFO for her left side but I am
not sure about her right side. On the right, she is flexible in all range of
motion and grades at least 4- in all MMT. Isolating her right side, an
articulating AFO may sound like the best choice.
However, my question is this:
If I was to apply a FRAFO on her left, and an articulating AFO on her right,
would the significant difference in the control of the AFO's significantly
compromise her gait? She is presently wearing SMO's and in my opinion, are
of little benefit to her. I would appreciate any feedback from anyone who
has had experience with this type of case.
Thank you
Patti Larkin
Answer:
As to your question: Brace to the minimum. Use the least restrictive
brace that deals with the problem, don't worry about uneven bracing.
The alternative would be to over-brace the right in an effort to
balance the orthoses. However, locking the ankle unnecessarily does
the child a disservice, making it more difficult to get up from the
floor.
Have you tried valgus correction extensions on her. I suspect that if you
align the foot your patient has a plantar flexion contractureas the primary
cause of the other symptoms. have you tried to muscle test for hamstring
contractures. the combination of these two problems is exactly what you
discribed. look also for hyper lordosis and or hip flexion contractures. I
currently have a patient with distal spinal muscular atrophy that presents
the same way. check for these things and let me know what you find.
why not make a FRAFO & let her walk with that on the left side & her SMO on
the right - then the question of whether two different designs will
negatively affect her gait will be answered without costing you anything
interesting post - let me know how it works out
First buy the following videotape and do a Preparatory AFO. You need to get
the foot ready for an AFO! If you do the AFO well then the foot will change
in a very short time, and you can make it over under your warranty
provision. Or you can use a Preparatory AFO idea that takes only 20 minutes
to create a new one.
Flexcast Video Web Site
Just a thought regarding the mild crouching on the stronger side....It may be
reasonable to go with the left FRAFO and continue to use the SMAFO on the
right so you can assess how more flexibility on the right with better left
control works out. I find that even mild crouchers sink into free DF and I
haven't been very satisfied with DF stops. This suggestion assumes that your
child lives within an easy distance to allow for extra visits. Good luck
I no longer worry about the consequences of significant variations of
orthoses design for bilateral applications. A long time ago I was
introduced to the phrase the anatomical function lost is equal to the
mechanical function replaced. It still works for me today.
You may wish to look at the Cascade family of products for your little girl
It sounds to me like the biggest problem is a contracture of her Gastroc.
Check her range of motion with her hindfoot and forefoot in neutral, with her
knee flexed then extended. I think you will find a plantar flexion
contracture which must be accommodated for in the AFOs. If you do not
address the deforming force the foo t will still collapse.
why not make a FRAFO & let her walk with that on the left side & her SMO on
the right - then the question of whether two different designs will
negatively affect her gait will be answered without costing you anything
interesting post - let me know how it works out
Question:
I am presently working with a 8 yr. old girl diagnosed with Cerebral Palsy.
This young lady presents with severe pes plano valgus (navicular on floor
and head of talus exposed upon weight bearing) on her left side coupled with
a moderate amount of crouching. However, on her right side she is quite a
bit stronger and only presents with a mild/moderate form of pes plano valgus
and very mild crouching (may be caused by a compensatory gait deviation due
to LLD and left leg deformity). Her balance is good and does not need any
assistive devices to ambulate.
I am comfortable recommending a Floor Reaction AFO for her left side but I am
not sure about her right side. On the right, she is flexible in all range of
motion and grades at least 4- in all MMT. Isolating her right side, an
articulating AFO may sound like the best choice.
However, my question is this:
If I was to apply a FRAFO on her left, and an articulating AFO on her right,
would the significant difference in the control of the AFO's significantly
compromise her gait? She is presently wearing SMO's and in my opinion, are
of little benefit to her. I would appreciate any feedback from anyone who
has had experience with this type of case.
Thank you
Patti Larkin
Answer:
As to your question: Brace to the minimum. Use the least restrictive
brace that deals with the problem, don't worry about uneven bracing.
The alternative would be to over-brace the right in an effort to
balance the orthoses. However, locking the ankle unnecessarily does
the child a disservice, making it more difficult to get up from the
floor.
Have you tried valgus correction extensions on her. I suspect that if you
align the foot your patient has a plantar flexion contractureas the primary
cause of the other symptoms. have you tried to muscle test for hamstring
contractures. the combination of these two problems is exactly what you
discribed. look also for hyper lordosis and or hip flexion contractures. I
currently have a patient with distal spinal muscular atrophy that presents
the same way. check for these things and let me know what you find.
why not make a FRAFO & let her walk with that on the left side & her SMO on
the right - then the question of whether two different designs will
negatively affect her gait will be answered without costing you anything
interesting post - let me know how it works out
First buy the following videotape and do a Preparatory AFO. You need to get
the foot ready for an AFO! If you do the AFO well then the foot will change
in a very short time, and you can make it over under your warranty
provision. Or you can use a Preparatory AFO idea that takes only 20 minutes
to create a new one.
Flexcast Video Web Site
Just a thought regarding the mild crouching on the stronger side....It may be
reasonable to go with the left FRAFO and continue to use the SMAFO on the
right so you can assess how more flexibility on the right with better left
control works out. I find that even mild crouchers sink into free DF and I
haven't been very satisfied with DF stops. This suggestion assumes that your
child lives within an easy distance to allow for extra visits. Good luck
I no longer worry about the consequences of significant variations of
orthoses design for bilateral applications. A long time ago I was
introduced to the phrase the anatomical function lost is equal to the
mechanical function replaced. It still works for me today.
You may wish to look at the Cascade family of products for your little girl
It sounds to me like the biggest problem is a contracture of her Gastroc.
Check her range of motion with her hindfoot and forefoot in neutral, with her
knee flexed then extended. I think you will find a plantar flexion
contracture which must be accommodated for in the AFOs. If you do not
address the deforming force the foo t will still collapse.
why not make a FRAFO & let her walk with that on the left side & her SMO on
the right - then the question of whether two different designs will
negatively affect her gait will be answered without costing you anything
interesting post - let me know how it works out
Citation
Patti Larkin, “AFO Question Replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/218490.
