Answers to AFO question

Answers to AFO question

Molly Pitcher C.P.O.

Thanks for all your help with this question. I've compiled the answers below
along with my original questions. Thanks again to all who responded. I now
have a plan. Molly Pitcher CPO
Original question: 1.  What has your experience been with wearers of poly
AFO's experiencing severe cold even in warm weather.  Any solutions?  Is a
laminated AFO less cold conducting?
On this particular person, he was switched to a conventional AFO and the cold
problem was rectified...now for the second part of my question 2. He wants
to wear a sneaker.  Does anyone know of a sneaker that would work with a
stirrup?  We've cut into plenty of sneakers and they are often hollow and
unsuitable for stuirrup attachment.
>Our Shadow Series of braces may be just what you are looking for.
They were developed to be a hybrid between thermoplastics and conventional
AFO's, having the lightweight quality of thermo's while possessing the
strength and stability of metal and leather braces.  Equipped with a
neoprene interface there wouldn't be any cold conducting issues.  I have
attached pictures of the braces,  if this looks like something you might be
interested in don't hesitate to give us a call at 1-800-866-7522, and we'll
be happy to answer any questions you may have or send you additional info.
>The best athletic footwear for a conventional AFO is a motion control
running shoe such as a New Balance 587, Brooks Addiction, and Brooks
Addiction Walker.  These are just a few available.  However, I have the
most success with the three listed.  All three have a firm counter, wide
mid-foot and a very firm flat sole.
>The cold issue should be your first concern my concern for this patient
would be
1) is the skin cold to the touch?the cause of this would be excessive
sweating and the temperature change caused by evaporation of perspiration
Change to all cotton socks that cover the entire AFO  if this is still a
problem the problem should be resolved by layers, Nylon over cotton
2) Is the patient feeling cold or  physically cold?could this be nerve
impingement? Often we overlook the obvious check the height at the fibula
neck not the fibula head
3) The shoe you are looking for is usually the cheap ones from K- Mart and
Walmart. They have a thin rubber sole that can be peelfeeled off add the
stirrup and add a 1/4 inch wedge over the stirrup You may have to adjust the
Metal work for 90 degrees but it works well.
>1. Could the poly AFO have been impinging on the neck of the fibula or
related nerves?
2. We attach stirrups to tennis shoes on a regular basis.  The application of
a midsole on the exterior surface of the cut sole is a must.  A heavy russet
(7-8oz or thicker) on the inside of the shoe, skived and extending to
the metatarsals will sandwich the flimsy sole more than adequately.  A shank
my also be inserted prior to application of the midsole.  We also use wide
tongue stirrups on most jobs like this.
>P.W. Minor makes a leather sneaker that is suitable for stirrups, have done
it many times. And they are not that bad looking either.
>New Balance or Nike without air chambers usually work.
>WE DO SNEEKERS ALL THE TIME.  DON'T CUT INTO THE SNEEKER MOUNT THE STIRRUP
ON SOLE AND THEN ADD A NEW SOLE TO BOTH SNEEKERS WORKS WELL.
>If you choose to use a sneaker in your conventional application, it is
necessary to reinforce the shoe with a suitable material. I frequently use
Fillauer's heat moldable carbon sheets.  In addition, you will need to think
about using a longer tongue on your stirrup (particularly if the function is
not free motion).  I have found that New Balance shoes work extremely well in
this type of application provided that they have a firm heel counter.  The
sole is easy to cut on the bandsaw and is easy to glue together with Masters.
>We use running shoes all the time...you may have to add a carbon plate
(or something) to rivet into, but it works OK.