MD AFOs

MD AFOs

Jeff and Diane Conuel

3/11/2003

I have an interesting patient. 48yo active slim male (5'9, 140#) with
dx of FSH Muscular Dystrophy. Patient has had dx for about 12yrs and
tried a hinged (gillette?) AFO w/PF stop years ago. Patient presents
with bilateral poor dorsiflexors AND plantarflexors. Knee strength is
still good. Patient walks with very severe steppage gait and foot slap
bilat. Patient has learned very well how to compensate. His main
complaints (leading him to seek bracing) are 1) inability to stand still
for any period of time -- even 10 seconds (needs to hold on to something
or finds himself catching himself by stepping backwards as his weight
shifts back on his heels). It is very interesting to watch him have
difficulty with this -- his DFs and PFs are so weak that he can't
stabilize his body weight over his ankles. 2) awkward gait and 3)
tendency to turn ankles (inversion). Remarkably, he hasn't fallen much.

Patient has waited a long time for orthotic intervention and is now
seeking state-of-the-art. Patient is a businessman and wants to wear
oxford shoes (he is willing to get a roomy style). He wants no noise
(his old AFO clicked at PF stop). Patient is active in walking outdoor
activities, boating and riding his Harley.

I'm considering laminated AFOs (at his request for light and low
profile). I have a couple of design ideas but want yours! I think he
needs an anterior stop (or floor reaction design) to rest on for
standing. I looked at the Townsend premiere, but I think it is too bulky
and heavy. Let me know your design ideas and suggestions for where to
central fab laminated AFOs. Would love to hear about any patients with a
similar presentation as well.

Thanks in advance,
Diane Tormey CO

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