ankel orthosis for supination responses.
Vicky Jarvis
Description
Collection
Title:
ankel orthosis for supination responses.
Creator:
Vicky Jarvis
Date:
3/23/2004
Text:
Thanks a lot for all your help, below is the original question along with responses. I have just fitted the patient with an articulated orthosis (camber axis) with a total contact foot shell laminated in flexible resin with carbon reinforcement of the sole plate and joint attachment area, all as thin as possible. Above the joint is now laminated in carbon, with a cut out mid-calf to reduce heat problems and strong straps just above the joint and round the calf. This has worked very well in controlling the varus and with help of intensive physio, the pasient can now manage 5 degrees of d/flex, so we are all happy with progress. I may reake it later in pre-preg if the fit is satisfactory enough.
Just out of interest I also have another patient with the same problem, who is older and less motivated to regain joint movement and a leather boot with carbon reinforment has worked very well for her.
Vicky Jarvis CPO
---------------------
> I have a teenage patient who has an ankle injury after a sport accident 1 year ago, this has resulted in high tone that causes extreme supination of her foot and internal rotation of the tibia. Medical/surgical treatment including botox has not helped. It is possible to manipulate the foot into a neutral position, the manipulation causes pain particularly under the patella, but once in neutral there is no pain. I have succesfully made a bivalved night orthosis. I now need a replacement for the Walker currently used during the day as the height difference is causing hip problems. She cannot tolerate joint movement whilst weight bearing, but her physio is hoping to build up tolerance. My question is has anyone got any treatment ideas for this type of problem? So far I have tried a Chamber axis joint in a laminate shell, but the laminate above the ankle was not stiff enough to control the tibial rotation, am now considering either pre-preg carbon or side steels. Would pr!
efer not
to use plastic because of heat problems. Any ideas or advice would be greatly appreciated.Thanks in advance
>
> Vicky Jarvis CPO
---------------------------------
if the only clinical issue is the LLD from the walker I would propose a
shoe lift until tolerance is sufficient for a hinged orthosis.
If the issue is to move into an articulating AFO and it has to be super
rigid for control, perhaps Townsend Design can help.
------------------------------------------------
I have two of these type of patients one a strong male 18 year old and One a 45 year old female. The male is a result of reaction to a Immunization and the female is a result of a accident. Both present with varus heels plantar flexion or supination as you said. both when they are seated and relaxed can be moved into neutral/90 degrees and a little past. however
when the walk with no brace there foot spasticly goes into varus so bad that they are walking on the lat. side of their foot.
On the female I have in a flexible inner boot( 1/8 polyethel) and a solid ankle afo over that out of (1/4 poly pro)with varus tab with a heavy push. The male I have in a Solid ankle afo 1/4 copoly with ankle reinforcements and varus tab. I have currently made three brace for the female and two for the male over the last three years. Each one has been a improvement on the last. I now have them both postioned in a slightly supinated postion that seems to be the trick. Basiclly when casting I push as hard as I can to get the postion and then leave it there. I cast seated with the foot in the air like you would for a c.p. child cast. I have found that joints only weaken the plastic shell and control is lost in these really powerful spastic patients also if they are firing their plantar flexors the joint never actually is used during the gait cycle. I have had no luck with anything but plastic. The carbon afos are not forgiving enough for me when it comes to adjust!
ments
with these hard patients I have found ability to adjust to be number one.
And metal just does not get a good enough grip to control. Both patients are now very happy and are walking farther with less pain. I feel the real diffrence in the braces I have made for them over the years is postion. With the foot in pronation it seems to solve all the problems I had with the past braces that were made in a neutral postion. This is just what I ended up with with a lot of trial and error. Not saying its the right thing to do just what I did.
----------------------------------------------------------------------------
Sounds like your client may be suffering from the effects of Complex
Regional Pain Syndrome. See:
<URL Redacted>
Your orthotic treatment is appropriate, but no doubt your client may also need aggressive physiotherapy in the form of TENS or Ultrasound treatment to address the underlying neurological condition, which if left untreated will progress.
---------------------------------------------------------------------------------
External rotation of the tibia with supination. Why not go with laminated solid ankle for strength dual side element.? BAR 2804
--------------------------------------------------------------------
Very interesting problem. I use prepregs extensively. It has taken me about three years to finally find a composite combination which stands up to daily abuse. Please feel free to contact me if you would like us to fabricate an orthosis for you.
----------------------------------------------------------------------
Challenging case. I find that I can much better control transverse plane rotation with a full circumferential design--similar to floor reaction trim lines. This makes the device far more rigid--approximately 5 times more rigid, than a circle with a mere slit in it, because of the moment of inertia. Good luck
---------------------------------
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should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Just out of interest I also have another patient with the same problem, who is older and less motivated to regain joint movement and a leather boot with carbon reinforment has worked very well for her.
Vicky Jarvis CPO
---------------------
> I have a teenage patient who has an ankle injury after a sport accident 1 year ago, this has resulted in high tone that causes extreme supination of her foot and internal rotation of the tibia. Medical/surgical treatment including botox has not helped. It is possible to manipulate the foot into a neutral position, the manipulation causes pain particularly under the patella, but once in neutral there is no pain. I have succesfully made a bivalved night orthosis. I now need a replacement for the Walker currently used during the day as the height difference is causing hip problems. She cannot tolerate joint movement whilst weight bearing, but her physio is hoping to build up tolerance. My question is has anyone got any treatment ideas for this type of problem? So far I have tried a Chamber axis joint in a laminate shell, but the laminate above the ankle was not stiff enough to control the tibial rotation, am now considering either pre-preg carbon or side steels. Would pr!
efer not
to use plastic because of heat problems. Any ideas or advice would be greatly appreciated.Thanks in advance
>
> Vicky Jarvis CPO
---------------------------------
if the only clinical issue is the LLD from the walker I would propose a
shoe lift until tolerance is sufficient for a hinged orthosis.
If the issue is to move into an articulating AFO and it has to be super
rigid for control, perhaps Townsend Design can help.
------------------------------------------------
I have two of these type of patients one a strong male 18 year old and One a 45 year old female. The male is a result of reaction to a Immunization and the female is a result of a accident. Both present with varus heels plantar flexion or supination as you said. both when they are seated and relaxed can be moved into neutral/90 degrees and a little past. however
when the walk with no brace there foot spasticly goes into varus so bad that they are walking on the lat. side of their foot.
On the female I have in a flexible inner boot( 1/8 polyethel) and a solid ankle afo over that out of (1/4 poly pro)with varus tab with a heavy push. The male I have in a Solid ankle afo 1/4 copoly with ankle reinforcements and varus tab. I have currently made three brace for the female and two for the male over the last three years. Each one has been a improvement on the last. I now have them both postioned in a slightly supinated postion that seems to be the trick. Basiclly when casting I push as hard as I can to get the postion and then leave it there. I cast seated with the foot in the air like you would for a c.p. child cast. I have found that joints only weaken the plastic shell and control is lost in these really powerful spastic patients also if they are firing their plantar flexors the joint never actually is used during the gait cycle. I have had no luck with anything but plastic. The carbon afos are not forgiving enough for me when it comes to adjust!
ments
with these hard patients I have found ability to adjust to be number one.
And metal just does not get a good enough grip to control. Both patients are now very happy and are walking farther with less pain. I feel the real diffrence in the braces I have made for them over the years is postion. With the foot in pronation it seems to solve all the problems I had with the past braces that were made in a neutral postion. This is just what I ended up with with a lot of trial and error. Not saying its the right thing to do just what I did.
----------------------------------------------------------------------------
Sounds like your client may be suffering from the effects of Complex
Regional Pain Syndrome. See:
<URL Redacted>
Your orthotic treatment is appropriate, but no doubt your client may also need aggressive physiotherapy in the form of TENS or Ultrasound treatment to address the underlying neurological condition, which if left untreated will progress.
---------------------------------------------------------------------------------
External rotation of the tibia with supination. Why not go with laminated solid ankle for strength dual side element.? BAR 2804
--------------------------------------------------------------------
Very interesting problem. I use prepregs extensively. It has taken me about three years to finally find a composite combination which stands up to daily abuse. Please feel free to contact me if you would like us to fabricate an orthosis for you.
----------------------------------------------------------------------
Challenging case. I find that I can much better control transverse plane rotation with a full circumferential design--similar to floor reaction trim lines. This makes the device far more rigid--approximately 5 times more rigid, than a circle with a mere slit in it, because of the moment of inertia. Good luck
---------------------------------
Yahoo! Messenger - Communicate instantly...Ping your friends today! Download Messenger Now
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Vicky Jarvis, “ankel orthosis for supination responses.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/222618.
