Plantarflexion Assist
Becky Meyer
Description
Collection
Title:
Plantarflexion Assist
Creator:
Becky Meyer
Date:
9/21/2004
Text:
Thank you to everyone who commented on my question. I am sorry that I
have not responded sooner. I have not decided on a form of treatment
yet. The patient wanted to try repositioning his feet on the pedals
first, before resorting to orthotic intervention. I really appreciate
all your helpful comments and suggestions. I will keep you posted on
his progress! Below are some of the responses I received. Thanks
again!
Becky Meyer
-I don't know of anything that is actually strong enough to create
plantar flexion assist orthotically, but you can block dorisflexion with
a ground reaction AFO. Believe it or not there is actually a
hingedplastic design that allows partial movement, stopping dorsiflexion
at the desired point (as can be done with metal and leather). THe other
approach for a softer resist that we use quite a bit with L5 level
and some L4 is a flexible SMO with anterior wrap and strap (modification
to the Cascade #4). This does appear to increase stride length in gait
for people with the short stride pattern and decrease crouch for the
hang-on-the-Achilles- tendon pattern.
-I have several patients who wear solid ankle AFO's while riding. This
may seem a bit extreme, but is the best way, I have found, to offer them
the control and efficiency they are looking for. This is part of what
your patient has already discovered in the taping of his ankles.
-Currently it sounds like the pedal shoe interface may need some
reconsideration. i would modify this area before ai made any type of
plantar flexion assist or dorsi resist brace. I would guess that he
used a clipless pedal system. The cleats on the shoes can probbly be
moved posteriorly in more than one way. re-drilling the shoe would be a
simple way to move the cleats if he has already maximized his
adjustment. In moving these cleats the stress on the plantar flexors
woould be reduced dramatically.
-I wonder if something as simple as heated plastic in a strip along the
anterior foot/shin and ace-wrapped on. The goal being to limit DF. The
plastic could be the stuff you can heat in water and mold along shin and
foot.
-May want to consider something like an ASO ankle brace. When applied
it would have the effect of making his ankle more rigid. Power to the
ankle would come more from the knee flexors now pushing his foot down
onto the pedal. The ankle brace might be a more effective substitute
for the taping. This would increase his power requirements for the
hamstrings and quads though.
-Recommend that he go to his local bike shop and try out a recumbent
bike. There are many different types that hold the feet in different
positions. I've run across a couple CVA patients who've gone this route
and found it solved most of their upright bike problems.
-Would suggest double aluminum upright AKO with reversed dorsiflex
assist ankle joints.
-A molded polyethylene or copoly dorsal AFO that extends to the MTP
might
provide enough resistance to dorsi flexion. A lightly padded shin
shell
could wrap around to the midpoint of the leg and fasten around the calf
with
a Velcro strap.
-If you are willing to experiment I would consider trying Tamarack
joints put on the AFO backwards. You can try two, try different
durameter and just one flexion joint with a straight joint on the other
side. This should give plantar flexion assistance.
-Have you tried making a regular hinged AFO with Tamarack dorsiflexion
assist ankle joints put in backwards? I would use the 85 durometer ones.
-I have made anterior shells thin AFOs with dorsi assist
gillette(Marizano style) that has done the job.You can make them low
profile enough by eliminating the joint and building a reverse toe off
.As far as a therapy type brace for this problem,Comfy makes a few that
aid plantarflexion.Hope this helps.
-I would try using a cheap atom ankle or something similar. Rivet some
elastic straps to the foot plate, criss-cross them posteriorly and
attach them proximally to the uprights. You can even use some 1 drywall
screws to attach the footplate to the shoe beneath the removable insole
to make for easier donning/doffing.
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have not responded sooner. I have not decided on a form of treatment
yet. The patient wanted to try repositioning his feet on the pedals
first, before resorting to orthotic intervention. I really appreciate
all your helpful comments and suggestions. I will keep you posted on
his progress! Below are some of the responses I received. Thanks
again!
Becky Meyer
-I don't know of anything that is actually strong enough to create
plantar flexion assist orthotically, but you can block dorisflexion with
a ground reaction AFO. Believe it or not there is actually a
hingedplastic design that allows partial movement, stopping dorsiflexion
at the desired point (as can be done with metal and leather). THe other
approach for a softer resist that we use quite a bit with L5 level
and some L4 is a flexible SMO with anterior wrap and strap (modification
to the Cascade #4). This does appear to increase stride length in gait
for people with the short stride pattern and decrease crouch for the
hang-on-the-Achilles- tendon pattern.
-I have several patients who wear solid ankle AFO's while riding. This
may seem a bit extreme, but is the best way, I have found, to offer them
the control and efficiency they are looking for. This is part of what
your patient has already discovered in the taping of his ankles.
-Currently it sounds like the pedal shoe interface may need some
reconsideration. i would modify this area before ai made any type of
plantar flexion assist or dorsi resist brace. I would guess that he
used a clipless pedal system. The cleats on the shoes can probbly be
moved posteriorly in more than one way. re-drilling the shoe would be a
simple way to move the cleats if he has already maximized his
adjustment. In moving these cleats the stress on the plantar flexors
woould be reduced dramatically.
-I wonder if something as simple as heated plastic in a strip along the
anterior foot/shin and ace-wrapped on. The goal being to limit DF. The
plastic could be the stuff you can heat in water and mold along shin and
foot.
-May want to consider something like an ASO ankle brace. When applied
it would have the effect of making his ankle more rigid. Power to the
ankle would come more from the knee flexors now pushing his foot down
onto the pedal. The ankle brace might be a more effective substitute
for the taping. This would increase his power requirements for the
hamstrings and quads though.
-Recommend that he go to his local bike shop and try out a recumbent
bike. There are many different types that hold the feet in different
positions. I've run across a couple CVA patients who've gone this route
and found it solved most of their upright bike problems.
-Would suggest double aluminum upright AKO with reversed dorsiflex
assist ankle joints.
-A molded polyethylene or copoly dorsal AFO that extends to the MTP
might
provide enough resistance to dorsi flexion. A lightly padded shin
shell
could wrap around to the midpoint of the leg and fasten around the calf
with
a Velcro strap.
-If you are willing to experiment I would consider trying Tamarack
joints put on the AFO backwards. You can try two, try different
durameter and just one flexion joint with a straight joint on the other
side. This should give plantar flexion assistance.
-Have you tried making a regular hinged AFO with Tamarack dorsiflexion
assist ankle joints put in backwards? I would use the 85 durometer ones.
-I have made anterior shells thin AFOs with dorsi assist
gillette(Marizano style) that has done the job.You can make them low
profile enough by eliminating the joint and building a reverse toe off
.As far as a therapy type brace for this problem,Comfy makes a few that
aid plantarflexion.Hope this helps.
-I would try using a cheap atom ankle or something similar. Rivet some
elastic straps to the foot plate, criss-cross them posteriorly and
attach them proximally to the uprights. You can even use some 1 drywall
screws to attach the footplate to the shoe beneath the removable insole
to make for easier donning/doffing.
********************
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
Becky Meyer, “Plantarflexion Assist,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/223680.
