Response summary: Ankle joints suitable for valgus control AFO?
Ted Trower
Description
Collection
Title:
Response summary: Ankle joints suitable for valgus control AFO?
Creator:
Ted Trower
Date:
8/12/2005
Text:
My question to the list was:
It seems like we are seeing an increasing number of individuals with
posterior tibialis tendon dysfunction (PTTD). They generally have good ROM
and control in Dorsiflexion / Plantarflexion and only need M-L
control. While I am aware that the best M-L control is obtained if you
lock the ankle I do not believe in restricting motion unnecessarily. What I
am wondering is what ankle joint other orthotists prefer to use when
constructing a free ankle AFO when strong resistance to pronation is
needed. Ease of construction would be nice but what I really want is
durability and torsional rigidity.
Responses follow:
===========================================================
>I have used the double plate Appalachian joint with good success. My
>concern is how severe is the deformity and will you get enough control of
>the subtalar joint as to limit pronation and contact with the joint. I
>prefer an Arizona, Southwest, or the new Ritchie Californioa afo's. They
>provide better total contact.
----------------------------------------------------------------------------------------------------------------------
>I have found the Gaffney's to work well: strong, durable, and simple
>enough to fab. We always use their alignment kit.
'----------------------------------------------------------------------------------------------------------------------
>Gaffney Joints. Or Becker's.
----------------------------------------------------------------------------------------------------------------------
>Townsend now makes a custom carbon ankle orthosis with free motion
>dorsiflexion/plantarflexion with adjustable varus/valgus. It's much more
>rigid than the current Ritchie braces available.
----------------------------------------------------------------------------------------------------------------------
>Camber axis hinged AFOs in a stirrup design can offer rigidity and ROM
>control,I have also used a Utley style AFO to aid in these problems. This
>can be modified with different structural strengths as to give a more
>flexible actuation. If all else fails I would try a leather ankle AFO with
>various varus/valgus control straps. It is a common problem these days and
>creativity seems to be the best resouce in dealing with these unquie
>cases. Good luck.
----------------------------------------------------------------------------------------------------------------------
>I usually lock up the ankles, I'll be interested in the responses.
----------------------------------------------------------------------------------------------------------------------
I too have seen many of these patients.
If it is early on in their treatment they respond to the use of a rigid
AFO (even an Aircast walker) to reduce pain and inflammation.
If they have the typical mid-foot collapse it is a challenge. The
deformity has a significant medial tibial rotation component which needs
to be addressed to restore function. I cast in a corrected position and
apply pressure to the shaft of the 5th metatarsal, m and L calcaneous
and up under the navicular. The Oklahoma joint or some home-made
equivalents of c-fiber composite gives a nice wide surface to pad both
malleoli. A dynamic valgus control strap is also a must.
----------------------------------------------------------------------------------------------------------------------
We make several short articulated AFOs every month to address PTTD. We
use the Gaffnee joint with very good success.
----------------------------------------------------------------------------------------------------------------------
Hope all is doing well; durr fillauer has Wally Motlocks self adjusting
joints. it is like a carburator linkage and unscrews from a sidebar. I
would get the adult size for a charcot.
----------------------------------------------------------------------------------------------------------------------
Have used the Camber Axis Hinge for just this purpose with good success and
patient acceptance. Use the Small size to keep a low profile, and allow
for mid foot control through footplate contouring and interface
padding. The stainless steel joint, when incorporated into the
thermoplastics, stiffens the AFO structure to resist deforming forces.
Becker also uses this configuration in the central fab XAFO device.
----------------------------------------------------------------------------------------------------------------------
Thanks to Roger Marzano, we use the short articulated AFO system for most
severe PTD/PTT cases. This comprises a short articulated AFO with anterior
calf, Oklahoma ankle joints with special ankle screws, short copolymer foot
plate with an FO incorporated.
----------------------------------------------------------------------------------------------------------------------
We use free motion, artic AFO with Oklahoma joints. They seem to resist
rotation reasonably well and are relatively long lived and easy to fab.
Don't forget to accommodate tight plantarflexors (heel lift) and
forefoot varus (medial post) frequently seen in this population.
----------------------------------------------------------------------------------------------------------------------
As i gathered from your mail you should go for
chamber axis ankle joint from becker orthopaedic.
===========================================================
End of responses.
My thanks to all who replied. I'll be using the Camber Axis joints with a
molded internal SMO for increased surface area in the control regions and
improved ease of donning.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
CONFIDENTIALITY NOTICE:
This email message, including any attachments, is for the sole use of the
intended recipient (s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure, or distribution is
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and destroy all copies of the original message.
It seems like we are seeing an increasing number of individuals with
posterior tibialis tendon dysfunction (PTTD). They generally have good ROM
and control in Dorsiflexion / Plantarflexion and only need M-L
control. While I am aware that the best M-L control is obtained if you
lock the ankle I do not believe in restricting motion unnecessarily. What I
am wondering is what ankle joint other orthotists prefer to use when
constructing a free ankle AFO when strong resistance to pronation is
needed. Ease of construction would be nice but what I really want is
durability and torsional rigidity.
Responses follow:
===========================================================
>I have used the double plate Appalachian joint with good success. My
>concern is how severe is the deformity and will you get enough control of
>the subtalar joint as to limit pronation and contact with the joint. I
>prefer an Arizona, Southwest, or the new Ritchie Californioa afo's. They
>provide better total contact.
----------------------------------------------------------------------------------------------------------------------
>I have found the Gaffney's to work well: strong, durable, and simple
>enough to fab. We always use their alignment kit.
'----------------------------------------------------------------------------------------------------------------------
>Gaffney Joints. Or Becker's.
----------------------------------------------------------------------------------------------------------------------
>Townsend now makes a custom carbon ankle orthosis with free motion
>dorsiflexion/plantarflexion with adjustable varus/valgus. It's much more
>rigid than the current Ritchie braces available.
----------------------------------------------------------------------------------------------------------------------
>Camber axis hinged AFOs in a stirrup design can offer rigidity and ROM
>control,I have also used a Utley style AFO to aid in these problems. This
>can be modified with different structural strengths as to give a more
>flexible actuation. If all else fails I would try a leather ankle AFO with
>various varus/valgus control straps. It is a common problem these days and
>creativity seems to be the best resouce in dealing with these unquie
>cases. Good luck.
----------------------------------------------------------------------------------------------------------------------
>I usually lock up the ankles, I'll be interested in the responses.
----------------------------------------------------------------------------------------------------------------------
I too have seen many of these patients.
If it is early on in their treatment they respond to the use of a rigid
AFO (even an Aircast walker) to reduce pain and inflammation.
If they have the typical mid-foot collapse it is a challenge. The
deformity has a significant medial tibial rotation component which needs
to be addressed to restore function. I cast in a corrected position and
apply pressure to the shaft of the 5th metatarsal, m and L calcaneous
and up under the navicular. The Oklahoma joint or some home-made
equivalents of c-fiber composite gives a nice wide surface to pad both
malleoli. A dynamic valgus control strap is also a must.
----------------------------------------------------------------------------------------------------------------------
We make several short articulated AFOs every month to address PTTD. We
use the Gaffnee joint with very good success.
----------------------------------------------------------------------------------------------------------------------
Hope all is doing well; durr fillauer has Wally Motlocks self adjusting
joints. it is like a carburator linkage and unscrews from a sidebar. I
would get the adult size for a charcot.
----------------------------------------------------------------------------------------------------------------------
Have used the Camber Axis Hinge for just this purpose with good success and
patient acceptance. Use the Small size to keep a low profile, and allow
for mid foot control through footplate contouring and interface
padding. The stainless steel joint, when incorporated into the
thermoplastics, stiffens the AFO structure to resist deforming forces.
Becker also uses this configuration in the central fab XAFO device.
----------------------------------------------------------------------------------------------------------------------
Thanks to Roger Marzano, we use the short articulated AFO system for most
severe PTD/PTT cases. This comprises a short articulated AFO with anterior
calf, Oklahoma ankle joints with special ankle screws, short copolymer foot
plate with an FO incorporated.
----------------------------------------------------------------------------------------------------------------------
We use free motion, artic AFO with Oklahoma joints. They seem to resist
rotation reasonably well and are relatively long lived and easy to fab.
Don't forget to accommodate tight plantarflexors (heel lift) and
forefoot varus (medial post) frequently seen in this population.
----------------------------------------------------------------------------------------------------------------------
As i gathered from your mail you should go for
chamber axis ankle joint from becker orthopaedic.
===========================================================
End of responses.
My thanks to all who replied. I'll be using the Camber Axis joints with a
molded internal SMO for increased surface area in the control regions and
improved ease of donning.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
CONFIDENTIALITY NOTICE:
This email message, including any attachments, is for the sole use of the
intended recipient (s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure, or distribution is
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and destroy all copies of the original message.
Citation
Ted Trower, “Response summary: Ankle joints suitable for valgus control AFO?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/225307.
