Outer boot opinions continued
Kevin Matthews
Description
Collection
Title:
Outer boot opinions continued
Creator:
Kevin Matthews
Date:
7/29/2007
Text:
Replies continued to outer boot request for opinions.
Hi Kevin
Your idea sound very interesting and I would love to hear more about how you make it and how it goes.
I've not heard of inner boots or one piece wraparound AFOs for use after Botox. We would tend to use serial casting or fabricate an AFO or use AFO/ DAFOs.
It would be great to hear more about your methods.
Kindest regards
Yvonne McIntosh
Orthotist
Basingstoke
England
UK
Hi Kevin
If I can be blunt, to make a new design it starts with physical concept,
then what materials will work best to achieve the concept. It is my feeling
making a new AFO without a physical concept that is workable is a waste
time, unless you are very lucky.
Serial cast work, and Flexcast works even better on tone. Serial cast does
not work when there is discomfort! So the goals are to make it as close to
serial cast/Flexcast as possible, and maximize the patient comfort. See it
is that simple, any part of the design that does not lend itself to the
goals is not following the concept.
Well we started something in Jan of 94 called THE R-WRAP AFOC which we are
now close to charging for 2500 units. The following is something I wrote in
2002. We have learned a lot more since then and still learning.
THE R-WRAP AFOC
The R-Wrap AFOC is a new orthotic design, which has proven very successful
in inhibiting severe spastic hypertonus and reducing equinus contractures.
Materials and design: This AFO is a 2-piece, ultra-thin, polypropylene,
total-contact AFO.
The inner, dorsal section covers the anterior, medial and lateral leg shaft,
malleoli and midfoot to the metatarsal heads. It is flexible and easy to
don.
The outer, posterior-approach section is an ultra-thin, polypropylene AFO,
made thicker at the calcaneus and posterior vertical shaft.
These two combined layers completely enclose the foot and ankle, holding
them in the best possible anatomical alignment, and within the patient's
comfort and tolerance. (That is, not in subtalar joint neutral - ie. full
foot joint congruity - but more in functional calcaneal midpostion.)
When the orthosis contains the foot and ankle, it fully secures the
calcaneus, blocks sagittal, and frontal plane motion at the ankle and
subtalar joints, and allows small increments of movement in the transverse
plane. Comfort is achieved by the combination of maximum surface area for
pressure distribution and slight rotary flexibility.
The incidence of orthotic revisions for this design is extremely low.
The heel is loaded in weightbearing positions on a post, which might be
inherent in the AFO. And if flexcasting did not precede orthotic
intervention and the equinus contracture warrants, another post might be
added outside the shoe at orthotic checkout. Usually, the need for a new
orthosis is signaled by an increase in circumference of the leg and foot,
causing discomfort due to improper fit.
We have observed in several cases that after months to years of solid R-Wrap
AFOC use, spastic muscles relax, and variable measures of voluntary motion
of the antagonists around the ankle joint emerge. The later the orthotic
intervention after the insult, the longer it seems to take such changes to
appear.
How does this relaxation happen? We propose that comfort is a key, that the
total contact design and flexibility combine to contain the spastic foot and
ankle in a more functionally appropriate alignment. In a comfortable way,
much like a well-padded and well-molded cast boot.
Perhaps the improved joint alignment also permits the muscles crossing the
joints of the foot and ankle to adapt physiologically to more normal length,
and to operate at the more optimum mechanical (lever arm) and kinesiological
(muscle length) advantage.
In four years of increasing use of the R-Wrap AFOC at Kaiser Vallejo
Rehabilitation Hospital, only three surgeries to lengthen heel cords were
undertaken. All still wear AFO's
CORE BELIEFS
WHY WE STARTED ON THIS TRACK
. Patients asked for the improvement
. To improve our delivery systems
. Bottom line
BELIEFS
. Basics BioMechanics should be our guide
. Spastic lower extremity was the most time-consuming with the least
rewards
. The patient instincts were usually correct and helped guide us
. Thought that Flexible Stability was the way to go
John G. Russell Jr. CPO, FAAOP
3161 Putnam Blvd.
Pleasant Hill, CA. 94523
V-925-943-1119
F-925-943-2493
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105
Hi Kevin
Your idea sound very interesting and I would love to hear more about how you make it and how it goes.
I've not heard of inner boots or one piece wraparound AFOs for use after Botox. We would tend to use serial casting or fabricate an AFO or use AFO/ DAFOs.
It would be great to hear more about your methods.
Kindest regards
Yvonne McIntosh
Orthotist
Basingstoke
England
UK
Hi Kevin
If I can be blunt, to make a new design it starts with physical concept,
then what materials will work best to achieve the concept. It is my feeling
making a new AFO without a physical concept that is workable is a waste
time, unless you are very lucky.
Serial cast work, and Flexcast works even better on tone. Serial cast does
not work when there is discomfort! So the goals are to make it as close to
serial cast/Flexcast as possible, and maximize the patient comfort. See it
is that simple, any part of the design that does not lend itself to the
goals is not following the concept.
Well we started something in Jan of 94 called THE R-WRAP AFOC which we are
now close to charging for 2500 units. The following is something I wrote in
2002. We have learned a lot more since then and still learning.
THE R-WRAP AFOC
The R-Wrap AFOC is a new orthotic design, which has proven very successful
in inhibiting severe spastic hypertonus and reducing equinus contractures.
Materials and design: This AFO is a 2-piece, ultra-thin, polypropylene,
total-contact AFO.
The inner, dorsal section covers the anterior, medial and lateral leg shaft,
malleoli and midfoot to the metatarsal heads. It is flexible and easy to
don.
The outer, posterior-approach section is an ultra-thin, polypropylene AFO,
made thicker at the calcaneus and posterior vertical shaft.
These two combined layers completely enclose the foot and ankle, holding
them in the best possible anatomical alignment, and within the patient's
comfort and tolerance. (That is, not in subtalar joint neutral - ie. full
foot joint congruity - but more in functional calcaneal midpostion.)
When the orthosis contains the foot and ankle, it fully secures the
calcaneus, blocks sagittal, and frontal plane motion at the ankle and
subtalar joints, and allows small increments of movement in the transverse
plane. Comfort is achieved by the combination of maximum surface area for
pressure distribution and slight rotary flexibility.
The incidence of orthotic revisions for this design is extremely low.
The heel is loaded in weightbearing positions on a post, which might be
inherent in the AFO. And if flexcasting did not precede orthotic
intervention and the equinus contracture warrants, another post might be
added outside the shoe at orthotic checkout. Usually, the need for a new
orthosis is signaled by an increase in circumference of the leg and foot,
causing discomfort due to improper fit.
We have observed in several cases that after months to years of solid R-Wrap
AFOC use, spastic muscles relax, and variable measures of voluntary motion
of the antagonists around the ankle joint emerge. The later the orthotic
intervention after the insult, the longer it seems to take such changes to
appear.
How does this relaxation happen? We propose that comfort is a key, that the
total contact design and flexibility combine to contain the spastic foot and
ankle in a more functionally appropriate alignment. In a comfortable way,
much like a well-padded and well-molded cast boot.
Perhaps the improved joint alignment also permits the muscles crossing the
joints of the foot and ankle to adapt physiologically to more normal length,
and to operate at the more optimum mechanical (lever arm) and kinesiological
(muscle length) advantage.
In four years of increasing use of the R-Wrap AFOC at Kaiser Vallejo
Rehabilitation Hospital, only three surgeries to lengthen heel cords were
undertaken. All still wear AFO's
CORE BELIEFS
WHY WE STARTED ON THIS TRACK
. Patients asked for the improvement
. To improve our delivery systems
. Bottom line
BELIEFS
. Basics BioMechanics should be our guide
. Spastic lower extremity was the most time-consuming with the least
rewards
. The patient instincts were usually correct and helped guide us
. Thought that Flexible Stability was the way to go
John G. Russell Jr. CPO, FAAOP
3161 Putnam Blvd.
Pleasant Hill, CA. 94523
V-925-943-1119
F-925-943-2493
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105
Citation
Kevin Matthews, “Outer boot opinions continued,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/228420.
