responses - reduction in cast modification time for thermoplastic AFO's

responses - reduction in cast modification time for thermoplastic AFO's

Skewes, Ed

3/26/2008

Thanks to all, and thank you to Paul E. Prusakowski,CPO for a great
list serve !

 

 

 

 

Ed,

 

Adding pads may be an option with SAFOs, but create an additional
dilemma when fabricating articulated AFOs since it becomes difficult to
determine the apex of the lateral malleoli and the distal aspect of the
medial malleoli. As for adhesive, wouldn't rubber cement provide the
adhesiveness you are looking for, provided you cleaned the areas with
alcohol first.

 

I remain interested in the conclusions you receive from the list serve.

 

Hi Ed

I have done this on occaision, and your question reminded me that I seem
to have stopped without thinking about it.

I used low tack polycusion and bevelled the edges with scissors or the
grinding machine. As they were stuck directly to the skin with the cast
sock/sleeve over top I had no problems with migration.

As for cast modification time it probably reduced it a bit as I did not
have to add additional plaster and the densities/hardnesses were not
different.

Regards

 

Hi Ed

I have tried multiple times to pre-modify the casts during the castig
procedure by adding adhesive backed Aliplast pads to malleoli navicular
etc. with less than ideal results. Each time I have tried I was not
pleased with the results and went back to the old way. I still insist
on modifying every cast I take. It may work for you but I am too much
of a perfectionist and I was never happy with the ultimate fit.

 

I have tried various pads over the years and find that it is very
difficult to use since I have my guys modify with exacting heights and
diameters for the numerous bony sites that exist. It would be VERY
important that the technicians understand that the mold has already been
pre-modified during the casting. Again, I've experimented with that
technique a number of times and have not found a good way to bridge the
obvious communication breakdown. A lot of people are happy with rather
ill-fitting orthoses, however, and maybe those folks wouldn't mind
gappy

braces or blowing out braces that fit too snug. I am use to walking in
and fitting braces that just fit so well-almost like a suction fit and
would love to find a way that gets me there more quickly but, alas, I've
not found it. I'll be interested to see what else pours in over your
query.

Thanks,

 

Hi Ed,

I wrap the pt. leg in cellophane - no stockinette at all, cover boney
prominences with tongue pads or precut self adhesive aliplast, then
cover the pads with cellophane. This saves a little time in
modification. I would like to find the best way to extend the foot
plate as this seems to take the most time. I will be interested in the
replies.

 

Holding the anatomical appendage you are working with to achieve a
correct cast is very important; however when I worked at Lerman and Son
in Beverly Hills, Ca. , we used to add buildups when possible before we
casted. I do not know how far they have gone with that concept since
they have a cad system now. You can call them and ask Jack Schwartz,CO
if they are still using some of those methods they used during the
1980's.

 

Ed, I avoided buildups almost completely by the following method:

Place a narrow plastic bag (like the ones newspapers come in) over the
patient's sock. Over this, add a nylon. Hold the nylon under tension
with elastic and a couple of Yates clamps.

Mould as usual.

I sometimes added a thin pad in the finished orthosis, but usually this
was sufficient.

 

Hi Ed, years ago we used self sticking felt pads directly to the skin,
like metatarsal pads, or fracture brace ankle pads, then put the
stockinet over them. Then casted over it all. We had instant build ups
in our mold.

 

I have been using pads prior to casting for over 7 years now. I also
use thick nylons (not stockinette) 1 layer or two layers of thin nylons
over the leg and over the pads. The nylons give compression and reduce
roping and makes separation off the mold easier. I have two size pads
(like a tongue pad) 1/8 and 1/4 and decide do I want a big or little
buildup. I apply them directly to the patient. I also cut them for
smaller pads. Do not use felt as it will stick to the fiberlass or
nylons. Plastizote or aliplast self stick pads (no migration)work best.
I also have toe plates made up of pre bent 2 aluminum (1/8) and just
rebend to what I need. I don't remember the last time I had to do a
build up on my casts and smoothing takes almost no time at all. I do
use salt in my plaster. I try to modify my casts the same day they are
poured. You can use my name.
Jonathan Breux CO CPed

 

    Hope this helps.

     Thanks again everyone !

 
 
 
Edward A. Skewes CPO
Director Orthotic and Prosthetic Department
Shriners Hospitals for Children
950 W. Faris Road
Greenville, SC. 29605
(864) 255 - 7951 ext. 7112
 


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