TA Rupture responses Part 1 A

TA Rupture responses Part 1 A

Shane Jansen

1/6/2010

Hi All and Happy New Year from New Zealand

Thanks to the many who responded to my enquiry.

Sorry for the delay in responding and for the confusion created by using

the abbreviation TA instead of saying Archillies Tendon.

Here is the question with the responses following.

I have ordered a Blue rocker for him.

Dear colleagues.

I have a pt who presents with a ruptured TA (7/52 ago) that missed out

on early treatment. He has a visible gap in the TA and the Specialist

advises he is not for surgery and should not expect any improvement on

his current state (nor any deterioration). He has full active ankle DF

and some active ankle PF (suprisingly about power level 2+). He works as

a builder and finds he is unable to do some things like climb ladders

etc. Essentially he lacks some toe off propulsion on the affected side.

The specialist has asked if we can supply something to help with toe

off. Some products come to mind but I wonder how practical it is to try

to suppliment lost plantarflexion power to this level.

Your thoughts welcome.

Shane Jansen

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You will need to fit him with an AFO with a Dorsi-flexion stop, or use

a

floor reaction carbon or plastic AFO strong enough to give him push-off.

Good Luck

Charles C.A. LeDoux, CPO

Certified Prothetist / Orthotist

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There is a new Canadian design called the plastic reinforced chevron

AFO. It`s cheap and easy to make with a certain technique. Check out

Don Weber from Chedoke Hospital. This design is very effective for

plantar flexion and doesn`t need all of the high-tech components. They

have really good videos that they will send you if you contact them.

Cheryl Lewis, BSc(HK), CO(c)

Certified Orthotist

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Shane,

I had a patient that had no plantar flexors, so he had no propulsion to

help his leg into swing. I fit him with an Otto Bock Walk On, thinking

that the carbonfiber would store enough energy to help him swing his leg

forward. It did work well for him.

Scott Amyx CO

PS let me know what other people have tried, thanks.

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Carbon graphite struts would be the simplest way. Otto Bock's carbon

ankle 7 good but can be more bulky than prefab. Have you tried a

WalkOn on this guy?? I assume by TA you mean he has a ruptured tib

ant. Then why does he present with perfect DF?

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Try the allard toe off afo. I've been impressed for this problem.

Karl

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I would first try the Allard Blue Rocker toe off brace. The carbon foot

plate will also help him a lot on ladders for foot comfort. Good Luck

Mark Bondurant CPO USA

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Hi Shane

around here, TA is tibialis anterior.

solid ankle kicks into knee, by forcing it into flexion at heel strike.

but it is a simple and viable option. now, truly, there's very little

triceps surae action walking. it is more of momentum thing. climbing up

stairs is not as much TS, as it is hip/knee extensors.

so, anything that will lock him in about 3-5 degrees of dorsiflexion and

is strong enough to carry his weight around tarsus, should do the job.

you just need to find something that will allow you some adjustability,

so that you can fine tune it. hope it is not his driving side.

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Shane,

I have never had this particular issue before, but I have some

suggestions. Hope this helps you.

The Trulife matrix max or Allard Toe off offer some propulsion. I

typically use these braces for drop foot, but have noticed definate

propulsion at the terminal rocker/toe off phase of gait. I have even

tried these braces myself. When I was trying these braces out, I had

normal gait with a little extra kick. For me, it was like having a

spring on my toes.

Other options: use gaffney flexor joints backwards, possibly in

combination with a PF assist joint at the ankle.

Don't know if any of these ideas will work or be practical for your

patient. Good luck!

Kim LCO,CP

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