Trans-tibial flaccid limb prescription responses

Trans-tibial flaccid limb prescription responses

dEntremont, Andre RQHR

7/13/2010

Here are the responses to the flaccid Trans-tibial limb. Sorry for the
delay. My client has opted not to go to a locking knee and therefore I
am using offset knee joints with plantar flexed foot to help control
knee buckling. Thanks very much for all your responses!

 

Andy d'Entremont C.P.(c)

 

Original question:

 

I have a male client who is 60 years old and had polio at when he was 14
years old and had a KAFO with locking joints to start with. Apparently
at 16 years of age he had a trans-tibial amputation and was fit with
thigh-lacer and outside joints that were free. He has absolutely no
muscular control of hip and knee and used the foot plantar-flexed to
about 40 degrees to control his knee by causing a knee extension moment.


 

I have tried to convince him to go to locking knee joints in order to
put his foot in a proper alignment, but he wouldn't allow this. Now he
has some sound side issues with his foot and is possibly going to agree
to locking up his knee with bail locks or similar.

 

My question: Is there any other options out there? I know there are
stance phase controlled knee joints for orthotics, but not for
weight-bearing through these joints??

What may be some other options?

 

Thanks for any help with this.

 

Responses:

 

 

 

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.....Your patient may get by with posterior offset knee joints, and a
single axis

foot with a super-soft heel plantarflexion bumper. Then you could
approach

more normal alignment without locking up the knee. Given his condition,
you

no doubt have to accommodate a little genu recurvatum, and can't change

that. Otherwise your bail lock idea would be the next step, as far as I


know.

 

Would be interested in hearing other's opinions, though...

 

 

The E-Knee was not designed to be a weight bearing knee joint from an
ischial brim type of proximal weight structure. As to whether your
patient would be imparting too much weight is hard to judge.

Any KAFO will transfer some vertical load through the joints.

 

 

 

You might want to look at the Horton's Stance Control joints. When I
went to the course, John Michael showed a picture of a BK prosthesis
being used with the Horton Joints. You could contact him, or he might
see your post also. Just a suggestion.

 

 

 

ok, here's the thing with polio patients. they are always willing to
try something new. and that is ok if you deal with one that has no
previous braces. but the very moment you have one that had a brace, even
a terrible one, but they spent some time using it and their spine(i do
not think they have any control over this) worked its way out with the
device, that's it. they will agree to a change. you will fit something
different. fitting will go ok. then, you will see them every week or so,
for adjustments that will slowly end up in well, my old brace didn't
do this, or that, and it felt better and you will end up in making a
free copy of what they had before.

they are super sensitive. i had a guy who could tell a yellow page (ONE)
difference in height between lateral and medial foot. anything you do,
is never right, there's always something a little bit here or there,
and slowly it becomes a follow up(free of charge) nightmare.

they simply do not like any changes on the spine level, whilst
consciously are willng to try. that goes for everything, every single
piece of whatever you fit them with has to be same, look same, feel same
as before.

ask oldtimers. they will tell you. YOU DO NOT CHANGE POLIO PATIENT.

 

 

This would be an excellent question for Gary Bedard at Becker orthopedic
who knows everything about stance control kafos.

 

 

How about a stance phase knee joint like the fillauer SPL?

 

 

We've attached custom knee braces to the BK socket. Cast for KO over
socket then rivet it into place.

 

 

what ever reason for that amputation I hope it was

good one........I'm a polio patient myself pretty close to the age of
your

patient..........That locking knee is really a good suggestion for this

guy.....but if he is not wanting to listen to you then I don't know
where to

go from here. I've worn braces all my life from KAFO's to everything in

between and being in the business for almost 40 years you get to know
what

works and doesn't.

When I was 12 years old they also wanted to amputate my leg....... but
some

how if only by the grace of God they didn't do it. If your patient would


like to speak to someone who has walked in there shoes feel free to give
my

email out to this fellow......I loved to talk to them and at least kick
back

and forth some ideas........who knows he may just see a different light
on

things........

 

I have used orthotic locking joints with a Becker trigger lock for a
patient with a transtibial amputation and a paralyzed limb. The trigger
is a less obvious compared to a bail lock.

 

Townsend may be able to make a custom knee brace that attaches to a
prosthesis, I have used this combination before for someone with weak
knee extensors because they have a strong extension assist. I don't
think the extension assist alone would be sufficient for someone with no
hip or knee control

 

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