Sturdy Carbon fibre AFO - RESPONSES

Sturdy Carbon fibre AFO - RESPONSES

Cheryl Lewis

11/28/2012

Hello All,
 
Thanks to everyone who sent in suggestions - once again this list proves to be a very helpful and valuable resource!
 
I have posted the responses anonymously below.

Basically the responses focussed on OTS or/vs Custom designs. The OTS designs most commonly recommended were the Matrix from TruLife and the ToeOff from Allard. Both of these have a sturdier version that can be used for running. They both have some tricks to optimize them for running and foot orthoses are suggested over the foot plate.
 
There are a few manufacturers who have OTS or will also do custom to cast based on the clinicians specifications. They can be created stiffer or more flexible in the strut and or the footplate based on individual spec. The Kinetic Noodle design can be OTS or casted and seems to have a nice spiral loading design - but to me the downside was the lack of anterior shell to get maximal loading for piush off (although one of their forms has it as an option). The Noodle can also be made to measurements OR cast provided and have different stiffness of strut and/or footplate.
 
For purely custom designs there were 2 mentioned repeatedly - the PHAT Brace and the Dynamic Bracing Solutions DBS AFO. The IDEO was also mentioned but I think this is still only experimental for military - it's design is very similar to the PHAT, the PHAT is lower profile. The PHAT AFO uses pre-preg CF, has circumferential foot control which can address M/L instability and prevent the need for an additional foot orthosis on top. The DBS AFO is a dual upright design with a spiral and anterior tibial shell - looks very sturdy and does provide M/L control as well as not needing a foot orthosis.
 
I have decided to try the PHAT AFO - it rec'd the most positive responses, it provides excellent M/L control without the need for a custom FO and it can be thermoformed to adjust. It is expensive (less so if you take the course) but I feel it will hold up better to her activities. I will try to follow-up with the list after she has had it for several months - I am curious to see how well this holds up!
 
Thanks again to all who responded!! Responses are below....
 
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670

RESPONSES:


Greetings Cheryl! Allard just did a Toe Off workshop with us and about 30 local PT's. They billed the Toe Off as more than capable in terms of running. I would try their Blue Rocker style if you worry about her activity level. They also offer a custom molded proximal portion or sell the footplate blank with the upper shank to allow one to attach a custom molded shin portion of their own. If you have any other questions please feel free to email. Best of luck!
 
 
I'm working for Centri and manufacture the Dynamic Walk. We can do custom made Dynamic Walks to fit the patient's individual requirements. We can adjust the amount of energy return in the peek rods by adding more rods or take away rods. For more information you can contact www.Fillauer.com
 
Here is also a video from Youtube this video was made by a Canadian medical company. It shows the training of a male rugby player wearing the Dynamic Walk. <URL Redacted>

 
 
 
I have had success with the Noodle from Kinetic Research talk to Wade Bader: <URL Redacted>
 
And the best AFO and much more expensive is the Double Helix AFO made by Marmaduke Luke: <URL Redacted>.

 
 

All of the prefab AFOs are slightly disappointing in one way or another,
especially for inversion/eversion. She may be a good candidate for a custom
C-fiber AFO which is a bit of a long process with a check fit. I think Otto
Bock is offering this fabrication.
 
Some runners / patients just don't know when to quit.
 
Only carbon AFO I can think of is a custom version. Center for the Intrepid at Brooke Army Medical Center in San Antonio has designed one for active duty soldiers who are recovering from lower leg trauma. Check out the link below for more info...
 
http://www.bamc.amedd.army.mil/articles/prosthetist-recognized-locally.asp
 
...problem is, I'm not sure it's commercially available yet. Good luck!
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Are you sure her plantar flexors are weak? If its isolated to weak dorsiflexors and mild weakness to inverters/everters it would benefit the patient to use a custom finnestrated design with tamarrack Dorsi joints and add the gaffney flexor anterior to the joint when running and sports demands on pretibs. With weak plantarflexors, the design changes to control tibial advancement which would require a floor reaction design and with sports demands the blue rocker or matrix max may not be adequate. I trial would be easy to do to optimize the Rx criteria.
 
I use Custom Composites quite a bit -- they will make custom from an
impression and do a phenomenal job with great durability, relatively low
price, and incredible turn around time. The website is below -- there
are many designs for increased ground reaction force and activity
levels, and their clinical specialists are helpful with selecting
design. Essentially, they can make custom versions of the common
off-the-shelf designs with increasing strength -- the medial-anterior
design is usually highest stability and good for strenuous activity
where increased ground rctn is needed.
 
Hope this helps, I think it is definitely worth taking a look.
 
http://www.cc-mfg.com/

 
 
Consider the PHAT Orthosis from Biomechanical Concepts in IOWA.
This orthosis is likely a good fit for your patient's functional deficits. Consider the PHAT Orthosis from Biomechanical Concepts in IOWA.
This orthosis is likely a good fit for your patient's functional deficits.

 
 

I use the Spiral AFO from Trulife. If you do a search for Spiral AFO by
Lehneis you will see that he made one out of a non-carbon material but
clearly indicated the use for a spiral AFO and if you search further you
will find that a later document surfaced showing how to make a Carbon
Spiral AFO in-house, which I have done myself.
 
I recommend the PHAT carbon fiber AFO. Very durable and well designed to the patient's needs.

phatbraces.com
Cheryl. Check out phatbrace.com. Very cool new brace design.
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I have just recently dispensed a Townsend Ankle Brace with dorsiflexor assist. This is quite low profile and I made the footplate full foot. Further, I would suggest using the harder Tamarak joints. Please share the other results you get with us so we can interact.
Thanks,
 

Allard has been promoting a female runner using a toe-off. You might want to get more info. from them.
 
Sounds like she would be an ideal candidate for the Phat Brace design from Biomechanical Concepts.

Biomechanical afo from Noel chladek in des Moines Ia. (This is the PHAT Brace)

Phat Braces might be the right way to go.
Look up PHAT brace or IDEO, not sure if latter is available to civilians, also get a hold of Kevin Matthews CO in Texas
Have you ever heard of or tried the PHAT brace by biomechanical composites?
It too has some of the limitations of carbon, but seems so far to be the
best for an active adult.
It is custom made to your specifications based on muscle strength.
I use kinetic research, prepreg they have custom and off the shelf. Have had great luck with the noodle afo. Website kineticr.com and staff is friendly and knowledgable.
If the Allard Blue Rocker isn't durable enough you could always order a custom one with max build up in the frequent break points and toe lever.
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I have used custom Carbon AFOs in the past and had the best outcome with the PHAT AFO from Bio Mechanical Composites out of Iowa. They are pricy and the company requires a training course for certification. The company owners name is Nole Chladek he can give you more information his number is 515-554-6132
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Sounds like a good case for a custom fabricated Noodle. It could be laid-up to promote running.

Check out:
 
http://articles.chicagotribune.com/2012-07-23/news/ct-met-runners-with-paralysis-20120723_1_half-marathon-marathon-runner-roll-half-marathon
 
Beth is running 22 half marathons this year wearing a ToeOFF. I have to tell you that she broke her first ToeOFF in 3 weeks, her second one in 3 months, and it wasn't until she got correct custom foot orthotics fit in the right shoes and changed her running style from a strong heel-striker to a toe runner that she is now able to run and practice in the ToeOFF for 2 to 3 years without product failure. Other devices do not have the energy reflection that ToeOFF does. Even that response can be customized to the runner - smaller sizes are a little more flexible while larger ones become a little more supportive. I would suggest starting with the patient's size, and base on her 1/5 status, you may have to go up one size to provide a little more support and trim the footplate as necessary. I also recommend using the Comfort Kit as opposed to the SoftKit for the pre-tibial interface.
Good luck! I'd love to hear how this turns out.
Have you tried the Otto Bock Walk On or Walk On Flex? With the muscle grades you describe, the Walk On Flex might be a good candidate. Having played rugby for many years I can say that the ability to utilize whatever M/L strength and ROM the patient has without locking up those motions will be important to her success in play. That is a very dynamic sport as far as the lower extremity goes. Being able to make use of the plantarflexion strength she has with something dynamic will also help.
 
I'd love to hear how this one turns out!
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I love using the kinetic research noodle. First reason, they are custom molded so great fit, second I can specify the strength strut and footplate independent of each other I want, therefore not limited to one stock strength. I use the more flexible for my higher end energy users if it is simply for drop foot.

I have used the Noodle made by Kinectic Research on many active patients and it has worked well. You can have one made from a cast and specify how you want it fabricated or use an OTS model.

Fillauer makes one. It's the dynamic walk. You can either get it single strut or bilateral strut. It has a cable spring system at the ankle that allows plantarflexion with a nice dorsiflexion return. Our patients have been satisified with it. Cons would be if she has any inversion or eversion one has to be careful of clearance for the struts. They can't be adjusted well if they rub. I add a off the shelf insert like a diabetic preformed to provide arch and some medial lateral support. It has a posterior calf band. Give them a call. It's also on the website. Fillauer.com
 
I have used all of the carbon AFOs you mentioned, and others, but if you want maximum push off you will need a fairly beefy anterior panel design. Both the Toe Off and its cousins and the Ossur Dynamic are anterior panel, but the Toe Off designs would never survive those loads, and the Dynamic and Matrix would not provide enough resistance for meaningful push off. You may want to consider a custom Noodle TA, but I would speak with Wade at Kinetic Research about what your needs are and see if he has any suggestions, as I suspect that no carbon brace is going to survive those kinds of loads for very long. I think that the Otto Bock Walk On is the most durable of the carbon designs, but it would be too soft and springy for what your patient needs, and I have never fit one to a patient who would be using it quite as aggressively as the way you are proposing. I have a number of patients who use Walk On AFOs for running, but not for cutting activities like rugby, and their only need for running assistance was blocking a foot drop, not generating push off force.