Active orthosis to limit dorsiflexion

Active orthosis to limit dorsiflexion

Gary Seaman

9/19/2013

Hi All

I have had a run of patients who are quite active, walking, cycling, golf
etc. All the patients suffer from OA of the midfoot and experience extreme
when dorsiflexing the foot past the 0 degrees. I have tried unsuccessfully
to use standard ankle orthoses, the soft lace up, and the figure of 8 and
the rigid lateral struts. A heel raise does help reduce the pain and gain a
few degrees of pain free ROM. I was wondering if there are any braces that I
have missed. I have been thinking of the carbon AFO's, I am hoping for a
more cost effective solution. One last thought, easy donning and doffing and
that will fit in most normal shoes.

Thanking everyone in advance for their replies.

Kind regards
Gary Seaman MSc. MISPO, MNZOPA
Prosthetist & Orthotist
Dip. Clinical Gait Analysis


Shore Orthotics
34a Rawhitiroa Road
Kohimarama
Auckland 1071

Email <Email Address Redacted>
Web site: www.shoreorthotics.co.nz
Tel (B) : +64 (0) 9 479 3874
Fax     : +64 (0) 9 280 6294
Tel cell: +64 (0)212650082
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-----Original Message-----
From: Gary Seaman [mailto:<Email Address Redacted>]
Sent: Wednesday, September 11, 2013 2:52 PM
To: <Email Address Redacted>
Subject: FW: [OANDP-L] Toes curling under when donning an AFO - replies

Hi All

A big thanks to all who responded, there were about 30 suggestions. This
patient has really flaccid toes and the slightest pressure concertinas the
toes and then they fold under the metatarsals. I do suspect that the
shearban and the stockings might be the answer to the problem.


Here are the suggestions.(I have not posted all as many were very similar)

I have had this issues with CMT patients with intrinsic foot weakness. I
have used shearban from the mid foot forward and that has helped. I cheaper
alternative is duct tape, and if you can find some with a low thread count
that can work just as well.

Have you already used a sulcus pad? You can make custom ones yourself using
RTV silicone for podiatry.

From experience, I would suggest lining the area distal to the met heads (on
either the AFO or on the insole covering an Allard ToeOff-like footplate)
with shearban to decrease the coefficient of friction. I would also suggest
that the patient uses ample foot powder and opens the tongue up as much as
possible when donning the AFO-shoe combo. Furthermore, I would try
practicing other AFO donning techniques to ensure proper toe placement
before shoe donning.

Shear Ban is the cure-all. Use just enough to get the job done. Too much and
the patient will complain of slippage etc.

I have lined areas distal to the met heads with ShearBan for patients and it
has worked very well! (sometimes just under the great toe, sometimes just
under the 4th and 5th, sometimes all of the forefoot area)

Gary, use a nylon....knee high anything and leave 6 in front of the toes,
wrap it over the dorsum of the foot toward the ankle so you're in affect
extending the toes and hold it while pushing everything into the shoe.
Nylons are thin enough that it will not bulk up and cram the toes.

Try this. Provide a toes crust pad & surgical opening shoes.

Kind regards
Gary Seaman MSc. MISPO, MNZOPA
Prosthetist & Orthotist
Dip. Clinical Gait Analysis


Shore Orthotics
34a Rawhitiroa Road
Kohimarama
Auckland 1071

Email <Email Address Redacted>
Web site: www.shoreorthotics.co.nz
Tel (B) : +64 (0) 9 479 3874
Fax     : +64 (0) 9 280 6294
Tel cell: +64 (0)212650082
This email may be confidential. Any distribution, use or copying of this
email or the information it contains by other than an intended recipient is
unauthorised. If you received this email in error, please advise me (by
return email or otherwise) immediately.


-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Gary Seaman
Sent: Saturday, September 7, 2013 8:00 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Toes curling under when donning an AFO

> Hi All
>
> I am sure this question has come up several times in the past. The patient
is having real issues when donning a carbon AFO with all her toes curling
under. Any suggestions?
>
> Kind regards
>
> Gary
> Shore Orthotics
> <Email Address Redacted>
> 09 479 3874
> 021 265 0082
> Sent from iPhone

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