[OANP-L] Responses to HD torsion issue
Rick
Description
Collection
Title:
[OANP-L] Responses to HD torsion issue
Creator:
Rick
Date:
9/24/2013
Text:
Thanks to all. Will look into new foot option 1st as his previous provider gave him a foot one size too small (?!) My 2nd choice & one I had been considering is using the OB torsion adaptor w/signed waver.
Original post:
Does anyone know of an axial rotation option for a 332 lb, 6'1 gentleman with a TTA & a long history of dysfunctional gait due to 25 years of various surgical attempts at limb salvage. Someone put him in a HD Harmony which he reports being unable to tolerate & refused to use it... so a week after receiving the device, the prosthetist just disconnected it...leaving this gentleman lugging the extra weight around, no valve, a gel knee sleeve & limb pistoning. Oh, & he absolutely crushes the vertical shock in the unit. I digress...
We have discovered that he needs the axial rotation available in the harmony due to no pelvic rotation & odd trunk movement from years a habitual & compensatory movements. Every tube clamp arrangement tried ends up with the prosthetic foot internally rotated & huge genu varus moment. The torque in his biomechanics from mid-stance on prosthetic side to initial swing just overwhelms the tube clamps and the foot internally rotates. Using a fused clamp on proximal or distal end of the pylon...the other clamp turns. Tried same manufacture tube & clamps, varied manufacturers tubes & clamps, HD products & always torqued to spec's. Tried roughing up the non-fused end of the tube (tough to get into/out of clamp), but still turns.
The gentleman suggested spot welding the clamps to the tube, but then he'll have a static prosthetic situation resulting in all his torsional forces affecting him proximally. Not an option.
*********
Responses:
Maybe a diet is in order? He is 8 pounds over the Ossur Reflex Rotate.
CPO
*******************
I had a similar situation once, with a slightly larger patient who was suffering severe back pain for similar reasons, although his gait was not as abnormal as your patient's gait sounds. What we ended up using was the Otto Bock 4R40, which as far as I know is the highest weight-rated torsion adapter available (275 lbs), informed the patient that it would likely break frequently, and had him sign waivers of liability and warranty. He was surprisingly active for his size (5'11 and about 355 lbs, if I recall correctly), and the adapter usually lasted 8-12 months before the torsion spring broke, although once it lasted only two months. It was worth it to him in any case, because it resolved about 90% of his back pain. It is worth noting that the structure never broke, just the torsion spring, although when that does break, the foot then flops from end to end of the available range with no resistance at all. After a few years he always bought a
spare to have on hand, and when the spring broke, he would bring in the spare, we would replace it, and order another. His insurance paid for a few of them, again if I recall correctly.
CPO
****************
Try the Triumph foot from Trulife. The weight limit is 366# and it has significant axial rotation and shock absorption built into the foot design. Not to mention it's inversion/eversion is best in this category foot. Plantar/dorsi flexion is superior as well!
CPO
Original post:
Does anyone know of an axial rotation option for a 332 lb, 6'1 gentleman with a TTA & a long history of dysfunctional gait due to 25 years of various surgical attempts at limb salvage. Someone put him in a HD Harmony which he reports being unable to tolerate & refused to use it... so a week after receiving the device, the prosthetist just disconnected it...leaving this gentleman lugging the extra weight around, no valve, a gel knee sleeve & limb pistoning. Oh, & he absolutely crushes the vertical shock in the unit. I digress...
We have discovered that he needs the axial rotation available in the harmony due to no pelvic rotation & odd trunk movement from years a habitual & compensatory movements. Every tube clamp arrangement tried ends up with the prosthetic foot internally rotated & huge genu varus moment. The torque in his biomechanics from mid-stance on prosthetic side to initial swing just overwhelms the tube clamps and the foot internally rotates. Using a fused clamp on proximal or distal end of the pylon...the other clamp turns. Tried same manufacture tube & clamps, varied manufacturers tubes & clamps, HD products & always torqued to spec's. Tried roughing up the non-fused end of the tube (tough to get into/out of clamp), but still turns.
The gentleman suggested spot welding the clamps to the tube, but then he'll have a static prosthetic situation resulting in all his torsional forces affecting him proximally. Not an option.
*********
Responses:
Maybe a diet is in order? He is 8 pounds over the Ossur Reflex Rotate.
CPO
*******************
I had a similar situation once, with a slightly larger patient who was suffering severe back pain for similar reasons, although his gait was not as abnormal as your patient's gait sounds. What we ended up using was the Otto Bock 4R40, which as far as I know is the highest weight-rated torsion adapter available (275 lbs), informed the patient that it would likely break frequently, and had him sign waivers of liability and warranty. He was surprisingly active for his size (5'11 and about 355 lbs, if I recall correctly), and the adapter usually lasted 8-12 months before the torsion spring broke, although once it lasted only two months. It was worth it to him in any case, because it resolved about 90% of his back pain. It is worth noting that the structure never broke, just the torsion spring, although when that does break, the foot then flops from end to end of the available range with no resistance at all. After a few years he always bought a
spare to have on hand, and when the spring broke, he would bring in the spare, we would replace it, and order another. His insurance paid for a few of them, again if I recall correctly.
CPO
****************
Try the Triumph foot from Trulife. The weight limit is 366# and it has significant axial rotation and shock absorption built into the foot design. Not to mention it's inversion/eversion is best in this category foot. Plantar/dorsi flexion is superior as well!
CPO
Citation
Rick, “[OANP-L] Responses to HD torsion issue,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/235633.
