Finding a Creative Solution for My Own Comfort, SAFOS

In this edition of Stepping Out, The O&P EDGE brings you problem solving for AFO comfort from the perspective of a long-time consumer and graduate student in applied craft and design. I have spastic cerebral palsy, and I wear an AFO on my right foot and a special pair of shoes that accommodate my right leg-length discrepancy of ¾ inch. I have been wearing a leg brace on and off since I was nine years old. When I started wearing one, the braces were made of clear, hard plastic, and it was difficult to find a pair of shoes to accommodate the bulky plastic brace around my foot and leg. Once my parents found and purchased shoes that worked well with my brace, my mobility increased. However, there was a downside because as my mobility increased, so did my injuries. When I was ten years old, I fell a lot due to balance issues with my brace. In addition to falls, I suffered from blisters and other painful red abrasions where the hard, unforgiving plastic was pressing and rubbing against the soft tissues of my foot and ankle. When I complained about the soft tissue injuries to my practitioner, he said, "wear softer socks and get some mole foam." That worked about half of the time. The other half of the time, I had to limit my activity for a couple of days and not wear my brace while my foot healed. From the age of 27, an AFO or brace of some type has been part of my daily life. While not much seems to have changed in the design of braces since I started wearing one, my activities have changed, and my need for a good pair of shoes and a supportive AFO has gotten considerably more important. In keeping with the traditional design, the various AFOs I've worn have always been next to my foot. Because the plastic support is inside the shoe, the AFO negates all the comfort features of shoe designs. All the fancy foams and the soft leather or fabric that make up the upper part of some shoes and all the air-cushioned soles they may have are counteracted by the orthosis, and what I am left with is 1/8 inch of foam to bear all my weight while walking each and every day. In the fall of 2011, I moved from a small town in California to start graduate school in Portland, Oregon. During the first weeks, walking from class to class and on the cement sidewalks of a new city increased the time that I spent on my feet and the time that I spent with my foot in the brace. Wearing a leg brace and walking is hard enough, and now I was on my feet a minimum of ten hours a day. During that first semester, my right foot was pounding away on a hard piece of plastic with just the comforts of a wool sock and a thin layer of off-the-shelf shoe insert padding under my foot. At this point my two-year old shoes were wearing out, and the brace that I had been wearing for the last four years was causing pain in my foot. I found a podiatrist in the phone book and made an appointment. He said that first I needed to visit an orthotist to help me with the brace, and after I got the orthosis problem solved, he could potentially help me with my foot problem. I took his advice and found a new orthotic practice. My new orthotist took one look at my old clear plastic brace and told me that there were many new styles and kinds of brace technology that would help to improve my condition. So I obtained a prescription from my primary care physician, and we began exploring options. At this point my leg had started growing around and over the edge of my old plastic brace, in the same way that a tree grows around a fence or foreign object. My new orthosist recommended a Bio-Mechanical Composites Phatbrace made of carbon fiber instead of just hardened rigid plastic, and as an added bonus I got to choose a surface color or a pattern for the brace. At first this was a great change, but after a couple of months I was right back where I was before I got the new brace. My leg was getting weaker instead of stronger, and the pain from the lack of padding came back. [caption id="" align="alignnone" width="300"] Figure 1[/caption] Around this same time, my old shoes finally wore out. Finding a new pair to fit the new orthosis seemed impossible. I usually wear a size nine and a half or ten, but the new brace was shaped differently to accommodate the needs and shape of my right foot. So, I altered a new pair of shoes out of pure necessity (Figure 1). These shoes accommodated the shape of my feet and the size of the brace on my right leg, and they gave my toes ample room. These shoes were the first pair of comfortable shoes that I had worn in the last four years. With more comfortable shoes, I turned my attention to trying to find a more comfortable orthotic solution since I was still having difficulty with weakness and pain. Over the next year, I went to three different O&P offices and tried five styles of orthoses. Finally I found a really good orthotist. After much conversation, together the orthotist and I decided that Allard's BlueRocker would be the correct orthosis for my situation. The BlueRocker worked very well for me. It gave me the support that I needed, but with new and different geometry. However, the brace still was close to my foot and inside of the shoe, with only 1/8 inch of padding to bear all of my weight. I knew that there was a better way. I am 33 years old and I have a lot of walking ahead of me, and walking every day on a thin piece of 1/8-inch foam is not enough. [caption id="" align="alignnone" width="200"] Figure 2[/caption] For my final project of my graduate work in applied craft and design, I decided to address my problem. I modified an existing pair of work boots to fit my feet more comfortably with my AFO. I did this by integrating the supportive AFO into the boot itself, so that the actual orthosis is on the outside of the boot, away from my foot. I also built the lift into the alteration. Instead of using rubber and placing the ¾-inch lift on the outside, I built the needed height into the shoe insert. The result is a lifted boot with the AFO on the outside away from the foot and a plush ¾-inch padding on the inside of my shoe next to my foot. In this way, I have the best of both worlds-the comfort of a shoe and the support of a brace. I should note that this project involved some minor modification of the orthosis itself, which, of course, I generally would agree should only be done by a credentialed professional. However, since I was doing this design as a one-off for myself only, I felt qualified to do it given my years of experience as a consumer. I call the design SAFOS (Figure 2), which stands for supportive ankle foot orthotic shoe. I made and customized this walking system to address and support my specific needs. In this system, the AFO and the shoe are working together in a final singular unit. Now I have all the comforts of a regular shoe and all the supportive attributes of an AFO. I can walk better and keep on walking. Joshua M. Unterman received a master of fine arts degree in applied craft and design in May 2013 offered jointly by the Pacific Northwest College of Art and the Oregon College of Art and Craft, both in Portland, Oregon. Unterman currently lives in Portland and can be reached at junterman@pnca.edu

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O&P JOBS

Certified Prosthetist/Orthotist (CPO)

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