High-energy extremity trauma is common in combat and orthotic options for patients whose lower limbs have been salvaged are limited. Study results published in the March 2012 issue of The Journal of Bone and Joint Surgery conclude that the Intrepid Dynamic Exoskeletal Orthosis (IDEO), designed by Ryan Blanck, CPO, at the Center for the Intrepid (CFI), Fort Sam Houston, Texas, significantly improves performance on validated tests of agility, power, and speed as compared to other types of AFOs or no bracing.
Eighteen subjects with unilateral dorsiflexion and/or plantar flexion weakness were evaluated with six functional tests while they were wearing the IDEO, a non-custom carbon-fiber orthosis, posterior leaf spring, or no brace. The brace order was randomized, and five trials were completed for each of the functional measures, which included a four-square step test, a sit-to-stand five times test, tests of self-selected walking velocity over level and rocky terrain, and a timed stair ascent. The subjects also completed one trial of a 40-yard dash, filled out a satisfaction questionnaire, and indicated whether they had ever considered an amputation and, if so, whether they still intended to proceed with it.
Study results showed that performance was significantly better with the IDEO with respect to all functional measures compared with all other bracing conditions (p < 0.004), with the exception of the sit-to-stand five times test, in which there was a significant improvement only as compared with the non-custom carbon-fiber orthosis (p = 0.014).
Of the 18 subjects, 13 initially considered amputation, but after completion of the clinical pathway, eight desired limb salvage, two were undecided, and three still desired amputation.