RE-Sending – missed one reply – Thanks
Thankyou to those who replied to my query
I have a 13y old patient with Coffin Loury Syndrome.
We have been managing his plano-valgus posture over the years with UCBL’s and semi-rigid FOs.
Just in the last few months he has developed a startle reflex that causes all his muscles to relax, so he has drop attacks – about 6-7 a day. This may be a side effect from recent mufti level spinal surgery.
This of course causes concern from a falls point of view but he also somehow on his R>>L side goes into an equinas position at foot/ankle – that in turn has been causing soft tissue injuries.
I am looking for some solutions to prevent the equinas and to some extent knee flexion. A GRAFO’s are the obvious choice – but I don’t want them too rigid either for everyday walking. I was thinking long the lines of a custom carbon ½ proximal GRAFO with a flex strut still like the Kinetic research noodles, or maybe an adjustable dorsi/plantar stop Co-Poly AFO.
I know i can’t have the best of both worlds – but does anyone have other suggestions?
Check out the ISPO 2007 pdf program for the plastic reinforced AFO – I just googled it and there is a description and pictures of the fabrication technique on pages 148- 150. It is a great design – very cost effective and virtually unbreakable. Here is a picture of one of mine – i add a lateral flange to mine about half way up the shank to help control varus instability – i rarely use a varus strap anymore. Its hard to see the reinforcement but it ends about 8cm below the proximal trimline.
Hope this helps – if you want more pics i can send them next week just email me. This is my number one design now – it is very versatile.
My best suggestion is a rigid plastic AFO and then remove the heel which will allow it to plantar flex a little at heel strike. Trim it back after the heel is opened to the dorsiflexion flexibility desired
How about a Surestep SMO combined with a Kiddie gait or Toe Off AFO.
I think you have a startle reflex my friend.
Our profession really does have limits. I think you found one example of them. Have a nice Holiday!
Yes – your correct It is a startle reflex – but he relaxes rather than going into spastic pattern
Double action joints is your best bet as you can fine tune them. GRAFO is “by the book” solution, but it limits ankle ROM greatly and continuous fit maintenance is PITA. One thing kids do NOT like is not be able to keep up with their peers.
Best. He’ll also break anything you put on him.
Thanks again everyone
My choices now are a rigid-reinforced PP AFO – or a PP AFO with adjustable ROM hinges
Thinking the second option
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