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
Thanks again everyone
My choices now are a rigid-reinforced PP AFO – or a PP AFO with adjustable ROM hinges
Thinking the first option
BPO, M.A.O.P.A, CPO
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