Saturday, March 2, 2024

Responses regarding direction of straps


Dear Colleagues

Thank you to all who answered and shared their experience and thoughts with

The following are the many varied answers I received-

I personally do not rely on straps to correct anything. I only use straps
to hold the body into the device.

I do not use toe straps, I am very concerned the medially directed force to
correct hallux valgus applies a distractive force at the metatarsal
phalangeal joint and possibly will dislocate the joint or at least apply an
unwelcome force – many the times the 1st ray is abducting as well so the
force on the hallux can be substantial.

I do not believe straps alone have much effect on gait.

Hope all is well

At ankle area, I would mount chafe on Medial side w/strap attached
(possibly) internally on the Lateral side. Toe strap from Medial side to
Lateral. Third strap could be from (internal to) Lateral& proximal to
Lateral Malleolus The theory for holding the toe And forefoot would be to
help gait providing a more “anatomical neutral” foot in stance(to hopefully
improve gait).—–Bruce Strelow, CPO

Will be interested to see what people say. As, I have heard many interesting
things over the years. When it comes down to it most straps are like your
belt to hold up your pants. They are there to secure you in place, but no
matter which way you put the belt on, it does one thing;)
Now you will find some other factors that come into play. Such as a distal
strap that is placed internally in the base of the orthosis that when pulled
will actually pull the tissues or a strap that is located under the mid line
of the arch. These all make a true difference – Warren Hagen

Depends on the severity of the in toe gait pattern. Often I will pull an
ankle strap from the lateral inside of the brace to a chafe on the medial
outside of the brace. Also a lateral sabolich modification coupled with a
forefoot wall extension. Don’t forget about a slight lateral heel post to
encourage external rotation.

Alexander L. Lyons, C.P.O.

Your question confuses me –

CP kids usually in-toe because or muscle imbalance. – I like to use molded
inner boots inside the appropriate AFO to manage triplanar issues at the
foot & ankle. (This could include an SMO with a Kiddie Gait AFO)

Femoral/Tibial torsion often occurs in otherwise normally developing
children & is best treated from hip level down. I use twister cables still
(often) attached to AFO’s & to shoes used at day or at night & have had
success de-rotation straps on smaller children. Heather M Davidson CO

I often extend the plastic on the medial side of the fore foot, then add a
strap above the ankles. The strap is placed on the lateral side of the AFO
(strap is placed on the inside of the AFO) and the buckle on the medial side
(on the outside of the AFO) that allows me to provide a valgus directed
force to the ankle and the distal and proximal part of the AFO adds a three
point of contact. It works well with fore foot adduction. Good luck!

Charlie Mata CO/LO

lots of things in play here….
Typically, the simple answer would be an internal ankle strap pulling from
lateral to medial, and a higher tab just behind the 1st metatarsal head to
give counter-force to the strap.
In my opinion, it won’t do much for true torsion, but it will prevent some
of the inversion/forefoot adduction that would be evident through
weightbearing while internally rotated.
We do 2 different types of straps for peds here- custom leather for the
larger kids, and a double slotted velcro (padded with skived felt) for the
smaller guys. The double slots give you better control. I can send you a
picture of one if you like.
I hope this is helpful.

I would love to point you in the direction of Elaine Owens and Beverly
Cusick. It’s way too involved for me to try and describe with my iPhone
emaIl and my computer is down. If you wish you cam call me at 312-925-9396.
When I get my computer back I’ll see if I can email you some of their work.
It’ll change almost everything you do in terms of LE intervention where
spasticity is involved.

Jack Hanan, CO

With equino-varus type deformity I use slotted instep straps with the strap
originating on the lateral side slot down as low as possible, padding the
strap where it contacts the lateral and dorsum portion of the foot. Forefoot
strap I slot just where the medial wall turns into the plantar surface and
pull to the lateral wall. When molding I use a dummy for the instep strap on
the lateral side. Walz Konrad p

Thanks once again



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