Saturday, December 3, 2022

Responses: Pre-Fab Carbon AFOS

John Brinkmann

Thanks for all the responses to my questions about pre-fab carbon AFOs.

Question: I’m interested in hearing your experience regarding the Matrix
vs Toe Off carbon AFO products. Do you prefer one over the other, and
why? Is one more durable?

Responses: Edited to remove any non-essential info.

For the past 5-7 years. I’ve used prefab and custom composite
AFO’s…The patients needs severe as the best barometer with regard to
type. Successful, I’ve use Ossur’s toe off and Ottobock’s walk on.

I have been using the Matrix. I prefer it over the toe off because the
anterior tib shell is more adjustable being thermoplastic. I have had
problems with the strap tabs on the Toe Off breaking off. The Matrix has
its down falls as well. Have had recurring issues with the chafes
breaking off with them. I find they work well for MS patients or anyone
who has generalized lower extremity weakness (specifically weak quads
and weak dorsiflexors). Both braces tend to make recurvatum worse and
offer little support in the coronal plane for the ankle. I love to use
them on diabetics who may swell too much for a plastic afo and need some
toe pick up since you can slide the foot plate under their inserts. I
also have made some brownie points with PT’s by offering to bring a
brace in to try during therapy.

I use toe off’s on my light, low impact patients, otherwise I’ve had
durability issues. I’ve ordered the Matrix, when we received them both
were cracked at the strut, we returned them and never ordered them
again, figuring that was a sign of problems to come.

I do a fair amount of these carbon fibers. The Toe-off has proven in
past to be least durable. they do have a year warrantee if you fill out
the warantee card.

However, if the second fails, which usually is where the strut meets the
foot plate, no third is given. Matrix I have only used a few times and
have no track record with. Allard has addressed this problem with the
toe off by introducing the Blue Rocker which seems more durable. I did
a seminar here…with Allard being the co-sponsor and bringing in their
speaker to discuss mechanics of the toe off. I liked their ideas on
biomechanics of the orthosis.

Also, I like the ease of donning. Will be fitting a toe off at hospital
this morning. Also, dont forget the Walk on by otto bock, perhaps, in
my opinion, the most durable of the lot. Problem is donning and also
the medial strut is a problem for big pronators. PLEASE steer clear of
the Easy step form Spinal Solutions. With it’s wide stirrup attachment
to the footplate, I cant seat it properly in many shoes.

I’ve used both in my practice and much prefer the Toe Off over the
Matrix. The Toe Off is much slimmer in profile on the patients leg and
the foot plate fits much easier into the shoe. I also don’t really like
the attachment that the Matrix has on the tibial section as over time
the shell migrates prox. and distal on the attachment screws.

matrix max outlasts the toe off 10 to 1 in my opinion. both work great.
Don’t really see a functional difference, just a major durability
difference.

We experienced a problem with the matix a while ago and stopped using
them when they shifted to plastic chaffes and they kept breaking. I
also have an issue with their screws when tightened that go through the
retainer holding it, causing sharp edges. We have had to grind these
down, and discussed with the sales rep with regard to this. We had also
complained about the plastic chaffes. We ended up switching to another
company’s brace that you did not mention. I would check to see if the
screws poke through when tightened, and know that the company has been
informed of this. If they still are, are there other issues is the
company aware of that have not been upgraded? I hope the shorter screw
issue has been fixed, though, as it seemed to work well except for the
issues.
I did not compare the toe off to the matrix though.

I have used the Matrix and found the anterior shell and straps to be
rather ‘cheap’ in design and function. But the device does work for the
right patient population. I have started using the Noodle AFOs from
Kinetic Research with much better success…both OTS and
custom…anterior shell or posterior cuff.

toe off is stiffer, good for heavier pts and when more rigid control is
needed. Matrix max is a little more flexible. We use the matrix max
primarily and find it to do the job very well when we need that sort of
thing.

John T. Brinkmann, CPO, LPO, FAAOP

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