Hi All and Happy New Year from New Zealand
Thanks to the many who responded to my enquiry.
Sorry for the delay in responding and for the confusion created by using
the abbreviation TA instead of saying Archillies Tendon.
Here is the question with the responses following.
I have ordered a Blue rocker for him.
Dear colleagues.
I have a pt who presents with a ruptured TA (7/52 ago) that missed out
on early treatment. He has a visible gap in the TA and the Specialist
advises he is not for surgery and should not expect any improvement on
his current state (nor any deterioration). He has full active ankle DF
and some active ankle PF (suprisingly about power level 2+). He works as
a builder and finds he is unable to do some things like climb ladders
etc. Essentially he lacks some toe off propulsion on the affected side.
The specialist has asked if we can supply something to help with toe
off. Some products come to mind but I wonder how practical it is to try
to suppliment lost plantarflexion power to this level.
Your thoughts welcome.
Shane Jansen
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You will need to fit him with an AFO with a Dorsi-flexion stop, or use
a
floor reaction carbon or plastic AFO strong enough to give him push-off.
Good Luck
Charles C.A. LeDoux, CPO
Certified Prothetist / Orthotist
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There is a new Canadian design called the plastic reinforced chevron
AFO. It`s cheap and easy to make with a certain technique. Check out
Don Weber from Chedoke Hospital. This design is very effective for
plantar flexion and doesn`t need all of the high-tech components. They
have really good videos that they will send you if you contact them.
Cheryl Lewis, BSc(HK), CO(c)
Certified Orthotist
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Shane,
I had a patient that had no plantar flexors, so he had no propulsion to
help his leg into swing. I fit him with an Otto Bock Walk On, thinking
that the carbonfiber would store enough energy to help him swing his leg
forward. It did work well for him.
Scott Amyx CO
PS let me know what other people have tried, thanks.
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Carbon graphite struts would be the simplest way. Otto Bock’s carbon
ankle 7 good but can be more bulky than prefab. Have you tried a
WalkOn on this guy?? I assume by TA you mean he has a ruptured tib
ant. Then why does he present with perfect DF?
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Try the allard toe off afo. I’ve been impressed for this problem.
Karl
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I would first try the Allard Blue Rocker toe off brace. The carbon foot
plate will also help him a lot on ladders for foot comfort. Good Luck
Mark Bondurant CPO USA
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Hi Shane
around here, TA is tibialis anterior.
solid ankle kicks into knee, by forcing it into flexion at heel strike.
but it is a simple and viable option. now, truly, there’s very little
triceps surae action walking. it is more of momentum thing. climbing up
stairs is not as much TS, as it is hip/knee extensors.
so, anything that will lock him in about 3-5 degrees of dorsiflexion and
is strong enough to carry his weight around tarsus, should do the job.
you just need to find something that will allow you some adjustability,
so that you can fine tune it. hope it is not his driving side.
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Shane,
I have never had this particular issue before, but I have some
suggestions. Hope this helps you.
The Trulife matrix max or Allard Toe off offer some propulsion. I
typically use these braces for drop foot, but have noticed definate
propulsion at the terminal rocker/toe off phase of gait. I have even
tried these braces myself. When I was trying these braces out, I had
normal gait with a little extra “kick”. For me, it was like having a
spring on my toes.
Other options: use gaffney flexor joints backwards, possibly in
combination with a PF assist joint at the ankle.
Don’t know if any of these ideas will work or be practical for your
patient. Good luck!
Kim LCO,CP
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