Thursday, May 19, 2022

Hinged versus solid, my abbreviated argument for solid

Kevin Matthews

Hello again.
 
I posted my videos and responses to the posting, but I never addressed an issue that came up often, except in individual replies.  A very valid and professional recommendation was the laminated, double action, double upright AFO.  This would be the most stable and dynamic design available.  The old and very current OOS/Becker system. 
 
I had one reply that said my design was good as a last resort.  I’d like to try to explain in few words why this is often a first resort for me.  My outcomes have been great.
 
For many years I have practiced to protect the integrity of the ankle, maintain ROM or work to gain as much as possible.  I hinged most AFO’s for what I thought would be improved function, and what I believed the prevailing protocol to be.  I work with a lot of therapists and hear it from them often. 
 
I have recently had my opinion changed about hinges and their contribution to function.  If the most dynamic energy storing prosthetic foot is relatively solid why shouldn’t we do similar things in our AFO’s.  In a rigid design there’s still an amount of flex and give with polypro, similar to the flexibility of a prosthetic foot.  What I would call a very dynamic design most see as a rigid design.  Am I making any sense.
 
I feel with more control we can impact gait much more effectively.  My patients walk beautifully and comfortably with a rigid ankle that has dynamic alignment (SACH heel, knee in flexion…on video).  I don’t always use the SACH heel, sometimes it’s not necessary.  I believe hinges add a measure of uncontrolled motion, even though it is controlled to a degree.  And I ask to what benefit.  ROM can be maintained outside of the orthosis.  The orthosis is designed for function and I believe in functional outcomes most of the time.  The dynamic rigidity of this design is hard to explain. 
 
Please try it.  Your best first patient should be on an ankle that suffers from chronic pain.  It really doesn’t matter how severe, this design made correctly locks them up.  In the vast majority of chronic ankle mortises I’ve seen are due primarily to motion.  Eliminate motion and you’re a hero.   This has been a miracle worker for many in my practice.
 
Once you see the functional outcomes in this patient population you will undoubedly try it on others.  This design is now by far the most popular in my practice.
 
Try it in yours.  
 

 
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
 
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233

Phone: 210-657-8100
Fax: 210-657-8105
www.AdvancedOrthopedicDesigns.com

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