Sunday, May 29, 2022

Responses-survey : brace for anterolateral tibial bowing

Mohammad Reza Mirheydari

My warm thanks to whom responsed to my question and helped to cure a sinless child .

Below I bring the original question and recieved responses :

Dear list members

A 3 years old child patient has been reffered to us with anterolateral tibial bowing and pseudoarthrosis . I,m looking for the best design of brace for this patient . I would be greatly appriciated if one describes the design and making procedure of this device for me .

Best Regards

Mohammad Reza Mirheydari , CPO

Answers :

The current view for children of this age is to use a non articulated KAFO until further growth occurs. I myself have had psuedoarthrosis of the tibia since birth with anterolateral bowing. I did start in an articulated KAFO but by the time I was 7 years old (and since then) have used a modified PTB style AFO with gaffney joints. The AFO is modified to allow knee flexion instead of coming up over the knee, but unweights the tibia via a deeper patella tendon bearing groove and by narrowing the overall circumference to get more unweighting over the tibial condyles. The clam shell design also offers some protection to the bone structure during activity. The KAFO that I wore consisted of a leather calf lacer and drop lock knee joints and a clam shell style AFO. Wearing this type of orthosis I still continued to fracture repeatedly. There are no instances of fracture or worsening of the bowing in my case since the PTB style AFO has been used. (I have worn this for 19 years)

Andrea Jeske Orthotic Resident

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Dear Mohammad:
We’ll typically fabricate a bivalved (total contact) thermoplastic AFO with an articulated ankle allow free dorsi- and plantarflexion. The anterior shell protects the area of pseudarthrosis, and it should be designed to allow tightening within the posterior shell for an adjustable, snug total contact fit. We’ll also have an aliplast liner along the tibial crest for comfort. These patients typically have normal motors across the ankle, and utilizing those motors are good for the overall health of the lower leg, hence the idea of offering free sagittal plane motion across this joint.

I hope this helps, and good luck.

-Don Katz.

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I have two sisters with this condition. I feel the best and only way to treat this is with a single upright KAFO with a free knee and bivalve plastic AFO with a solid ankle. You shouldn’t try to correct the deformity. The physician will correct surgically when child is mostly finished growing. My goal with my patients is to limit progression of the deformity and allow them to be fully active young girls. Please e-mail if you need more info on fabrication.

Kevin Matthews, CO/LO

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I have treated several children with this condition. The orthosis of choice in our clinics for the younger children have been a thermoplastic, polypropylene KAFO with drop lock knee joints, solid ankle and a polyethylene tibial anterior shell. The anterior shell extends from the MTP level to distal to the malleoli. We control the knee and ankle until the children are ten or so, then remove the thigh section and allow dorsiflexion at the ankle. The anterior tibial shell is used until skeletal maturity.

Terry Supan, CPO, FAAOP, FISPO
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Hello Mohammed In response to your question I have apatient with the same problem that I have been treating now for about five years The orthopedic surgeon recommended a bivalved AFO (no hinge) mainly to protect the bowed area from fracturing due to abnormal stresses on the bone. All I can add is so far so good I.d love you to send me any other suggestions

Good luck

Vivian CO PT

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