I greatly appreciate who responded to my question and helped in this case . I,ve been from top students of Iran country in university enterance exam and have being in intimate relationship with some of postgraduate students of human genetics since several years . considering their research routine , I conclude that close and every day finding exchange among genetic researchers plays one of main roles in rapid extension of genetic science . My patient consulted with her doctor and he said her that correcting the varum angle couldn,t surmount her knee pain so I decided to make a special Ischial weight bearing brace as Mr John Russell has described for me below . .below I bring the original message I posted and responses , I recieved :
Dear List
In clinic we have a 52 years old woman who is suffering from severe genu varum since several years .She is a housewife and couldn,t undergo total joint replacement surgery .She has fitted a knee cage device with tarpaulin thigh and leg shells , steel side bars and steel knee joints to control the deformity .Of course this device could control her leg deformity to some extent , but some degrees of deformity and consequently some amount of pain remains even when she uses the knee cage and she complains about the weight of device . I,ve searched for correcting device in this case in literature but I haven,t found a worth device yet .As a trial way I think that if I make a kneecage with single medial joint and bars , anterior leg and posterior thigh custom moulded plastic shells , lateral knee straps to pull her knee to correct position and make some extra gap between knee joint and anatomical knee to make enough space for this act it will work ? but it may rotate on the knee an!
d loose
its function ?Does anyone know of an exprienced efficient way to correct this knee except total knee replacement surgery ? or discuss the way I said ?Best regards , Mohammad Reza Mirheydari , CPO
RESPONSES :
I do this for post polio patients :Ishium support and to the foot, a knee cage will not work Rehearse the angle and position before casting, and have the patient lying flat (of course find the position where the knee is not in pain and then with the patient input then decide what angle you want. Do not use plaster in casting!!! 1/8 in polypro Plastic over the medial knee and metal knee joint against the plastic .Do a test socket before doing a trial fit. That would be a good start . John Russell , Collier Rehabilitation Systems Inc.
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I think that your answer could work well but I believe that you should try to keep the lengths of the thigh and leg sections as long as possible to increase the leverage of control and spread the loads over greater area. I would be also a little concerned that only a medial upright may not be strong enough for the forces needed to correct this old deformity.
I have generally found that close fitting appliances of this type, using the longest levers possible generally feel lighter than they are in fact and ceratinly lighter than appliances with all their load concentrated in a small er area.
Hope that this helps Richard Ziegeler (P&O Australia)
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Degree of deformity? weight and activity level of patient? probably
KAFO. Bruce Russel
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Have you considered a plastic KAFO, aluminum uprights, knee pad with a lateral pull, and hinged ankle? If you don’t want to get that complicated, Townsend makes a nice custom unloader knee orthosis. If migration is an issue, you can have a medial or lateral extension to a footplate.Tom Wilson, C.Ped, CO
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My name is Mark Joyce. I’m a CO. My father, Raymond Joyce, CO, created a KAFO a number of years ago that we have both used with considerable success in treating varus/valgus deformities of the knee. When surgery is not an option, the best thing to do is use an orthosis that does a serious job of correcting the deformity. As you mentioned, rotation is a proble. Also, when using a single upright orthosis…rigidity is in the upright is important to provide adequate corrective force. Please look over the pictures I have attached which illustrate a single upright KAFO which may be a good solution for your patient. I have not constructed one to be used for genu varum, so I have no experience to share with you on whether the bulk of the knee joint will be a problem. I suppose it will depend heavily on the alignment of the contralateral knee. At any rate, I thought the information might be helpful to you. Please let me know if you have any questions. Mark
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You are on the right track. I would go ahead and take the orthosis to the floor (KAFO) to control the rotation. Keever Wallace, CO
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generation II ….Ossur owned now out of california , Ross Jones
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If offloading the medial compartment of the knee is your primary goal…look into a new product called the V-Vas distributed by Anatomical Concepts Inc. 1-800-837-3888. It is a custom double upright KO or KAFO that captures the thigh and calf and varies the varum or valgum angle through an adjustable upright system. Joe Whiteside CO
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In this type of situation it usually requires controlling the foot and ankle as well as putting a three point force system to bear on the problem; this will lengthen your control lever and help control rotation of the lower limb. Check out our KAFO system at www.ossur.com . John Parks CO LO , Clinical Orthotist
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i also got same pt.F-56, i put plastic band with medial bar for night, and fabric with plastic jt.reinforced for ambulation, the deference between ur and my pt. is my pt,. is working lady, thanks, urs , prasant kumar , p/o
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You may want to try extending orthosis to kafo length with a posterior shell added from calf to floor (making orthosis into clamshell based on your design idea) extending to a heel cup configuration terminating at the mid foot to provide additional leverage and control and eliminate rotation because it will then be anchored in the patient’s shoe. You may also want to preload some more valgus force by contouring the uprights accordingly. I hope this helps. please let me know what you end up doing for future reference. Thankyou and best regards, Martin Stevens, CPO
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Have you heard of any of the premade orthoses like “Breg Counter force”, “GII Unloader express” and “GII Unloder custom”?Are you able to access commercial “off the shelf” knee braces or are you having to custom make one yourself? Kind Regards Shane Jansen New Zealand
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Townsend Knee orthoses are great and control genu-varum well. They are in California and Jeff Townsend is the owner and I went to school with him. Ask for orthotist and they are will help you, they are custom made and stand behind there product one hundred percent. the offical name is TOWNSEND DESIGN if you cant contact them write back. Kathi E. Ensweiler, C.O., C.Ped.
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