I have previous sent these responses, but haven’t seen them posted, so will try again now. Thanks for all your help. Heres the original post:
I have a teenage patient who has an ankle injury after a sport
accident 1 year ago, this has resulted in high tone that causes extreme supination of her foot and internal rotation of the tibia. Medical/surgical treatment including botox has not helped. It is possible to manipulate the foot into a neutral position, the manipulation causes pain particularly under the patella, but once in neutral there is no pain. I have succesfully made a bivalved night orthosis. I now need a replacement for the Walker currently used during the day as the height difference is causing hip problems. She cannot tolerate joint movement whilst weight bearing, but her physio is hoping to build up tolerance. My question is has anyone got any treatment ideas for this type of problem?
Following some of the advice I laminated an orthosis with mainly carbon frame around the calf with good strapping anteriorly just above the ankle, camber axis joints and flexible resin foot wrap with carbon reinforment of the sole plate and joint attachments. This works extraordinarily well in controlling her, and though its a tight fit, has been well accepted. She is now able to walk with some joint movement. I don’t think this is a long term solution, pre-preg would be far stronger, however we’re hoping with more medical treatment that the problem can be resolved.
Thanks again, heres all the responses:
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External rotation of the tibia with supination. Why not go with
laminated solid ankle for strength dual side element.? BAR 2804
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Challenging case. I find that I can much better control transverse
plane
rotation with a full circumferential design–similar to floor reaction
trim
lines. This makes the device far more rigid–approximately 5 times
more
rigid, than a circle with a mere slit in it, because of the moment of
inertia. Good luck
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Very interesting problem. I use prepregs extensively. It has taken
me
about three years to finally find a composite combination which stands
up to
daily abuse. Please feel free to contact me if you would like us to
fabricate an orthosis for you.
