Many many thanks to all who took the time to reply to my question. I will
repeat the question for your convenience then follow this with the replies I
received. As more than one of those who replied asked for anonymity I will
post all relies with the names deleted. I will follow the replies with the
final outcome.
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ORIGINAL QUESTION:
Greetings fellow list members,
I am hoping for some feedback on your experiences with the Springlite
Chopart foot.
I have a client who weighs about 110Kgs (about 240lbs) and a Rx specifying
this foot. I was a little doubtful about the ability of the urethane
adhesive to handle a man of this size. Consequently I followed the
instruction video to the letter and waited much longer than the suggested
curing time to be sure of no mess ups.
Despite this, the foot parted company with the socket before the patient
ever got near it. I just put it on the ground and put my own weight on it (I
weigh in at a massive 85Kgs/185lbs). I have contacted the local distributor
who told me they have had some trouble recently and I was advised to ignore
the instructions and to laminate the foot onto the socket.
Is this good advice? Has anyone had trouble like this. Has anyone had
trouble with the warranty on this foot having followed advice like this?
I would really appreciate hearing from others who have had either similar
results to me or who have used the foot successfully.
Cheers,
Grant Crosthwaite BSc (Hons) P&O, MBAPO
PS (Before anyone tells me I have to keep the surfaces REALLY clean I should
say I was scrupulous about it as the video says.)
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I wish I could tell you that I’ve used this foot successfully. My
experience is with one of my kiddo patients, a Symes. I’ve been laminating
this foot onto her socket since she was 7 years old (now 15). She plays
softball, volleyball, very active.. we even sent the whole thing to
Springlite to have them fabricate it properly, it still broke. And, if
memory serves me, she was all of 70 pounds when I first started using it! I
can’t imagine getting it to work on someone who’s 240!!!!
I too would be very interested in hearing if someone has actually been
successful in fabricating this system according to Springlite’s recommended
technique.
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I had similar results. Did the bonding per video. Patient, who weighs
245 lbs, separated the foot from the socket in one day. Since I
followed the directions accurately, I did not know what I would do
different the 2nd time around. I contacted Otto Bock/Springlite, and
they said pretty much what you said, but nothing about laminating. To
avoid future hassles and more wasted time, I sent the foot, socket, and
polyethylene mold I made to Bock to have them do the bonding. Although
there were central fab costs incurred, it came back with a warranty
(can’t recall how long), and I got peace of mind. The patient has been
on it for 3 months so far with no problems.
Although this was a problem, I have had good experience overall with
Springlite products, and will continue using them.
**************************************
My name is [Name Deleted] and am a technician in the Maryland area. I’ve
recently
had the experience with the chopart foot that you describe. I too, was told
to laminate the foot directly to the socket. This was approximatley two
months ago and have not heard from the patient since. The gentleman patient
we provided this device for was also large and active. I’m sure he was well
over the 245 lbs. as was your patient. Hope this helps to ensure your
confidence.
**************************************
My colleague had a problem with it breaking on the pt and then sent it to
Otto Bock for them to do it. It broke again and was sent back to be re-done.
It subsequently broke again and my colleague ended up using a different
foot. You are not alone. OB has a problem and they know it. It didn’t seem
to be a problem when it was Springlite. Not sure if the urethane is still
formulated in the same way. The pt was about 80kg
**************************************
I have had varying experiences in dealing with that particular foot. I
actually have a patient currently who has an amputation level, which can
only be dealt with using such a foot. The entire adhering process does seem
a little hokey and regretfully, i find myself procrastinating his delivery
as he is also a large man. With the posting of your comments, I may seek
other alternatives. I do know that i had some success in the past with
actually grinding a small lip in the socket, maybe 1″ from the distal end,
however it is difficult to say whether it had any effect because, while the
gentleman was active, he was not as large as the man you spoke of. Please
let me know if you find any alternatives.
**************************************
The trouble I had with this was not how clean but with what I
cleaned. Be sure it is acetone and not thinner. May be coincidence but it
worked the second time around
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Yes it is nice to get non-association emails. We have our own forums here
in Canada and don’t have to voice it through the international listserve.
I have fit this foot on two children and one adult so far. One of the
children’s foot came off about 3 months into the wearing of it whil he
was at school… how embarrassing for him. I remember when our techs were
fabricating the prosthesis, they too followed the video and written info
to a “T” and the first batch of urethne did not even cure. The second
attempt seemed to b succssful until he was carried through my door with
no foot. I had to fix it immediately because Mom was really annoyed, so I
ended up riveting the foot to the socket. I’m sure this voids whatever
kind of warranty exists but he needed a foot to stand on. I’ll see how
long it holds out. So far, so good and we’re going on 5 months now since
“the incident”. As for the adult, she was an older lady who is actully a
partial foot amputee. She is not very active and I chose the foot
primarily for the clearance. All’s good so far.
I am not very trusting with this urethane bonding kit though. I am more
and more feeling that a laminated socket/foot interface is the safest
route to go (with another foot though!). No comment on laminating the
Chopart foot-haven’t done it (yet!)
Hope you find the answers you need and would love to see your responses.
**************************************
I, too, experienced delamination after about three days. My patient weights
about 90-95 Kilos. However, my fabricator (I use a central fabrication lab)
rebonded the foot and it has been fine. The fabricator swears that he did
nothing differentl from the first to the second bonding.
Also, I would caution that this is a series of one experience. I would
neither recommend nor condemn the foot based on this example.
Good luck
**************************************
We laminate all ours with no failure – some carbon spring delaminations over
time though because you are eliminating 1/3 of the springs deflexion
capabilities. It is till the best option for chopart though
**************************************
My name is [NAME DELETED]. and I can tell you first hand I’ve personally
fabricated many-many of these devices and have had total success every time
with the exception of one. This “one” exception was due to the fact that the
customer strictly prohibited me form using any carbon whatsoever during
fabrication of the initial socket. I firmly believe this to be the sole
reason for failure. I haven’t read the instructions on fabricating one of
these devices in years BUT when this foot was relatively new to our industry
the instructions said to use carbon at LEAST on the distal end of socket and
before bonding the foot plate to the socket make sure that the entire distal
end is roughed up and THE ROUGHER THE BETTER!!!!! I do this religiously
whenever I fabricate one of these and as I stated earlier have never had
even one come apart on me except for the one that no carbon was used while
manufacturing the socket. Try this and I’ll bet you’ll have good success in
the future. GOOD LUCK
**************************************
Hello Grant, that urethane stuff is strong adhesive. Bock should back it up
for you . I might have them take a crack at fabing that leg if you choose to
have them send you another urethane kit and it fails again. What little give
it may have when all is said and done is definately to the advantage of your
amputee, as far as smoothing out the stance phase rockers.
Good luck.
**************************************
I have used a number of these feet in the past with great success it does
seems that there is a problem with the urethane and it could be a number of
issues age of urethane laminating resins ect. I would suggest thinking about
using one of the feet that are made to be laminated Flex, freedom ect.
Laminating the Springlite is OK but results in afoot that is too still and
then what is the point as the benefit will be mostly lost. If you have the
space both the Flex and Freedom Symes feet are excellent possibly the Flex
is marginally better. The patient can run on it and there is a significant
amount of heel loading and toe response. On the Ossur web page is a patient
that worked worth and ran with and he has really worked his feet hard and
they have lasted really well. he has tried all the feet and he prefers the
Symes feet as opposed to the chopart feet because of this his sound side is
raise 15 mm to accommodate the extra height requirement. You can view him
and the prosthesis http://www.ossur.com/template1.asp?PageID=6&newsid=61.
**************************************
We have had the same experience at our facility and in speaking with the
Canada Otto Bock distributor were informed that the video was being updated
todo just as you have been suggested to do – laminate it in. It’s a bit
rough to do – we tape the ant portion of the carbon plate with black
electrical tape and laminate over that. We still to the urethane thing
(sometimes to test walk it because once you laminate there ain’t no going
back!
**************************************
I would suggest that you call Otto Bock. In the past, Springlite as a
separate company they have offered to do the urethane bonding for you. Maybe
OTTO bock has the same offer. I have also had success doing it myself, but
you must be very careful with the cleanliness as mentioned. As for
lamination, ask around, but I think you will have problems where the
Lamination ends on the plate. I don’t believe the designs of the plates were
designed for that technique and you will have a structural failure.
**************************************
**************************************
THE END RESULT:
In the end we took the pragmatic approach and laminated the foot into the
socket. The patient was in dire need and had waited for a considerable time
while we attempted to make this work as advertised. Thus far all is going
well although we will know better once he is back at work next week.
If anything else of note happens in this case I will be sure to let you all
know. If I receive any more replies I will post them separately. Once again,
many thanks to all who took the time to share their experiences. Just shows
that we are not the mercenary types we sometimes are accused of being.
Cheers,
Grant Crosthwaite BSc (Hons) P&O MBAPO
P.S. A special thank you to all who recognised my name and welcomed me back
to the listserv. As a bonus I am now in touch with at least 2 people I had
lost touch with some time ago since moving to Australia.
