Thanks to all who replied. The initial inquiry is below, followed by
the responses.
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Have a 300 lb A/K patient currently using an Otto Bock Supra System
with
> a manual locking knee (good up to 330 lbs). From socket to foot is
all
> Bock and needs to be so to be warrantied. Problem is the patient is
> moderate activity level and compresses the heel excessively. Bock
will
> not warranty a stiffer heel foot due to the transfer of excessive
stress
> on the proximal componentry. This is understandable.
> I have tried using a slightly longer pylon to offset the heel
> compression to no avail.
> Thus my search for alternative componentry. Acquiring componentry
> below the knee is not a problem. However, I know of no
manual-locking
> knee for moderate activity level for a weight level up to 300 lbs.
> Hosmer’s is the closest I could get, but it is for lower activity.
> Any ideas?
>
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RESPONSES
Can you put a springlite blade in the shoe to stiffen things up a bit,
but
that may not work at all!?! How about aligning the prosthesis for a
longer
toe/shorter heel, that should stiffen it up, might throw everything
else off
though?
If you offset the pylon and foot posteriorly won’t you effectively
reduce
heel compression by getting weight onto the ball of the foot sooner?
Is there any way to firm the heel up? I remember drilling a 1/2″ hole
into
the bottom of a SACH foot and inserting a firm plug to stiffen the
heel. An
old trick taught to me by one of the old masters, but maybe that would
help.
Check wtih Ohio Willow Wood, I believe they have a variant of their
GeoFlex Knee which fits the bill.
If the Otto Bock foot is a 1D10, which I think it is in the kit, try
making a thermoplastic UCBL. The UCBL will decrease the compression of
the heel. It worked for me on a BK that was 325#.
With a lock knee set up you have the luxury of unlimited alignment
options.
Shift the socket anteriorly so as to decrease the heel lever arm. This
will
result in less time on the heel with little compression.
Try an Otto Bock alternative (to maintain the warranty) such as a
Springlite
product. Most Springlite feet offer incredibly high weight restrictions
therefore keeping in line with their warranty.
Check with Euro.
I would imagine that you should try to move the patient to a knee more
suited
to his activity level. Then I would look at feet like the Collage park
and
the new Renegade from Freedom feet these types of feet offer ankle
articulation
and is actually what your patient needs especially with a fixed knee. I
would
imagine that the shock that goes through the body with a lock knee and
firm
SACH heel would not be good for the patient.
