Friday, May 20, 2022


gene solyntjes

Hello Lisa,

With regard to the CROW orthosis, think of a custom ski-boot which locks

the ankle mortise in neutral and unloads the plantar portion of a charcot


The CROW is a padded AFO with an anterior shell, insert and crepe, rockered

sole. Relief of the ulcerated area is builtin to the positive model. The

posterior portion is made rigid for stability. The anterior portion can be

made of padded polyethylene. The insert provides for further unweighting of

the ulcerated area and I give my patients an extra insert . Since these

inserts are primarily accommodative orthotics (multi-density), they tend to

wear out. I found the crepe sole tended to come loose after protracted

usage. I now added leather to the plantar surface of the cast, rivet and

glue it; this makes the crepe- afo bond permanent. When making the anterior

shell its best to place the posterior portion on the positive model with a

spacer of some sort under the plantar surface. This allows room for the

insert, without creating excess presssure of the dorsum of the foot, and

still locks the ankle mortise into a neutral position..

Many of my patients are diabetics and the complications of diabetes,

neuropathy, and wounds close to amputation makes the fitting of these

devices; and their maintenance, oftentimes a long term situation, critical.

Gene Solyntjes LCO. C. Ped.


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