Responses to my original post:
Colleagues,
I make a concerted effort to NOT give SACH feet to AK’s and to convince our
rehab clinic that it is inappropriate.
Am I right, or is there a theoretical justification for giving Sach feet?
I am speaking of optimal gait,safety, and ease for the patient.
I prefer a foot that allows for significant plantarflexion and smooth
dorsiflexion roll over.
Mark Benveniste CP
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Mark:
I agree with your opinion on this. I have noticed a significant increase
in knee stability when a single axis foot is used. Perhaps a
soft-heeled SACH would perform a similar function, but my preference is
for the SA. I believe Medicare functional level guidelines allow for a
SA foot on the lowest functional level for an AK, indicating that they
see it the same way.
John T. Brinkmann, CPO
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>
Mark – You don’t state what you use in place of the SACH foot so I must
assume that you are using some sort of articulated ankle. While I am
certainly no fan of the obsolete SACH design neither do I feel that the
weight of a single axis foot is anything but a detriment to the AK amputee.
A single axis foot would be absolutely my LAST choice on almost any amputee,
but especially so on the AK or HD amputee where the length of the prosthetic
lever is so great.
In the early 80’s I remember reading several studies that were try to prove
either the SACH foot or the single axis foot to be superior. None of these
studies were able to provide any significant evidence that one was superior
to the other in any functional measure. Clearly multi-axis feet have
certain function advantages over either SACH or single axis feet but retain
the disadvantages of high distal weight and significant wear/maintenance of
moving parts.
My personal preference is to avoid both articulated and SACH feet in favor
of flexible dynamic response feet such as the Vari-Flex or the Sure-Flex.
Not only is gait improved by the full length keel but the real benefit comes
due to the minimal distal mass these feet offer. The pendulum of the AK
knee will swing faster and with less effort if the high distal mass of an
articulated is avoided.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
ted@amputee.com
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Mark,
I like the theory, but most elderly PVD amputees of AK level are felt to be
safer on the SACH. One particular comment is regularly received ” its like
walking on marbles” .
Put these people on loose shingle or a nonflat surface and I think they’d
feel decidedly
worse.
Scott
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Mark,
I have always thought that a soft SACH foot was ok for AK’s. The more
proximal the amputation the softer the foot. Many people use heels that are
to hard for the AK. Chuck Radcliffe advocates plantarflexing the foot for
even greater stability and better rollover at heel off.
–Gerry Stark, CP
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I would agree that it is desirable to provide a soft plantarflexion action
for AK’s. This can be accomplished with a SACH foot and they can certainly
be used effectively for this population.
So don’t rule them out, they can work very well.
Jack Uellendahl
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Thank you for your responses. Once again, we have a variety of opinions. Dr
Radcliffe posted a detailed justification of the SACH based on the ability of
the prosthetist to “fine tune” the SACH by grinding appropriately with
respect to the shoe and movement within the shoe, and insuring a soft heel is
used.
I think if we can determine what is OPTIMAL, we can inspire industry to give
us some options, or know what options we should look at more closely. If we
are not ruling out SACH feet, who are we reserving them for? Is cost the sole
criteria?
Other posts were forwarded directly to the list and were not repeated here.
I look forward to a future formalized panel to discuss these ideas.
Mark Benveniste CP
VA Med Ctr
Houston, TX
