I had posted the following and got lots of good suggestions. Thanks to all
that responded. Both this patient and the second one with similar
conditions were fitted this week.
First the responses: Most people suggested some type of ground reaction
AFO to provide the knee extension. If also most of the responses
suggested using a KAFO instead of the KO because of slippage and leverage
problem. If posterior offset knee joints were used then the OB rubber
extension assists or the Scott latex tubing extension assist were
recommended. If was felt by both manufacturers that neither theTamarack
dorsi assist joint used backwards nor the Generation II extension band
would creat enough force to protect the patient. And finally for the most
control a KAFO with locked knees was recommended.
Treatment used: Both patients were fitted with a thermoplastic articulated
ground reaction AFO (modified Newington type design). Casts were take in
planterflexed position. (One was not planterflexed enough and dorsi stop
had to be modified at the time of fitting.) Normal modification for bony
areas were made; Tamarack joint dumbies and pelite spacer pad for navicular
area were added. Model was vacuumformed with 3/16 polypro (homopolymer)
with seam running down the planter surface of the foot and up the back of
calf. Extra material was added at the time of forming to the dorsum of the
foot just anterior to the ankle level for extra dorsi stop material.
Orthosis has posterior opening from heel to top of calf. Proximal anterior
trim is at tib tub.level. Distal trim is at tarsal/metatarsal level on
dorsum of foot; just proximal of met heads medial and lateral and at the
toes on one AFO and at the sulcus on the other. Plasizote padding was added
to prox 25% of shin and over navicular area. Velcro pad wraps around
proximal leg.
Both patients were able to ambulate with free planterflexion. Knee
stability was good on the one but I had to weld more PP to the stop on the
other one to provide more of a extension moment for more stability. If she
had been cased in more planterflexion that would not have been necessary.
I will post follow-up information after the ISPO Congress. Again thanks
for all of the suggestions. Terry Supan, CPO
>Date: Wed, 6 May 1998 08:07:36 -0600
>To:oandp-l
>From:[email protected] Terry Supan
>Subject: Orthotic Knee extension assist
>
>I am looking for suggestions for a patient recently refered to me. Patient
>had total knee replacement four years ago. No problems until she fell last
>summer when she fell and shattered her patella. It was fixed and was doing
>fine until last Dec when she feel again and patella had to be removed.
>
>Loss of patella results in reduced quad strength. Her problem is that if she
>does not pay attention to how she is standing, her knee will trigger, buckle
>anterior and she falls backwards. No M/L problems at all. Ankle does have
>some laxity but normal ROM and funtion. She will need a total knee on the
>other (rt) side sometime in the future.
>
>Looking for suggestions. Have thought about: a) floor/ground reaction AFO
>with free plantar flexion to hold the knee in extention, b) KO with posterior
>offset knee joints, c) KO with some type of extension assist (Tamarack dorsi
>assist joint used backwards; overcenter spring; Generation II extension
>piece?), or d) KO with lock.
>
>I want the woman to be able have as much knee freedom as possible when
>walking. She is now using a knee immobilizer when she is up and a folding
>walker (wheelchair for long distances) when she leave the house. Patient is
>on disability leave but wants to return to work for two more years before
>retiring fully.
>
>The surgeon has two other similar cases that came from “St Elseswhere”, but
>this one is his. Pateint is scheduled back end of next week.
>
>What are your ideas? What have you tried and what kkind of success have you
>had.
>
>Thanks, Terry
>
>PS: Less than Two months to the ISPO IX World Congress. Will you be there? TS
Terry Supan, CPO
Associate Professor
Director, Orthotic Prosthetic Services
SIU School of Medicine
PO Box 19230
Springfield, IL., USA, 62794-1420
phone: (217) 782-5682
fax: (217) 782-7323
E-mail:
