Treatment of Symptomatic Foot and Ankle Deformities in the Nonambulatory Neuromuscular Patient

Foot & Ankle ◽  
1985 ◽  
Vol 5 (5) ◽  
pp. 238-244 ◽  
Author(s):  
John D. Hsu ◽  
Richard Jackson
Keyword(s):  
Surgical Procedures ◽  
Neuromuscular Disease ◽  
Severe Pain ◽  
Foot Orthoses ◽  
Foot And Ankle ◽  
Skin Breakdown ◽  
Ankle Foot Orthoses ◽  
Shoe Wear ◽  
Muscular Imbalance ◽  
Ankle And Foot

Thirteen nonambulatory patients, aged 7 to 15 years and with neuromuscular disease, had residual foot and ankle deformities secondary to persistent and continued muscular imbalance around the ankle and foot. Surgical procedures were done to correct these fixed contractures so that the ankle was neutral and the foot plantigrade at the conclusion of the procedures. Despite successful attainment of the preoperative objectives, surgery should not be performed unless the following indications are present: (1) severe pain, (2) skin breakdown and/or ulceration, and (3) the inability for the foot and ankle to accept reasonably costing and available shoe wear. Recurrence occurs if AFOs (ankle-foot orthoses) are not used after the surgical releases.

Effects of Ankle-Foot Orthoses on Ankle and Foot Kinematics in Patients With Subtalar Osteoarthritis

2006 ◽  
Vol 87 (8) ◽  
pp. 1131-1136 ◽  
Author(s):  
Yu-Chi Huang ◽  
Kimberly Harbst ◽  
Brian Kotajarvi ◽  
Diana Hansen ◽  
Matthew F. Koff ◽  
...  
Keyword(s):  
Foot Orthoses ◽  
Foot Kinematics ◽  
Ankle Foot Orthoses ◽  
Ankle And Foot

Effects of Ankle-Foot Orthoses on Ankle and Foot Kinematics in Patient With Ankle Osteoarthritis

2006 ◽  
Vol 87 (5) ◽  
pp. 710-716 ◽  
Author(s):  
Yu-Chi Huang ◽  
Kimberly Harbst ◽  
Brian Kotajarvi ◽  
Diana Hansen ◽  
Matthew F. Koff ◽  
...  
Keyword(s):  
Foot Orthoses ◽  
Ankle Osteoarthritis ◽  
Foot Kinematics ◽  
Ankle Foot Orthoses ◽  
Ankle And Foot

Design, Manufacture, and Selection of Ankle-Foot-Orthoses

2019 ◽  
pp. 250-266
Author(s):  
Hasan Kemal Surmen ◽  
Nazif Ekin Akalan ◽  
Yunus Ziya Arslan
Keyword(s):  
Lower Limb ◽  
Assistive Devices ◽  
Patient Specific ◽  
Foot Orthoses ◽  
Future Trends ◽  
Molding Process ◽  
Ankle Foot Orthoses ◽  
Manufacturing Methods ◽  
Selection Of ◽  
Ankle And Foot

Ankle-foot-orthoses (AFOs) are externally applied assistive devices that are prescribed to the patients with neuromuscular dysfunctions in order to improve abnormal lower limb motor functions. To improve the effectiveness of the AFOs, novel patient-specific designs have been carried out for recent years. According to the level and type of the dysfunctions, there are a variety of designs available in clinics. Different AFO designs, such as solid, dynamic, and hinged can be prescribed for different abnormalities. New designs lead to development of new manufacturing methods. The most conventional manufacturing technique includes a molding process in which the lower part of the leg is casted by producing a positive cast to represent patients' shank, ankle, and foot. However, different manufacturing methods have been improved due to the different design and material requirements. All these developments affect the selection of the AFO. In this chapter, a substantial survey regarding design, manufacture, and selection of AFOs is provided and future trends about these issues are discussed.

An Investigation of the Neurophysiologic Effect of Tone-Reducing AFOs on Reflex Excitability in Subjects with Spasticity Following Stroke while Standing

2010 ◽  
Vol 34 (2) ◽  
pp. 154-165 ◽  
Author(s):  
Aileen Ibuki ◽  
Timothy Bach ◽  
Douglas Rogers ◽  
Julie Bernhardt
Keyword(s):  
Repeated Measures ◽  
Intervention Study ◽  
Lower Limbs ◽  
Foot Orthoses ◽  
Foot And Ankle ◽  
Significant Treatment ◽  
Compression Garments ◽  
Reflex Excitability ◽  
Custom Made ◽  
Ankle Foot Orthoses

Tone-reducing ankle-foot orthoses (TRAFOs) are said to improve the control and functioning of spastic lower limbs by their biomechanic and neurophysiologic effects. Unfortunately, there is limited evidence in literature to support the theory that TRAFOs can effectively decrease spasticity in the foot and ankle neurophysiologically. The primary purpose of this investigation was to determine the neurophysiologic effect of TRAFOs on soleus muscle reflex excitability in subjects with spasticity following stroke while standing. A repeated-measures intervention study was conducted on 15 adult subjects with stroke who were recruited from the community. Custom-made articulated ankle-foot orthoses (AFOs) and TRAFOs with orthokinetic compression garments (OCGs) were fabricated for each subject. Five conditions were tested: (1) Shoes only, (2) AFO, (3) TRAFO, (4) TRAFO with OCG, (5) shoes only, to determine if the TRAFOs were most effective in decreasing spasticity as assessed by the ratio of maximum Hoffmann reflex amplitude to maximum muscle response amplitude (Hmax:Mmax ratio) of the soleus. The results found that there were no significant treatment effects for the interventions (F = 0.992, df = 2.167, p = 0.388), however, when analysed subject-by-subject, four subjects displayed significant increases in their Hmax:Mmax ratios to at least one treatment condition. Overall, the results demonstrated that the tone-reducing devices had no significant neurophysiologic effect on soleus reflex excitability in subjects with spasticity, however individual responses showed that the TRAFOs increased spasticity in some individuals.

A Preliminary Study on the Mechanics of Ankle-Foot Orthoses: From 3D Laser Scan to Smooth Finite Element Model

2009 ◽  
Author(s):  
Tomas Praet ◽  
Matthieu De Beule ◽  
Sofie Van Cauter ◽  
Benedict Verhegghe
Keyword(s):  
Finite Element ◽  
Complex Geometry ◽  
Element Model ◽  
Foot Orthoses ◽  
Foot And Ankle ◽  
Finite Element Analyses ◽  
The Past ◽  
Ankle Foot Orthoses ◽  
Preliminary Study ◽  
Mechanical Devices

Ankle-foot orthoses or AFO’s are external mechanical devices that support the foot and ankle to assist and improve the gait of patients with muscular and/or neurological problems in the lower leg region. To improve the functionality of these orthoses quite some experimental research projects have been carried out and published in the past. However, only a handful of projects included basic finite element analyses (FEA) [1–3], mainly because of the diversity and complex geometry of the AFO’s. This preliminary study should give raise to a series of detailed finite element analyses based on 3D laser scans of ankle-foot orthoses.

scholarly journals Individual stiffness optimization of dorsal leaf spring ankle–foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Niels F. J. Waterval ◽  
Merel-Anne Brehm ◽  
Jaap Harlaar ◽  
Frans Nollet
Keyword(s):  
Muscle Weakness ◽  
Energy Cost ◽  
Activity Level ◽  
Calf Muscle ◽  
Leaf Spring ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
The Individual ◽  
Optimal Stiffness ◽  
Walking Energy Cost

Abstract Background In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle–foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 ± 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 ± 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness. Conclusions In people with calf muscle weakness, current supplier’s recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes. Trial registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170.

scholarly journals Comparison of 3D scanning versus traditional methods of capturing foot and ankle morphology for the fabrication of orthoses: a systematic review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Muhannad Farhan ◽  
Joyce Zhanzi Wang ◽  
Paula Bray ◽  
Joshua Burns ◽  
Tegan L. Cheng
Keyword(s):  
Systematic Review ◽  
Plaster Cast ◽  
3D Scanning ◽  
Foot Orthoses ◽  
Foot And Ankle ◽  
Health Measurement ◽  
Traditional Methods ◽  
Rater Reliability ◽  
Promising Alternative ◽  
Speed Accuracy

Abstract Background In the production of ankle-foot orthoses and in-shoe foot orthoses, lower leg morphology is traditionally captured using a plaster cast or foam impression box. Plaster-based processes are a time-consuming and labour-intensive fabrication method. 3D scanning is a promising alternative, however how these new technologies compare with traditional methods is unclear. The aim of this systematic review was to compare the speed, accuracy and reliability of 3D scanning with traditional methods of capturing foot and ankle morphology for fabricating orthoses. Methods PRISMA guidelines were followed and electronic databases were searched to March 2020 using keywords related to 3D scanning technologies and traditional foot and ankle morphology capture methods. Studies of any design from healthy or clinical populations of any age and gender were eligible for inclusion. Studies must have compared 3D scanning to another form of capturing morphology of the foot and/or ankle. Data relating to speed, accuracy and reliability as well as study design, 3D scanner specifications and comparative capture techniques were extracted by two authors (M.F. and Z.W.). Study quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN). Results Six articles met the inclusion criteria, whereby 3D scanning was compared to five traditional methods (plaster cast, foam impression box, ink footprint, digital footprint and clinical assessment). The quality of study outcomes was rated low to moderate (GRADE) and doubtful to adequate (COSMIN). Compared to traditional methods, 3D scanning appeared to be faster than casting (2 to 11 min vs 11 to 16 min). Inter-rater reliability (ICC 0.18–0.99) and intra-rater reliability (ICCs 0.25–0.99) were highly variable for both 3D scanning and traditional techniques, with higher agreement generally dependent on the foot parameter measured. Conclusions The quality and quantity of literature comparing the speed, accuracy and reliability of 3D scanning with traditional methods of capturing foot and ankle morphology is low. 3D scanning appears to be faster especially for experienced users, however accuracy and reliability between methods is variable.

Sign in / Sign up

Export Citation Format

Share Document