Looking for a ankle brace that allows flexion

[mr_coffee]

Hello everyone, I have an AFO on my left foot and it doesn't allow any ankle flexion. I believe the ankle flexion helps kick in muscles and stimulate the weak leg. I can walk without any braces w/walker but my left foot will drag thats why i'm looking for a device that will hold the foot up but will also allow flexion. ANy ideas? Here are some sites I saw but i didn't know if it would work.

http://www.activeforever.com/product...0_T18,0142.htm
http://www.thesportsauthority.com/sm...i-1764871.html

[MikeC]

Mr Coffee - my AFO's have metal brackets at the ankle that allow my ankle to move. They can be adjusted to allow a little or a lot of ankle movement. I got my first pair with articulating ankles at the hospital and got a new pair at the VA after a year. Mike

T12 Incomplete - Walking with Crutches, Injured in Oct 2003

[metronycguy]

those two you put links to will not lift the foot up, as mike c says the metal brackets type are available in many styles and spring settings, however they are custom fitted by orthothic makers and are expensive if you dont have insurance

[Pluto64]

Mike C, can you post a picture of what your using? I'm looking for the same thing as mr_coffee is

[diane2]

There is something called I think "Toe-Ups". They are a pair of velcro straps that go around the ankle. On the front is a snap that attaches to another snap that you put on your shoe. It holds the foot up and allows for flexion. I have googled them and cannot find them, but my excellent PT recommended them for a para with a L1 injury who can walk with crutches.

[MikeC]

Here's a picture of one of my AFOs. Kind of hard to see; but the metal around the ankle can move (or have springs like metro said). I think they cost around $400 each - I didn't need approval from my insurance if they were under $500 so the hospital did one and then the next a month or so later. Mike



T12 Incomplete - Walking with Crutches, Injured in Oct 2003

[Benjamin]

What about this. http://www.townsenddesign.com/products.aspx?ID=11-0

I also use a tens unit w/ a heel switch for dorsi flexion.

"Our aspirations are our possibilities." - Samuel Johnson

[metronycguy]

Originally posted by Benjamin:

What about this. http://www.townsenddesign.com/products.aspx?ID=11-0

I also use a tens unit w/ a heel switch for dorsi flexion.

"Our aspirations are our possibilities." - Samuel Johnson

they bounced/rejected my email asking who the distributors are in the ny area....

[bruce]

Benjamin, I use a AFO from Townsend Design and it is excellent, way better than anything else I have tried. I posted a picture in another thread here.

It's carbon fiber with titanium hinges you can see right above my shoe. Inside the shoe is a foot plate that goes up about 2/3rds of the way up my foot.

Also, Benjamin, I haven't heard of the e-stim unit with a heel switch that you describe. Can you tell us more .. where did you get it and how does it work?


mr-coffee, I wouldn't suggest a Townsend Design AFO to you at this time. You are still pretty early in the game and will likely continue to change. The Townsend Design braces are expensive, but worth it if you are going to use it for a good amount of time.

I'd recommend that you find an orthotist who is familiar with the gait problems of people who are neurologically impaired. I would guess that for you, at this time, an AFO more like what Mike uses would help you. Later you may get strong enough that you don't need one, or would need a different one.

In another thread, you asked me if I had issues with knee hyperextension. I do, and that is a big reason for my using the brace, along with issues of toe drop and general weakness in the leg. Hyperextending your knee for long periods of time will result in serious complications. While some believe a knee brace can protect your knee, they don't do it very well. I did a bunch of research on this and properly designed and fit AFO is the best way to protect the knee.

Having foot drop also contributes to knee hyperextension. If you don't get a good heel strike in your gait pattern, when your body travels forward and weights the leg, the knee hyperextends. With the heel strike, the dorsiflexors act to cushion the blow, positioning the lower leg and knee to propeerly take the weight of your body. The hamstrings and quads are also involved in the shock absorbtion and knee protection.

[mr_coffee]

thanks for the tips guys. nice cast bruce, it loooks like that would work well but your right i wouldn't get one like that yet. So your saying if I use an AFO and a knee brace it won't help the hyperextension problem? The knee brace has 2 titanium rods that will lock the knee out, its kinda like the KFO but its not as cumbersum to put on nor as high up on the leg. It was such a pain using the KFO if i wanted to sit down on a chair.

[bruce]

What I'm saying is that a knee brace alone is not very effective preventing knee hyperextension in someone who has gait deficits like seen in incomplete SCI. An AFO works much better. It's hard to describe the kinematics of it. I found a picture on the internet last year that showed it well, but I don't remember where. Maybe I can find it again.

What you have, if properly designed, should protect you. However, since I can't see you walk, it's hard for me to say what might or might not work for you.

I used a KFO for a while, and yes, it was cumbersome and hard to put on. But until my quad got strong enough to lock my knee when I weighted it, I used it. Sounds like what you are using is better.

[Benjamin]

Hey Bruce, I can't wait to get my brace from Townsend. I was fitted for it last month at Hanger INC. in Lexington.

The E-Stim unit I use is an EMS+2 Neuromuscular Stimulator which clips onto your belt or pants.
As long as you have an E-Stim unit w/ an Accessory jack you can tape a heel switch under the weight bearing portion of your heel in your AFO.
The heel switch activates w/ heel lift causing the dorsiflexors to fire throughout the swing phase of the stride. The heel switch turns off when pressed during the brief heel strike.

I received my unit and switch from MARTIN TNS,INC 4209 Bridgemont Lane Lexington,Ky 40515 (859) 273-9877 a few years back.

"Our aspirations are our possibilities." - Samuel Johnson

[MikeC]

Maybe I should start a new thread; but thought I'd ask here since we're talking about AFOs. I just got a new right AFO at the VA and it's got a spring in it that forces my foot to return to slightly higher then a 'normal' position. My old AFO's didn't have springs - each allowed the ankle to move about 15 degrees. My left ankle is strong enough to lift to a normal position when I walk without a spring but they put one in it anyway so it would be like the right one. My question is - should I stick with the springs or will I improve by forcing my ankles to work?

The other big change is both AFO's used to lock when they were vertical - with the springs they don't do that (they allow fexion backward as well as forward) so I can move my feet more naturally. I used to stand unaided by locking my knees and the AFOs. Now if I try to stand unaided I fall backwards because of the extra motion in the AFOs.

I appreciate any opinions on springs.

Bruce did you have problems getting the plate under your foot adjusted? I've got 2 AFOs from the VA and both times I've had to make several trips back because the plastic under and and on the side of my foot rubs when I take steps.

Thanks to all.

T12 Incomplete - Walking with Crutches, Injured in Oct 2003

[bruce]

Benjamin, I hope your Townsend brace works as well as mine. If things aren't right, they will recast it within 30 days, though mine came out just fine. I'm interested to hear how it works for you when you get it.

Mike, I only had a little discomfort, and my orthotist put some padding on the foot plate to give me more arch support. It's been fine ever since. I was worried since it's carbon fiber and can't be heated and moulded like plastic can.

I'm interested to hear your description of the springs in your brace. Mine has some dorsi assist from what amount to very heavy rubber bands, but it also has both a posterior and anterior stop that are adjustable, so I have quite a bit of flexibility in adjusting it.

Are the springs easy to disable or take out? If so, you might want to try it without, though if the hinges don't have a posterior stop, they may not work very well. Also, the springs would work like the dorsiflexors in cushioning the force of your heel strike, something you may miss without them.

[MikeC]

Thanks for the thoughts Bruce. Actually I'm used to having the braces without springs so if I do decide to take them out it would feel more natural to me. It takes the folks at the VA about 15 minutes to take the springs out (I'm not mechanical at all). My braces have both anterior and posterior stops. For some reason when they put the springs in they removed the posterior stop - I can bend the brace backward till it's almost horizontal. The anterior stop is still in - I can't push it forward more then about 15 degrees. Guess I'll try them a bit longer with the springs and then decide which I like best.

Mike

T12 Incomplete - Walking with Crutches, Injured in Oct 2003