We appreciate that you have entrusted us with the fabrication of your patient’s orthosis. Every effort has been made to produce an orthosis that you will be proud to put on your patient.
As practitioners have varied manners to fitting their patients, the following are simple guidelines that may be helpful.
Donning the Orthosis
If you present the orthosis to the posterior of the patient’s leg, keeping the calf section down at mid-tibia height, open the calf shell and bring it forward around the leg. (Do not tighten at this time). Then open the dorsal foot shell and allow the patient’s foot to drop down into the orthosis. Ensure the foot is down but it is not pushed too far back, or posterior, the toe plate should only be about 3/16” longer than the end of the longest toe. The orthosis will have a looser fit in the heel. With the foot secure; move up the calf. Pull forward on the orthosis at the top back of the calf and this should compress the proximal calf muscle, fasten one then the second calf strap. (Repeat this process to tighten). The Velcro lining is very compressive. It will seem as if you are tightening the orthosis tighter than is customary. Communicate with the patient to ensure they are comfortable. It is important for the calf section to be secure to the patient as this is where the energy is transferred between the patient and orthosis.
As it quite amazing how quickly the patient adjust to this AFO, be careful to take appropriate precautions for the patient’s stability. i.e.: gait belt, walker, parallel bars… etc.
Have the patient stand in the orthosis/orthoses. Allow the patient time to become stable standing. Then have the patient attempt to bend their knees a couple of degrees while keeping their heels on the floor. Evaluate if the patient is loading the spring to bend or just shifting weight to the ball of the foot. Have the patient repeat this process a few times increasing the knee bend up to 10-15 degrees.
Please ensure the patient is secure.
Have the patient take a few steps and then proceed to walking across the room. Evaluate if the patient is loading the posterior spring. This is evident if the posterior spring is bending. Sometimes this is hard to see. Communicate with the patient as to what they are feeling the orthosis do.
If the patient seems to be only reacting to the pressure of the orthosis, not pushing into or loading the orthosis:
Have the patient perform a calf stretching exercise, wearing the orthosis. Standing an arm’s length from the wall or in parallel bars puts hands on the wall, step back with one foot, a short distance, and try to put the heel down to the ground. Repeat with other foot. This teaches the patient that they can bend the orthosis. Then have them walk in the orthosis again.
Remove the orthosis and evaluate the skin for any concerns in the fit, adjust as needed to be confident in the patient’s safety. You can instruct the patient on your normal break in procedure.
Please be advised that with the high function of this orthosis the patient will wear it longer and be more aggressive in it than anticipated. Please adjust your break-in procedure accordingly.
Adjusting the Orthosis
The orthosis is made with a Pre-Preg Carbon fiber Composite Structure. The carbon structure is not adjustable and will be damaged if exposed to high temperatures. The design of the orthosis Has been customized to accommodate relief of boney prominences. Modification to the EVA foam interface is the recommended way to adjust the fit to accommodate the patients’ comfort. If further adjustment is needed, the orthosis will need to be remade.
Bio-Mechanical Composites, Inc. Fabricating at a higher level