Inhibitive AFO's / Cerebral Palsy/Quadriparesis

Bilateral solid-ankle inhibitive AFOs in neutral.
Cerebral palsy and quadriparesis.
This 9-year-old male has no known allergies. He has not had surgery on his lower extremities, and he takes a variety of medicines including oral baclofen, breathing medications and Depakote. He stands in a stander daily. He has outgrown his current orthoses.
We note that on assessment, the patient is postured into pronation bilaterally. He has mild tone and nonsustained clonus. His heels are in valgus, and his forefeet are abducted. He stands in a stander only.
Fabricate bilateral solid-ankle AFOs set at 90 degrees.

Left AFO ground-reactive type.
Lumbosacral reflexopathy.
This 26-year-old female presents with left lower extremity paralysis. Her medical status has improved to the point where she feels she can ambulate effectively in this ground-reaction orthosis.
I had her in the parallel bars, flex and extend her left knee with her right foot completely off the ground. She was able to go into a crouch and then extend under her own power, use her arms for assistance.
Fabricate left ground-reaction AFO SET AT 90 degrees.

Custom Shoes/Patient/Periperal Vascular Disease

Shoes. Talk to the therapist to request a custom made insert.
Peripheral vascular disease.
This 81-year-old female is allergic to CODEINE & ESTROGEN.
Surgery includes a femoral bypass on the right leg on 11/29/2000. She was recently hospitalized approximately 1 week ago with sores on her toes and the lateral arch of the right foot. She currently takes blood pressure medication and blood thinners. She is nonambulatory at this time unless the foot heals. She receives physical therapy each day. She walks with pressure only on the left foot. She has not worn any type of brace previously.
The patient's right foot is wrapped in gauze and she is nonweightbearing on this side. According to the patient, there are ulcers along the 1st and 5th toes as well as the lateral arch of the foot. There is no history of open ulcers on the left foot and the skin integrity looks good. There is a shiny appearance to the skin and it is cool to touch. She has poor protective sensation on the left foot. I requested that the therapist talk to the doctor regarding using an insert on this side to protect the foot against future ulcerations. The therapist stated that she will talk to the doctor and call us. Measurements were taken for extra depth shoes. An impression was taken of the left foot for a diabetic insert. The therapist was also informed regarding the healing boot for the right leg, which they might be interested in using for the patient. She stated that she will see the doctor on Saturday and contact us.
Once we are notified by the therapist regarding this matter, we will order the shoes as well as fabricate an insert as indicated.
Evaluation, measurement and impression.

AFO-Ground Reaction Repair

The patient's father dropped off a right AFO-GR with SVSP trimlines for repair. The medial screw is backing out. Again, the top section is again wider than the bottom section. I heated the top section in several places and brought it in to match the bottom section. I allowed it to cool for several hours and it remained in place. I trimmed the joint surfaces to make them more congruent. I replaced the screws and Lok-Tited them in place. I tested this several times, and the screw did not back out. The parent will pick up the brace this afternoon.

prosthesis, preparatory, endoskeletal, PTB insert, distal end pad, cuff suspension, and SACH foot.

This is a 54-year-old black male who had his left BKA done in August of 1996 secondary to insulin dependent diabetes mellitus and peripheral vascular disease. This began by having his small toe amputated in 1993, he then went on to have his great toe amputated in January of 1996. This failed to heal and osteomyelitis set in. At that time he also began having problems with his right foot. He went on to have his amputation in August. He has a Charcot foot on the right side. Patient denies any problems but does wear an orthosis on this side attached to a shoe. This is not a custom molded shoe but does have a molded insert. He has in addition to the amputation hypertension, congestive heart failure, and proteinuria. He takes Lasix and Capitril. He takes approximately 7-8 other medications but does not recall their names. He has had knee and foot surgery done to his right side to correct problems. He has had eye surgery done bilaterally. He has had a lumbar laminectomy. He has had bilateral rotator cuff surgeries. He states that the left has failed. He has had heart catheterization which revealed no blockage. He had a penile prosthesis installed which became infected and had to be removed. He also has mild right hemiplegia secondary to a stroke which he suffered in March of 2006. He is wheelchair and scooter mobile and does not ambulate using a walker or crutches at this time. He states that the stroke has limited his ability to balance well.
Fabricate a left PTB temporary prosthesis with soft insert and SACK foot and cuff suspension made of ultra lightweight construction.
Cast and measurement today.
Approximately 2-3 weeks for a return visit and fitting.

Abducting R-Foot in AFO - Correction

The patient was seen today for a recheck of her bilateral WHOs and her bilateral solid-ankle AFOs. Everything is still fitting appropriately. She has not outgrown these devices. The nurse and the father understand how to apply the devices correctly. The patient was abducting her foot in the right AFO more than we wanted her to. I added a pad along the lateral 5th metatarsal. This straightened out her foot nicely. Everything else was appropriate. She was not getting any red marks from the braces. They are concerned about the fungus that is grown on her right toes. The brace is not touching the toenails in that area. She is also not wearing shoes, and not able to take any medication to treat the fungus due to numerous seizure medications. Other than keeping clean socks on her feet, I did not have any other advice for them. I advised them to contact their doctor with their concerns. The patient will be seen as needed.

Happy New Year 2009!

Lots of new stuff on the horizon for this blogger and the IndianaBraceStore. Adding full orthotic line from DJ, ProCare, and Aircast.

I am working on an OTS face mask. Sold several in '08 - suprisingly few fit problems.

Will continue to add to Sweet-Spot line. The turf toe product has sold well over the net last year. Plan to expand to sales people.

Determined to continue chart postings.