By Will Graybeal
The field of prosthetics is just like life—when something isn’t working, you need to evaluate the situation and figure out what you need to do different in order to obtain the result that you want. This past year, we’ve seen some things we were doing and not achieving the changes in the patient that we had desired. So, we had to reevaluate and redesign the types of bracing we are making, and we are seeing some great results. Some of these changes have led to major breakthroughs in issues we have never treated the way we are now.
In the past we have only used a leg brace if someone had an ankle issue causing it to not function correctly. Due to a need for new ideas, we have incorporated AFO’s (ankle foot orthosis) to treat forefoot wounds. The old way to offload a spot on the foot and possibly modify the sole of the shoe only worked some of the time. What we observed was that a patient would heal in a cast, but when they were put into a shoe with offloading, they would break their wound back open. Not the result we were looking for! So, we started looking at the forefoot and the function of the foot position to the ground, realizing that a mechanical solution to controlling the patient’s gait and how the foot hits the ground could make a major difference in keeping the foot healed. This new way of offloading the pressure and modifying the foot position with an AFO is allowing the foot to stabilize, as it did in the cast, and the wound stays healed.
A secondary result to offloading the foot wound with an AFO is that the overall gait is now being affected and the patient is seeing an improvement of knee and hip pain. Balance is improved in patients with neuropathy and poor proprioception (knowing where your body is positioned in space), and stability increases when this happens. If you take someone who walked differently due to neuropathy and then they got a foot wound, it was often the wound that was secondary to the gait pattern. In other words, the way they walked due to another issue (neuropathy) is what is causing the wound in the first place. Now that we can help correct these negative patterns, we are changing more than the foot position—we are changing the patients’ lives.
Bracing in a way that does not inhibit body movement is a creative way to increase confidence in people that have gait deviations. Sometimes all people need is a device to help them feel more steady, and they will push themselves further than without the device. It is as much psychological as it is physiological. Imagine walking across a swinging bridge high up over a gorge, like at Grandfather Mountain. Without something to hold onto, you may feel very unsteady and nervous about walking. The height and the movement of the bridge give an increased sense of fear or instability, both physically and psychologically. By using a handrail you may feel steadier and can walk across with greater ease. This is very much like what a patient feels with bracing for an impaired gait. Most of what we do in orthotics and prosthetics is working with both the psyche and the body.
How you can benefit
If you have dealt with a painful area in your body, unstable gait, an impaired limb due to accident or disease, or a wound, it is possible that a brace of some type can help you get back to your normal self. Many times these are temporary devices to help correct the problem and then no longer needed. Sometimes the device is a permanent fixture in your life, like eyeglasses, but it allows you to get back to living. Ask your doctor about an evaluation by our team for what is ailing you. Sometimes we can come up with unconventional ways of treating very old problems. That is our specialty—to think outside the box and develop new ways of treating old problems.
How to get in to see us
We do need an order from your doctor to treat you, but we can always get you in for an evaluation quickly. Most referrals state to evaluate and treat the issue. Just give us a call, and we will get you into the most convenient office location for you.
Bristol Orthopedics & Prosthetic