Ankle Foot Orthosis, Double Upright Free Plantar Dorsiflexion, Solid Stirrup, Calf Band/Cuff (Double Bar 'bk' Orthosis), Custom Fabricated (L1990)

Name of the Procedure:

Common Name: Double Upright Ankle-Foot Orthosis (AFO) Technical/Medical Term: Custom Fabricated Double Upright AFO with Free Plantar-Dorsiflexion, Solid Stirrup, and Calf Band/Cuff (L1990)

Summary

An Ankle Foot Orthosis (AFO) is a custom-made brace designed to support the ankle and foot. This specific type, known as a double upright AFO, includes free movement for plantarflexion and dorsiflexion (up and down movement), a solid stirrup for stability, and a calf band or cuff for additional support.

Purpose

The primary purpose of this AFO is to provide structural support to the ankle and foot, helping patients who have difficulty walking due to muscle weakness, nerve damage, or structural instability. The goal is to improve mobility, reduce pain, and prevent further injury.

Indications

• Muscle weakness or paralysis in the lower leg and foot
• Drop foot (difficulty in lifting the front part of the foot)
• Postural instability due to neuromuscular disorders (e.g., cerebral palsy, multiple sclerosis)
• Chronic ankle instability
• Recovery from ankle or foot surgery

Preparation

• Patients may be asked to wear loose clothing for easy access to the leg during measurements and fitting.
• No specific fasting or medication adjustments are typically required.
• A thorough physical and gait analysis may be conducted to tailor the orthosis to the patient's needs.

Procedure Description

1. Initial Assessment: A healthcare provider assesses the patient's condition, taking detailed measurements of the lower leg, ankle, and foot.
2. Casting or Scanning: A cast or 3D scan of the lower limb is made to create a mold for the custom brace.
3. Fabrication: The orthosis is custom-fabricated using durable materials. The double upright design allows for free plantar and dorsiflexion while providing robust support with a solid stirrup and calf band/cuff.
4. Fitting: The patient returns for a fitting session where the custom AFO is tried on and adjusted for comfort and efficacy.
5. Instruction: The patient is instructed on how to properly wear and adjust the orthosis.

Duration

The entire process, from initial assessment to final fitting, may take several weeks. Individual appointments range from 30 minutes to an hour.

Setting

This procedure is typically performed in an outpatient clinic or a specialized orthotic and prosthetic center.

Personnel

• Orthotist: Specialist who designs and fits the orthosis.
• Physical Therapist: May be involved in gait training and rehabilitative exercises.
• Physician: Oversees the treatment plan and provides medical clearance, if necessary.

Risks and Complications

• Skin irritation or pressure sores from improper fit.
• Initial discomfort as the patient adapts to wearing the orthosis.
• Allergic reactions to the materials used in the brace (rare).
• Joint stiffness if not appropriately used.

Benefits

• Improved mobility and gait.
• Enhanced stability and balance.
• Reduced risk of falls and further injury.
• Alleviation of pain and discomfort associated with muscle weakness or instability.

Recovery

• Patients may need a short adjustment period to get used to the orthosis.
• Regular follow-up appointments for adjustments and to monitor progress.
• Any skin irritation should be reported immediately to the orthotist.
• Physical therapy exercises may be recommended to ensure optimal use.

Alternatives

• Prefabricated AFOs: Less expensive but may not offer the same level of individualized support.
• Physical therapy alone: May help strengthen muscles but may not provide sufficient structural support.
• Surgical options: Considered in more severe cases but come with higher risks and longer recovery times.

Patient Experience

• Initial discomfort as the patient adapts to the brace.
• Gradual improvement in mobility and confidence.
• The orthotist will work closely with the patient to ensure comfort and correct usage.
• Pain management is typically minimal, but any persistent discomfort should be addressed with healthcare providers.