In this episode, we compare the Step-Smart AFO with the Dynamic Walk AFO, Dorsi-strap, and Swedish-style posterior leaf spring drop foot orthosis/brace. These ankle-foot orthoses are compared for shoe fitting, comfort, and general gait proficiency.
Hi! Ian here from Insightful Products. Welcome back to the Foot of the Week. A patient came in today with a set of braces that weren’t working for her and we took a look at each one of them. And wanted to share our findings with you.
So we have the Dynamic Walk that she’s been using, or trying to use — she’s had some problems. She didn’t find the Swedish brace worked at all. She did use the Dorsistrap for a little bit but had some issues with that. And today she’s determined that the Step-Smart brace is going to solve the issues that she’s been having.
Here we have the Dynamic Walk.
Stop right there, please.
The Dynamic Walk has problems with the medial upright digging into the medial side of the brace. If you notice, the heel is coming out of the shoe.
The heel pops out and rubs against the back of the shoe. You can see the shoe is bulging out and needs oversizing. The patient had to adjust the brace to fit into the shoe and now it irritates the ankle. The padding was added but only makes it more bulky and worse fitting.
Is it digging in right here?
Yeah. It is.
It looks really tight.
It is. It is, but I’ve got large calves too. The other guy said it was comfortable.
Mm hmm. Not for you. And you said your heel’s coming out every time?
My heel comes out. I’ve really got blisters.
You’ve gotten blisters on your heel? It’s creating blisters because there’s so much motion?
We’ve also tried the Dorsi Strap. This is the Dorsi Strap and you said it starts to hurt in the front of your foot?
Up in through here.
It pulls a lot.
After a long time, it hurts. Go ahead and take a few steps. And do you find it’s giving you enough clearance during swing phase?
Yeah, sometimes I need to tighten it up.
Oh, so it loosens up?
And it’s causing an abrasion where you end up getting a callous on the outside of your foot because of the way it’s pulling on the shoe? Is that right?
So you’re finding that it’s causing a callous right here on the base of your foot because it’s pulling up and squeezing your foot every time you take a step.
Tell me about the Swedish. What were the drawbacks with that?
Um, it’s too stiff. There’s no movement.
No movement. Yeah. The long toe plate is really unneeded and just causes more crowding in the shoe. The Step-Smart brace is shorter and it doesn’t go beyond or even to the metatarsal heads.
This demonstrates how the brace is not preloaded enough and actually comes off the calf at heel-off.
OK. Susan has the Step-Smart brace and it solved a lot of problems. She no longer has pistoning and she feels like she’s getting good shock absorption at heel strike.
I just fed it through the finger loop. How’s that feel?
Good. Yep. My foot’s not sliding out of my shoe. It feels good.
OK. This is a wrap for foot of the week. We’ll see you next week!