Composite material advances over the past 10 years have improved the design creativity and possibility for clinical orthotists worldwide. In the past, an ankle orthosis required a completely solid and fully encompassing design in order to attain the mechanical control, durability and ultimately the function needed for corrective ankle varus bracing. These devices were essentially plastic shells that created a solid/static environment which was safer than not using a brace at all, but they were also highly problematic with patients complaining of pressure points and a clunky gait. Today we can simulate more natural gait patterns while completely avoiding pressure points.
Controlling the Tri-Planar Deformities
Kinetic Research offers a variety of ankle braces, each with its own character and effect to meet the needs of the user, from the most basic needs to the most complex. For folks that have foot/ankle weakness but have good alignment of their ankle, we offer the Noodle line of AFOs. These are the most dynamic and least restrictive designs for controlling drop foot. When the user has a tight heel cord with mild supination or ankle varus, they become a candidate for a PLS design. When the user has more significant ankle varus he/she becomes a candidate for the ValgaNoodle AFO. The ValgaNoodle offers the highest degree of lateral control that we can provide. It’s important to have a team approach when choosing the type of AFO that will work best for your individual needs, and there is always a trade off between control and mobility. The team is made up of the patient, the orthotist and the physician/therapist, and all have to be involved for the best results. The objective is to “put on as little as possible, but get the job done”.
Improving Stability During Gait
The ValgaNoodle is made specifically for varus control. It’s a highly custom AFO, meaning. That it is not assembled using pre-made components. The creation of a ValgaNoodle begins with a highly skilled orthotist who will evaluate and cast for the device. That attending orthotist will manipulate and control the patient’s foot while he is casting, keeping the ankle in the best position possible to maximize the effect of the finished ValgaNoodle. Evaluations and observations made by the clinical orthotist are then incorporated into a design formulation that will work best for the individual patient. The design details are then determined based on the level of control vs free movement that is needed to maximize the performance of the user. One of the objectives is to keep the ValgaNoodle lightweight and as simple to use as possible. The orthotist will select the device based on the severity of the case, as well as the users lifestyle, activities and footwear.
Fitting the Device
The one common mechanical concept for the ValgaNoodle variations of AFOs is, that they will all have a single medial strut with a floating lateral “reverse T” cuff.
Design options for the footplate:
- Flat, in which we match the bottom of the shoe. When we make it in this format, it will usually have a custom foam removable arch support. It offers the least control but because it’s flat, we can make it flexible.
- Contoured. This is similar to a UCBL footplate. Our technicians will adjust the cast taken by your orthotist to increase lateral control in a compact way for easy shoe selection.
- Contoured with high control. This system goes higher than the UCBL, encompassing the dorsum of the foot, and has a special 3-point strapping system to provide maximum control.
Design options for the strut:
- Solid ankle, the highest level of control, removing the user’s ability to dorsi/plantar flex.
- Dynamic, which allows dorsi/plantar flexion, but with reduced lateral control.
Design options for the cuff:
- Posterior, for a normal or hyperextended knee.
- Anterior, generally used for knee extension weakness. Easier to don, but limited to low top shoes.