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Aircast walker or orthotic?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kahuna, Nov 15, 2011.

  1. Kahuna

    Kahuna Active Member

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    I'm interested in trying to ascertain if podiatrists are utilising Aircast walkers (or similar boots) in their clinical practice.

    I know many podiatrists in my geographic area who do not use them as an intervention, and, from what I've learned speaking to lecturer friends in two podiatry schools, the use and fitting of aircast walkers is not taught at podiatry undergraduate level in the uk.

    There clearly is an indication for using such an intervention in the management of some conditions, but, it seems, perhaps as if some pods are only considering orthotics as an intervention?

    Look forward to your thoughts,

  2. cwiebelt

    cwiebelt Active Member

    Hi have have used air casts or off loading walkers of various types from time to time.
    but its not that simple, you have to know what you are doing and provide a suitable off loading device.
    the fitting and supply of air cast need tomake sure it is the correct size, the limb lenght diffrence , will the client cope with the boot, suitable intructions etc
  3. Peter

    Peter Well-Known Member

    Use them all the time. We used to acquire them through an Orthotist, but the company charged a fortune for them (on top of the fee the Orthotist gets for doing a clinic with us!), so we now keep them in stock, and purchase through the NHS catalogue, cost approx £100, better than the £250 previously.
  4. G Flanagan

    G Flanagan Active Member

    I use them for quite an array of pathologies, or more often just to take weight off a re-calcitrant problem.
  5. Shalom

    Shalom Active Member

    I agree that undergraduate education should give students the opportunity to try these devices and to experiment with them. They are a fundamental to the healing process especially in a rehabilitation situation where partial weight bearing is indicated.
  6. Kahuna

    Kahuna Active Member

    I agree completely Shalom. I find that some podiatrists are nervous to use aircasts etc, but I don't see many complications when using them personally on patients. Actually, I find that patients can encounter more teething problems settling into orthotics.

    Is there any formal training available to pods in aircast use? Or is it really something our mentors train us in on the job!?
  7. Craig Payne

    Craig Payne Moderator

    Thats a shame. It is in Australia!
  8. Pod on sea

    Pod on sea Active Member

    .....sooooo, who's got the expertise to teach us? I end up referring patients to my local private Orthopaedic foot and ankle consultant if I think they need an aircast.
    Come on UK colleagues- can one of you teach us all we need to know? It would make a good CPD course.
  9. Lawrence Bevan

    Lawrence Bevan Active Member

    Whats to teach?

    Get the right size, put it on the foot.
  10. Pod on sea

    Pod on sea Active Member

    Thanks, please expand as you obviously think we are dimwits....are there different boots for offloading a met stress fracture, Tib Post or is it all the same? Any contraindications/cautions?
  11. Peter

    Peter Well-Known Member

    Pod on Sea,

    They come in sizes small, medium, large and X-large. they can be used on left or right, and have 4 air cells which you inflate after putting the walker on. The individual is taught how to do this, and they can adjust the cells themselves, ie if inflating the lateral ankle cell irritates the peroneal tendons, they can deflate it a bit.

    It is a doddle to fit, tricky initially to wear, but pts get used to the pain relief they generally offer.

    As for pathologies, i use them for tendinopathies, partial tears, Freibergs, stress #s, painful plantar fasciitis etc. They are used for any partial immobilisation you wish to undertake. Can't see anyone making money out fo teaching this as CPD however.

    If you are anywhere near the North Sea in Tyneside I can show you how.
  12. Pod on sea

    Pod on sea Active Member

    Thanks Peter, that's very helpful. It's prompted me to ask the aircast rep to come and have a meet up. I'm on the sunny south coast-beach is all pebbles though!
  13. Lawrence Bevan

    Lawrence Bevan Active Member

    I would add that the most likely "complication" is that as a result of being uneven (the walkers usually have a thick sole) a bit of back pain is not uncommon. I often issue the patient with a contralateral raise to balance them. I usually make this from sheets of EVA

    I dont personally use Aircast - they are very expensive and heavy in my opinion.Theyre are many alternatives onthe market in the £50 bracket. Also Air inflation increases the off-loading effect but not essential in all conditions - walkers without air inflation are cheaper still.

    I generally also put an orthotic inside the walker to support/cushion/pressure relieve the injured foot.
  14. Pod on sea

    Pod on sea Active Member

    Hi Lawrence
    Any brands/ suppliers you recommend for the alternatives?
  15. Kahuna

    Kahuna Active Member

    Thanks for providing a good place to start Peter.

    I have recently had good success in using an aircast for chronic unilateral plantar fasciitis. Pt wasn't responding to all of our usual treatments (including orthotics of different prescriptions from different pods) so I went for an aircast. Cleared it up in three weeks and no recurrence since.

    I recommend the use of aircasts as a serious treatment option in recalcitrant problems. I also recommend all pods get up to speed in using them personally rather than feeling it can't be within the scope of uk practitioners (as earlier posts in this thread have revealed).

  16. Peter

    Peter Well-Known Member

    nice result Kahuna,

    BTW I have used them a couple of times for painful Severs, one nice result, the other as I found out yesterday didn't respond well, the opposite in fact. The girl has a suspected CRPS and is being referred to Specialist, so it has to be borne in mind, what if this Rx plan doesn't work?
  17. BAMBLE1976

    BAMBLE1976 Active Member

    If you have an orthotic dept nearby and are friendly with the orthotist then I am sure they will do some training with you. I use them mostly in diabetic clinics where there is charcot problems or longstanding ulceration.

    The thing you must watch out for that no one has mentioned is there is no shaping for the malleoli in an aircast walker so if someone is prominent in this area or pronates/supinates then they can experience pressure problems. The aircast can be adjusted by the orthotist (carefully) to accomodate this. Also second the thought of adding a contralateral raise on long term users.


  18. The term "Aircast brace" or "Camwalker brace" are trade names to describe this category of braces probably best referred to generically as "boot-brace walkers". These braces also have names such as "walking braces", "walker boot-brace", "fracture braces", etc. These boot-brace walkers have revolutionized the treatment of foot and ankle injuries here in the USA for the past 15 years.

    I dispense approximately eight of these braces per month to my patients and they do require some custom fitting or the fit of the brace and walking mechanics will not be optimized. They have nearly eliminated fiberglass immobilization casts in my practice and patients greatly appreciate the ability to shower and perform range of motions out of the brace, which can not be done with a below-knee cast on the lower extremity. They are one of the greatest inventions that has positively affected my practice over the past two decades.

    In general, the most important fit consideration in boot-brace walkers is to make sure that the vertical arms which go up the medial and lateral aspects of the leg are parallel to a bisection of the leg, when viewed from medial and lateral. This will help make sure that the leg is perpendicular to the boot sole so that patient comfort and walking mechanics are optimized. Also make certain that the patient's heel is well seated posteriorly in the brace and that the patient's toes are not overhanging the end of the brace and that the superior aspect of the brace is not too close to the knee joint causing rubbing at the knee.

    Hope this helps.
  19. Lawrence Bevan

    Lawrence Bevan Active Member

  20. Orthican

    Orthican Active Member

    I use this now.


    I have used "Air Cast" plenty in the past but for my money this one from Ossur is best bang for the buck. Also there is less lift height needed on the contralateral. In addition the forefoot end has a buttress that protects the toes. I use them for fractures, initial treatment of third degree sprains, and for the most part as a part of our diabetic wound protocol. (Charcot etc)

    I am a bit shocked at the £250 cost you quoted Peter.

    In Canadian dollars thats about $400.00!! Yikes! I sell this really high end one for 175 Canadian dollars which converts to about 107 pounds sterling ...yes...your orthotist was a bit overpriced.

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