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Podiatrist prescribing AFO

Discussion in 'Biomechanics, Sports and Foot orthoses' started by sspod2001, Aug 13, 2008.

  1. sspod2001

    sspod2001 Active Member

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    Hi Guys,

    Just need some help regarding an elderly female pt (over 60) no notable medical hx, only on pain medication:

    S: Severe Pain and swelling in her Right ankle after falling and hyperplantarflexion over 2 years ago. She attended the hospital who performed x-rays and found nothing to be broken just soft tissue damage.

    O: O/e pt has swelling all around the right ankle joint, pain is palpable on both medial and lateral ligaments, also pain on palpation of the right achilles tendon (probably due to swelling). pain is also felt on the anterior of the ankle joint.
    She suffers pain on forced inversion and eversion of the foot, and plantar and dorsiflexion is uncomfortable

    she has bilateral rearfoot varus of 3 degrees and a functional lld of approx 8mm (right longer)

    P: Due to this lady's dispondance with other medical professions regarding her treatment she refuses to see anyone for a referral for further exploration, so I have set out this plan for her:-

    short term - to try and reduce the level of swelling by use of ice therapy, and nsaids, and to try some temporary orthoses to see if this improves the condition.

    longer term I think she would benefit from an AFO to provide further support to a very weakened ankle, which brings me to my question, can a podiatrist prescribe an AFO and if so how can I get hold of one.

    kindest regards in advance for taking the time to read this (sorry it is long)

  2. David Wedemeyer

    David Wedemeyer Well-Known Member


    Of course a DPM can prescribe an AFO, many of my referrals are from podiatrists.

    As for the type there are myriad designs to choose from. A Richie brace is one option and they are fairly simple to get the patient to comply with.

    If your primary goal is to immobilize the foot and ankle long term, a gauntlet type AFO is worth considering. Ultimately as her doctor it is your decision to make.

    I use AFO's designed by Dr. Richie, Rybo Medical and Southwest Orthopedic Designs to name a few.

    Her footwear of course should be evaluated accordingly as it is an integral part of the brace.

    Is her LLD functional or anatomic?
  3. Secret Squirrel

    Secret Squirrel Active Member

    sspod2001 - which country are you in?
  4. sspod2001

    sspod2001 Active Member

    I'm in Ireland.
    LLd is functional.

    Most of the AFO's i;ve seen on the net mention foot drop however I feel this pt requires an increase in stability and control of the inversion and eversion of the foot which allows for plantar and dorsiflexion.

    I've seen a few hinged devices which i was considering, would these allow this?
  5. Ella Hurrell

    Ella Hurrell Active Member

    Just a thought, but have you considered a Lisfranc injury that didn't show up on the original x-ray?
  6. efuller

    efuller MVP

    Using the tissue stress approach you should identify the injured anatomical structure and then devise a device to protect and/or take stress off of that/those structures. From you description of injury and palpation of location you are implying that it is the colateral ligaments and joint capsule that are injured. Are you sure that it is what it is? Do you get pain with muscle strength tests? Does she limp? Actually, I don't really want to know, but I do want you to tell me what you think is injured.

    I agree wtih the plan to reduce swelling with ice and relative rest.

    Aircast has a stirrup that limits inversion eversion for around $50. A Ritchie brace with hinges will allow ankle motion while restricting inversion/eversion as will a Gauntlet. The Ritchie Brace will cost more than a couple of hundred and the gauntlet more than that.

    Good Luck


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