Reason for Bracing
The goal of Rehabilitation is to improve upon an existing physical or functional
deficiency. There should be documented evidence to support
the achievement of this goal. In the case of ambulation,
there are complex mechanisms of the foot/ankle system that
require comprehensive evaluation. Supination and pronation
of the foot in the subtalar joint change as the foot is
non-weight bearing (open kinetic chain) or
weight bearing (closed kinetic chain) The
oblique alignment of the subtalar axis produces triplanar movement in all three cardinal
planes.
In open chain pronation,
the talus and the leg do not move, while the calcaneus moves
through all three planes and carries the foot with it. This
triplanar motion consists of simultaneous movement of the
calcaneus in eversion (frontal plane), abduction (transverse
plane) and dorsiflexion (sagittal plane). Open chain
supination is the reverse movement involving
calcaneal inversion (frontal plane), adduction (transverse
plane) and plantarflexion (sagittal plane).
During closed chain kinetic
motion, the foot and heel are in contact with the
ground and unable to move in the sagittal or transverse
planes. To allow supination or pronation, the head of the
talus must shift and the tibia must rotate around its
longitudinal axis. In closed chain pronation, the
calcaneus everts as in open chain pronation, but the head of
the talus compensates for the distally fixed foot by
adducting and plantarflexing. This movement is associated
with knee flexion, internal rotation of the tibia, abduction
and inversion of the forefoot on the hind foot and depression
of the medial longitudinal arch. This movement
pattern is the pathway for INTERNAL ROTARY PATTERN.
(IRP)
During closed chain supination, the
calcaneus inverts with abduction and dorsiflexion of the
talus. This movement is associated with extension of the
knees, external rotation of the tibia, adduction and
eversion of the forefoot and elevation of the medial
longitudinal arch. This movement pattern is the
pathway for EXTERNAL ROTARY PATTERN.
(ERP)
When the closed kinetic
chain is altered by neuromuscular disorders creating IRP or ERP deformity, it must be
re-established and maintained with a device that will meet
each and every deficit. The bones, muscles, and ligaments of
the foot and ankle mechanism in the closed kinetic chain
have a relationship in triplanar motion. Each
joint has force couples of agonists, antagonists,
synergists, stabilizers, and neutralists to work
efficiently. Even though the majority of motion
occurs in the sagittal plane, stability and balance are maintained in the remaining two planes. This allows for
more efficient movement patterns during the dynamic closed
kinetic chain functions.
Orthotic intervention in the past did not
address the demands placed upon the foot and ankle in closed
kinetic chain function. This practice continues to the
present day. Only a very small percentage of professionals
are aware of what is required. Too many over simplify the
complex issues to re-establish the altered closed
kinetic chain functions. The majority of AFO's and
KAFO's that are fit each day are primarily single
plane devices.
Orthotic intervention of the future must address these complex
issues in order to achieve the goal of Rehabilitation, which is to improve or restore
lost function. Deficiencies need to be addressed at their source. The intricacies of kinetic chain
motion during ambulation must be understood and related to
each pathomechanical situation individually. All functional
activities are triplanar and must be solved by triplanar solutions. Understanding this
complex integration of body dynamics and structures allows
the clinician to begin to solve them. It is this deeper
understanding that realizes the importance of maintaining
the structural integrity of ligaments, joints, bones,
tendons, and their relationships with each other in
maintaining efficiency.
There are no simple solutions to complex problems. All
professionals will need to develop a better understanding of
this mechanism in order to evaluate, predict and control
deficiencies with orthotic intervention. Treatment without results is NOT REHABILITATION. Solutions must be offered and Outcomes must be
demonstrated.
New Videos
Click below to see examples of our video's on a few results and testimonials.
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All braces are measured, fit and DBS Fabricated for each client's needs. (A sample AFO shown.)
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There often is a device that can alleviate premature wearing of joints, ligaments, muscle, and bones, along with preventing ulcers, reducing or eliminating pain, and improving balance.
DBS orthotists work closely with a patient's physician, and can send an elaborate evaluation report with recommendations back to the physician.
Lectures & Presentations
To schedule for your organization or more on locally scheduled events, contact us.
A few Titles from the lecture series...
