hi All,
with regard to the question of rigid AFO my initial reponse to its
biomechanical effects else where will depend upon the position the AFO is
cast in and how well it is "tuned". All AFO's affect the function of other
lower limb joints, this can be minimised with careful assessment, design and
tuning.
The application of a rocker sole by itself to this patient is only likely to
aggravate the problem. Rocker soles tend to influence tha latter stages of
mid stance and the 3rd rocker(propulsion). By applying a rocker to the shoe
by itself the shoe is effectively dorsiflexed more in early stance causing
increased strain on the ankle joint which is likely to promote secondary
compensations in the midfoot or hyperextension of the knee.
The provision of heel raise and rocker may be beneficial. It is likely that
any heel raise would need to be larger than the rocker height. This
combination is very effective particularly if the first ray complex is
degenerate. If the first ray is unaffected then the rocker is unlikely to be
beneficial if the AFO is used with a well tuned heel raise and its footplate
trimmed behind the MTH's
Regards
Simon Dickinson
Orthotist
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