Simon,

Thanks for getting back so quickly. Yes, I can see how SAFO achieves high
patient acceptability - a total contact orthoses if ever there was one.
Whilst this may be the treatment of choice for CMT, GBS and other
neurological conditions, I was wondering if consideration has been made to
incorporating a functional orthoses into the design. It strikes me that
for acute traumatic conditions, such as tears and disruption of ankle
ligaments, this type of device could revolutionise the management of such
cases in the emergency room. Are you aware of any such studies or results?

What this patient did recount was that the device gave her ‘better
feeling’ where her feet were at any given point. Her confidence, in
walking, had increased considerably, and in a remarkably short time.
Recently, she had managed to traverse the entire length of the esplanade
in Blackpool. Six months ago she needed assistance from a walking frame to
get from her bed to the bathroom. I hadn’t realised that proprioception
was such an important factor in propulsion. I’ve always managed to make it
back from the pub on a Friday night; admittedly not always to the desired
location, but then I have a more or less normal gait pattern to rely on in
my subconscious in times of such duress. She hasn’t.

It appears that the greatest tensile strength lies down the front of the
device, thus the foot is suspended in a neutral position as opposed to
supported from underneath, the way podiatric orthoses function. It was
also noted that her lower limb muscle function had improved markedly, and
I was wondering why this could be so? My patient notes that she feels the
greatest confidence during toe-off. Do you have any thoughts as to why
this should be so?

Lastly, do you think that by incorporating the SAFO principle into FFO
design, we might be able to improve the effectiveness of these devices and
to what degree?

Best wishes

Mark Russell

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