Friday, June 8, 2012

KNEE HYPER-EXTENSION - WHO KNEW!


Well for heaven's sake it wasn't the foot drop at all!  I got my referral to the orthotics place and hauled in all my devices:  that is, the AFO, the bungee cord Dorsiflexion Assist, the Bioness L300.  What I thought I wanted was the carbon fiber Allard device, possibly with the hyper-extension control that attaches to it, making it a combo device.

What I learned was that people with MS often progress into knee hyper-extension. Apparently it is a very stable position to have your knee locked like that, and we, being tippy and tippier as time goes on, just naturally want stability. Imagine that!

He was a great guy, this orthotic & prosthetic technician, and he laid out the usual order of foot drop devices that he might recommend as an MS client's foot drop and condition progressed:
1. Something like a Foot Up.  There are a number of people who make such devices -- they goes inside a lace-up shoe and pull the end of your foot and toes upwards My bungee-cord device is probably in this category.  2. The Bioness or Walk-Aide might come next.  3. the AFO follows, and I admit, I had returned to it because it was the most stable thing I had, and then finally, an AFO with a knee brace.  Hmmmm.  I admitted I had returned to my AFO because it offered the best stability.  But what about the Allard carbon fiber thingie, I asked?

The entire structure comes up the front of your leg, so it offers no help at all with the knee hyper-extension. "How about the combo--the knee brace part of it," I wanted to know.  He hadn't used the Allard but he had taken the training for another company's similar device and used it with people and thought it didn't work well at all.  Too flimsy, he said. Rats!

He held up my AFO and showed me the "stopper" at the back of the heel.  Ahhhh, I get it--it stops my leg from tipping backward any more so my knee can't hyper-extend.  Then he had me put it on and walk for him.  "You're knee is still hyper-extending a little," he said, "and you are also pulling a bit to the side.  The AFO isn't quite tall enough, and I can put in dorsiflex assists," (two stretchy strap things that pull the foot upward--I hadn't needed them 2-1/2 years ago when I first got the AFO.) He then delivered the final blow to my carbon-fiber dream:  "You don't want to blow out your knee."  

Ack!  No, I don't want to blow out my knee.  Sheesh, I'm trying to stay upright here. OK, it's an AFO after all.

After I took off the AFO so my leg could get cast for the new one, he pointed to the outside heel on mine.  "See how rounded it is here?  That creates more wobble.  The new one will be flat on the outside, (round on the inside,) so it will be flat against the inside of your shoe--that will add stability too."

So the upshot of this is that I'm expecting a new AFO on Monday and then we'll see about a knee brace.  I actually have a knee brace that I could use, as you may recall from my last post.  I ordered a black plastic AFO with black straps this time, as I was tired of having to put an extra sock over the foot and translucent brace to make it match my other sock, which is usually black, brown or navy blue.

So, realist that I am, though I'm disappointed that I can't have a magical carbon fiber AFO that would allow me to become the lovely woman who runs marathons as seen at the Allard website; nonetheless, I am looking forward to more stability, an AFO that works for me and the very excellent chance that I'll have improved my stability enough to be able to leave my scooter in the car more often.

FOOTNOTE:
 
In the Wahoo, Ride 'em Cowboy Department.  I've manged to get on my new recumbent bike 4-5 times a week and am up to 20 minutes. Watching something on TV has actually made me want to go longer. I admit it is sometimes 10 pm before the wheels see my approach, but oh boy, do I ever feel righteous!  

8 comments:

  1. I have had the same problem recently. The new AFO they made for me did not give me the knee support so we had to abandon it. So I had to go back to my Dynamic Walk carbon fiber (which I like since it is low profile and black) AFO and a Swedish cage knee device (whichis white) to control the hyperextension. It is hard getting used to this new device and it does not fit well either. You think they would have something better.

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    1. It's great to hear from someone else who is trying things different from what I am. After you've had a breaking in period, let me know what you think about your match of two devices, will you? I've never heard of the cage knee device before. Also, I read that the carbon fiber things can break if not used properly. Have you had any trouble with that?

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    2. No, my carbon fiber AFO has not broken and I have had it for about 18 months. You can find the Swedish Cage if you google Trulife knee braces. Not very sophisticated thing. I found a DonJoy type brace but they come in such a large price range. I gave my orthotist all the literature from the web on all the different carbon fiber AFOs but he was not familiar with them all and you need training I guess for some. The previous orthotist had more of a selection when I first went there but he has since left and do not know where he went. I hate shopping around for the right person!!

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    3. I found it and I see what you mean by a "cage." Thanks! Yes, I know what you mean about finding people. I was really happy to find this last fellow--he showed me a velcro wrap-on hinged knee brace that his company has specially made. It has hinges where you can insert a small plastic "shim" that changes the degree of the angle at the knee. He said with an Rx my insurance would pay for it or I could just buy it over the counter. I'm waiting a while to see if I need it with this new AFO.

      This one fits so much better than the one I got 2-1/2 years ago that I'm amazed at how little it bothers me. It's actually comfortable.

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    4. Hey Daphne,
      Have you seen or used the Smart Step AFO. I just saw a YouTube on it:

      http://www.youtube.com/watch?v=6YmAyzzKwAY&feature=related

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  2. Looks interesting--might have worked for me earlier but I can see that it won't help the knee hyper-extension. That reminds me, I never have posted a photo of my new AFO

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  3. I was given a swedish knee cage precription from my neuro after a physical therapist analyzed me. I wear a Walkaide. Townsend makes a brace called townsend air and I was one of the first 50 people in the country to try it. The thing slid down my leg uncontrollably at the gym, and even just regular every day walking. It is supposed to anchor where the walkaide does, so it would dig into my leg quite painfully. After ditching this new brace that did nothing for me, but was full of "hot air"

    I have an afo, but i absolutely don't want to live without my walkaide as I benefit so well from it, just dealing with this knee hyperextension. I see an orthopedist tomorrow to see if there is any hope for me in keeping this walkaide and what i can do to stay active. I have a 22 month old son - I've got things to do!!

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  4. Interesting that you should post this. I built up my knee muscles with Pilates work and went back to my Bioness L-300 after a year of the AFO. I was having terrible leg, foot and toe spasms and I just wanted the benefits I get from more natural walking without my foot being held in one position so much of the time. I tried a knee brace over the Bioness but it slipped down like crazy. Those things are not very helpful are they? I suppose I will eventually wear out the knee joint because it still hyper extends, but I'm as careful as I can be. Saw a friend with a titanium afo--now that looked like something I should investigate.

    Bioness has another device that connects to the L-300 and works above the knee if those nerves and muscles aren't responding, but I haven't yet tried it.

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