Coronavirus dystrophy

Coronavirus Dystrophy? A dystrophy is defined as a disorder in which an organ or tissue of the body wastes away. Dystrophy is globally prevalent, challenging those that fear those tiny microbes and avoid them. Further challenges are ahead for those that test positive. Then there is the likelihood of death. There is no clear cure, treatment, and vaccine.

I have myotonic dystrophy,type 1. Myotonic dystrophy affects at least 1 in 8,000 people worldwide. The prevalence of the two types of myotonic dystrophy varies among different geographic and ethnic populations. In most populations, type 1 appears to be more common than type 2. It is a genetic disease. It also has no clear cure, treatment, or vaccine. Myotonic Dystrophy is among over 150 muscular dystrophies monitored by the global Muscular Dystrophy Association network. It has challenges, disabilities, and deaths.

Greater prevalence and studies were aimed at Duchenne Muscular Dystrophy. At the age of 25, the survival rate was 13.5% in DMD patients born in the 1960s, 31.6% in those born in the 1970s, and 49.2% in patients born in the 1980s. Duchenne muscular dystrophy (DMD) is a muscle disorder but it is one of the most frequent genetic conditions affecting approximately 1 in 3,500 male births worldwide. … The disease is progressive and most affected individuals require a wheelchair by the teenage years.

Coronavirus diseases are types of a dystrophy as it threatens the majorities of people who never gave virus pandemics a second thought. There are many people for whom mobility involves social distancing and constant adaptations every day. More than 18 million people have limited mobility caused by everything from accidents to disease to the aging process. Six million of those 18 million are veterans. One in five elderly people struggle with mobility. The number of veterans with disabilities has increased dramatically by 25 percent since 2001. Many adapt to their world with canes, walkers, prostheses, and wheelchairs.

Coronavirus-19 or SARS-2 viruses are tiny microbes that pass through the air and linger on surfaces. They are germs and we live with germs in and around us every day. Coronavirus-19 is particularly infectious and invisibly travel within environments with wide temperature ranges. Over 400,000 have tested and have caught it. There are about 19,000 deaths attributed, and about 110,000 recoveries globally. About 300,000 are mild and about 110,000 are severe.

The numbers of those testing positive vary. Test availability is low and offered to those who display flu-like symptoms. As more testing is done, total numbers of potential coronavirus-19 cases rise within a distribution of people. Then the question arises whether tests are specifically measuring for coronavirus type viruses or only version 19. Coronavirus is not new to humans. 19 is.

Human coronavirus is a common, enveloped, positive-sense RNA virus, with most people contracting it during their lifetime. Coronaviruses cause mild to moderate upper-respiratory tract illnesses. There are six currently known strains of coronaviruses that infect humans. The most common infection globally is from human coronaviruses 229E, NL63, OC43, and HKU1. The much publicized human coronavirus, SARS-CoV, which causes severe acute respiratory syndrome, or SARS, has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause gastroenteritis. The six human coronaviruses are: alpha coronaviruses 229E and NL63, and beta coronaviruses OC43, HKU1, SARS-CoV (SARS), and MERS-CoV (the coronavirus that causes Middle East Respiratory Syndrome or MERS). Are professionals testing all 6 or only for 1? Test results have changed from taking days to minutes – in just a matter of weeks. Are analyses being compromised? For now,these are the best tests available.

Do pets factor in Sars-Cov spread? Over the last 70 years, scientists have found that coronaviruses can infect mice, rats, dogs, cats, turkeys, horses, pigs, and cattle. Sometimes, these animals can transmit coronaviruses to humans. Ancient plagues were likely results of rodent populations found in the hulls of cargo ships. Naples and Venice were identified as ports that needed to quarantine ships. Rats have been associated with shipping for thousands of years. Roman ships brought the black rat to the British Isles over 1,600 years ago. The brown rat, commonly known as the wharf rat, is found on every continent in the world except Antarctica — much of the spread attributable to being carried on ships and boats. Can hugging your cat or dog give you Sars-Cov? Can breeding animals or poultry contribute to numbers of Coronavirus cases?

A recent Scientific American article considered climate change as a possibility. “As the Earth continues to warm, many scientists expect to see changes in the timing, geography and intensity of disease outbreaks around the world.”

The coronavirus is an uncommonly common influenza or flu that has fever, congestion, coughs, and digestive symptoms. It is one of 6 identifiable types, with many variations and sub-types that are unknown. The World Health Organization estimates that worldwide, annual influenza epidemics result in about 3-5 million cases of severe illness and about 250,000 to 500,000 deaths. In the United States, individual cases of seasonal flu and flu-related deaths in adults are not reportable illnesses; consequently, mortality is estimated by using statistical models.

The US Centers for Disease Control and Prevention (CDC) estimates that flu-associated deaths in the US ranged from about 3000 to 49,000 annually between 1976 and 2006. The CDC notes that the often-cited figure of 36,000 annual flu-related deaths was derived from years when the predominant virus subtype was H3N2, which tends to be more lethal than H1N1. Yes, there are many families of viruses and some have greater and lesser impact. There are flu vaccines available that cover many known viruses.

As with a dystrophy, there are no specific treatments or cures. Unlike dystrophy, a flu tends to be acute rather than chronic. Yet, we know little of coronavirus-19. It, unlike most chronic mobile disabilities, is contagious.

A modeling study in Singapore of Coronavirus-19 (common name) was published 3/24/20 in Lancet, a British Medical Journal:
A new modelling study conducted in a simulated Singapore setting has estimated that a combined approach of physical distancing interventions, comprising quarantine (for infected individuals and their families), school closure, and workplace distancing, is most effective at reducing the number of SARS-CoV-2 cases compared with other intervention scenarios included in the study.

The previous week, the USA NIH/National Institute of Allergy and Infectious Diseases noted that “new research finds that the virus that causes coronavirus disease 2019 (COVID-19) is stable for several hours to days in aerosols and on surfaces. Scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.” It’s contagion possibilities are more enduring than merely sneezes in a public setting. Sneezes and coughs travel as much as 6 feet.

Prior and since this recent pandemic, some scientific studies were done. With small samples and short duration, these study results are rather inconclusive to large populations.

Science experimentation for large groups require time, depth, and retesting. Some are half-baked.

A quasi-experimental design is one that looks a bit like an experimental design but lacks the key ingredient – random assignment. These are “queasy” experiments because they give the experimental purists a queasy feeling. With respect to internal validity, they often appear to be inferior to randomized experiments. But there is something compelling about these designs; taken as a group, they are easily more frequently implemented than their randomized cousins. Queasy is easy.

A clinical study is based on selected populations with random and double-blind secure measures. A clinical study involves research using human volunteers (also called participants) that is intended to add to medical knowledge. There are two main types of clinical studies: clinical trials (also called interventional studies) and observational studies. ClinicalTrials.gov (USA) includes both interventional and observational studies.

ClinicalTrials.gov uses specific strict, ethical guidelines that filter out hunches and opinions. A clinical study is conducted according to a research plan known as the protocol. The protocol is designed to answer specific research questions and safeguard the health of participants. It contains the following information:

The reason for conducting the study
Who may participate in the study (the eligibility criteria)
The number of participants needed
The schedule of tests, procedures, or drugs and their dosages
The length of the study
What information will be gathered about the participants

Conclusions are statistically studied and interpreted. Idea in science is to determine the validity as to whether the original purpose was true or false. As you see, these studies can not be rushed. Many need several clinical trials prior to reaching conclusions. False sponsors and politics can confound results. Personal interests tend to prefer quasi-experiments.

People with dystrophy adapt their lives to a world that doesn’t recognize their special needs to use public and business areas. Many restrict. Years past, these were invalid – not valid individuals. Today. is a bit better. It’s life with distance and restrictions that require adaptations to do activities most take for granted.

Adapting to social distancing and curfews may reduce spread of contagion. We live in a digital age that allows work from home, video-conferencing, social media, investing-banking, and wide access to education and entertainment. Delivery services help businesses bring products and food to customers Coronavirus-19 impact is not yet known. The world is in panic mode. Eventually, a new normal will evolve.

Religious, social, and forums are finding avenues to use online access. Old methods of living are challenged by climate changes, social changes, and new diseases. When online developed, we knew it was wise to use internet security software. As we witness Coronavirus impact, we must study our powers and dystrophy to revise how we coexist with future changes. It’s adapting to new realities, based on our histories.

If one was a gambler, it’s likely that coronavirus 20 may be in our future. Odds are better than an asteroid hitting our planet. At the very least, lessons learned from current coronavirus dystrophy may help us improve coping with subsequent viruses. Rest assured, viruses have existed long before humans. They will evolve ever after.

Viruses will continue to be active and develop to cause new infections. Sars-Cov2 is the root of many fears. We hope that changing lifestyles, social distancing, and temporary quarantines help prevent spread. Continued virology research may produce weapons to allow humans to normalize. After a 2-trillion dollar USA economic package, I hope that the fiscal budgets consider more money to advance virus research to prevent calamities like the SARS-Cov2, coronavirus-19 pandemic. Without it, future generations will develop coronavirus dystrophy.

ToeOFF Walk Aide is for New Balance

Imagine, if you will, that a child or adult is stricken by an event that leaves muscles inactive. There is loss of movement and, with it, losses of freedom. New technologies and research are helping mobility challenged to meet those extra challenges that bring more than the sense of normal movement. We are talking 21st-century ways to help you move much better than you’ve dreamed.

Muscular Dystrophies, ALS and Multiple Sclerosis are leading diseases that immobilize patients. There are also conditions due to compressed or damaged nerves as results of development, accidents, and war. When nerves and muscles can’t evoke action potentials to stimulate movement, you are unable to move. There are many levels of research to infer causes and effects. Biochemistry has thus far been leading symptom control. Over the past 20 years, giant strides have developed technological devices that can help promote movement, albeit better movement than none. There are perhaps only a few million people in the USA where chronic immobilization is a symptom. New tech research is helping those walk forward.

Immobilization may often occur in the mind but many suffer immobility from muscle weakness to severe paralysis. Those with spinal cord injuries may become permanently paraplegic with the inability to move their legs at all but new studies with electrical impulses can help carve ways to mobilize the immobile of body. For those with weak leg muscles, pushing walkers or using wheelchairs and scooters are the common ways of finding mobility. Precious few seek out trying to walk with braces. Braces are changing. They are no longer clunky and heavy. ToeOFF is a leading orthosis that you fit in your shoe. For those who have a form of ankle weakness, ToeOFF offers dynamic mechanical devices that help people walk more naturally. In recent years, alternate technologies, such as Functional Electric Stimulation of nerves have been emerging (FES). Is there attractive hope toward mobilizing the immobile?

Until FES experiments began in the late 1990’s, if you couldn’t walk you used a cane or crutch for support. In more severe cases, you might have used a wheelchair or would have been bedridden and constantly dependent on others.

In the mid twentieth century during the polio epidemics, leather and steel leg-braces were quite a common sight. A Persian, in the 15th century, first described the coating of plaster for fractures and other bony injuries of the limb. By the 17th century, there were braces for those who could not walk but they were heavy and cumbersome. President Franklin Delano Roosevelt was stricken with polio and used braces to stand when making speeches. They were those heavy leather and steel contraptions that were difficult to put-on and take-off. His braces were extremely difficult to use. In recent years, uses of aluminum and carbon fibers make braces lighter. Adjustable rubber and/or Velcro straps make them easier to adjust. AA Swedish designed brace, sold in USA as ToeOFF, is a prescription brace that helps certain people walk better and more comfortably.

Allard ToeOFF is known as a dynamic Ankle Foot Orthosis, often referred as an AFO that aid those people that have muscular weakness from the muscle groups that disable ankles to move up and down. The result is foot drag. ToeOFF using a lightweight, mechanical carbon-fiber device that helps restore a more normal walking gait. It’s a great device and helps many people with muscular dystrophy, multiple sclerosis, neuropathies, and myopathies that are aware of ToeOFF and the availability of the ToeOFF line and the use of other dynamic AFO devices.

ToeOFF is an appliance that allows people to easily put on and fit into different types of shoes. It is a lightweight, supportive brace specifically designed to correctly position feet for walking without foot drop. It covers the symptoms attributed to weaknesses in dorsiflexion of the ankle. Dorsiflexion problems may come from acute or chronic conditions. ToeOFF is a non-electric device that acts as a dynamic brace that normalizes the way you walk when a group of muscles don’t allow that seemingly simple action. Foot Drop is a relatively common problem among people of all ages but is also a symptom of nerve and muscle diseases. It can disable walking. ToeOFF is a prescription brace that helps facilitate “normal” walking (within degrees and limits) in those people with dorsiflexion from weak muscles.

ToeOFF has become a great aid for people with diseases where dorsiflexion is a symptom. Where other muscles are not as weak, ToeOFF is a fantasy device that helps people with muscle diseases walk. For overcoming the challenges of biped walking, ToeOFF really offers an alternative to some from being confined to a wheelchair or scooter.

Science fiction sometimes becomes reality and neurokinetic and neuromuscular researchers have more avenues and tools with which to explore how to stimulate movement and mobility for many muscle group problems. Of course, many studies are too small to deliver impact. Through various independent resources, including injured veterans from recent and ongoing Asian wars, there has been a drive to test electrical impulses as means of preventing pain and restoring movement. It seems like fantasy but small steps are being realized every day. For some, small steps bring large results.

Stimulating muscle movement to enable the motion-challenged to find motion is now being experimented with as a means to help people walk. The principle isn’t a new one. About 300 years ago, Luigi Galvani at the University of Bologna in Italy. He realized that if he sent an electric impulse at the lower spine of a frog, the frog’s legs would twitch. Similar experiments helped Galvani create neurophysiology as a study of how nerves can activate muscles in the body.

Galvani’s studies transitioned to studies of stress. In law enforcement, a Galvanic Skin Response in the hand helps determine whether a person may be telling the truth or not. The skin conductance response, also known as the electrodermal response (and in older terminology as “galvanic skin response”), is the phenomenon that the skin momentarily becomes a better conductor of electricity when either external or internal stimuli occur that are physiologically arousing. It occurs in the fight or flight response at the root of placing the body on stress alert.

A Superman on screen, actor Christopher Reeve suffered virtually total paralysis after a spinal injury. The Christopher Reeve Foundation offered grants (in the last decade) to study Functional Electrical Stimulation of nerve tissue to help induce movement. Functional Electrical Stimulation applies small electrical pulses to paralyzed muscles to restore or improve their function. FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores.

For research, FES is extremely valid when FES is used with a functional task such as walking, cycling, or grasping objects for a number of rehabilitative purposes and across differing diagnoses. FES has demonstrated the capacity for strengthening muscles enhancing circulation and blood flow, reducing pain, and retarding muscular atrophy.

In 2001, Case Western Reserve University, Department of Veterans Affairs, developed an intramuscular implanted system that activates the hip, knee, and trunk muscles to facilitate ambulation. At the time, the problems of electrode integrity in addition to adjusting the wavelength and amplitude signal measurements demonstrated promise.

Over the years, Federal Drug Administration worked at approving several devices that could provide enhanced results. Bioness L300 Plus adds a thigh component that facilitates knee extension and adds stability during walking as well. Other similar peroneal nerve (associated with the muscles that cause foot drop) stimulators commercially available are the WalkAide System and the Odstock devices. These systems have demonstrated long-term improvement in walking skills for persons with stroke as well as persons with multiple sclerosis and, possibly, other (thus far) incurable muscular diseases.

Alas, the rub is that virtually all these disabling diseases and conditions have no cure. Devices like ToeOFF and FES help the immobilized meet the challenges of moving. When you’re immobile or paralyzed, the facility of movement is like a light from the sky, even if only a short one.

The AFO and FES devices available for public use have been approved by medical agencies and federal groups like the FDA. This doesn’t mean that there are no side effects and contraindications as patients use them. While ToeOFF and WalkAide (and similar devices) are approved for certain conditions, each individual may be affected uniquely. Improvements may be individual specific and may not likely be generalized to work equally for a general population.

FES seems to be laying the groundwork toward the future of orthosis and. thankfully, there are products that offer advanced alternatives to the AFO. As relatively new, and somewhat unknown through the medical profession, FES is still somewhat expensive and most insurances do not cover use of a device like WalkAide. In addition, a pair of AFO (generally covered by insurance) may cost in the $1,000 to $2,000+ range. The WalkAide System may cost around $5,000 for a single and, a bit more, for a pair. Often these conditions may affect both left and right legs. Poverty and lack of adequate health insurance for those disabled by chronic nerve and muscle diseases. The merits of these prosthetics, however, could be life-changing to those afflicted by conditions.

In cases like multiple sclerosis and muscular dystrophy, understanding the etiology (causes) of the disease dynamics and causes is extremely important. Dorsiflexion is only one of possibly hundreds of symptoms. ToeOFF and WalkAide are examples of special devices that assist at making immobilization levels more mobile. While FES is promising for some, others may not benefit from neural electric therapies and devices.

ToeOFF and other AFO may work better with patients of muscular dystrophy and diseases of weakening muscles that are not necessarily associated with nerve damage. WalkAide may have little or no effect in those cases and, ominously, dystrophies have not been indicated to be (possibly) effective using an FES product. FES has been shown to be effective by generating electrical signals along nerve pathways and the nerves that are primarily associated at controlling muscles in certain areas. Some cases of dystrophy patients may not gain positive effects from an FES device because weakness is due to a genetic disruption of a neurotransmitter called Dystrophin and those signals may not change the efficacy of those muscles that affect foot drop and some other gait issues. That is why ToeOFF may still be the most advanced form of orthosis for muscular dystrophy patients.

Understanding those subtleties requires an integrated approach between physiatrists and rehabilitation specialists familiar with the problems behind neuromuscular conditions of different severity and sources. This is one of many reasons why ToeOFF and WalkAide are prescription products. For the most part, the etiologies of many of these conditions still require further research as well. In limited studies, however, products like ToeOFF and WalkAide remain to offer considerable help for those that can benefit by them.

ToeOFF is a partial solution and professional orthotists like David Zwicker, in conjunction with your prescribing doctor, can help patients optimize mobile functions. An AFO is an appliance and the appliance fits in a shoe, primarily a New Balance sneaker is recommended. As shoes are designed for feet and not necessarily a foot and an orthosis, the material of the shoe needs to be strong and stable enough to support it. Otherwise your balance may be compromised. You may require a wider size and may find that shoes last months instead of years. It’s a consequence that can be annoying. It’s fortunate that New Balance makes shoes with several width selections. That helps. Afflicted with moderate to severe dorsiflexion, ToeOFF helps you walk more normally than if you did not wear it. As an alternative to one of those electric wheelchairs, ToeOFF is a good device.

WalkAide does not require to be placed in a shoe. The battery powered unit may be placed anywhere on the calf around the peritoneal nerve fiber that is beneath your knee. That makes WalkAide an attractive alternative but only where nerve fibers and muscles interact with functional electrical stimulation. It may not work with patients suffering from muscular dystrophies or certain myopathies.

An orthosis, like a dynamic AFO (such as the Allard ToeOFF device) is a form of prosthetic. You might have your physical leg but the muscles related to dorsiflexion (and walking) don’t work. For the past 100 years, these prosthetics were heavy and large. While wealthy victims of Polio (i.e. President Franklin Delano Roosevelt) had to learn how to use them, ToeOFF is part of a group of AFO that are light and easy to use. Neuro-prosthetics is the study and development of medical devices that replace or improve the function of damaged neuromuscular organ systems and restore normal body processes, create or improve function, and/or reduce pain.

There is no 100% solution as of yet. It is promising that technological strides are being researched to offer immobile, afflicted people some more choices at the ease of getting around. Ranges might be limited. I guess it’s better to have some mobile range than none. There is promise in better AFO and FES development as the future unfolds. At least, there is hope.

Toe-off braces against foot drop

While most evident with aging, foot drop is a condition when ankle muscles or nerve signals cause your foot to drop when walking. Foot drop makes it difficult to lift the front part of your foot, so it might drag on the floor when you walk. It can affect people of different ages as well. While some mild foot drop conditions respond to physical therapy, moderate to severe cases often require a brace that helps reposition your foot to a normal gait. The Allard Toe-off is one such brace and the best of its kind. There are others as foot drop is more common than most people think. Statistics are difficult to ascertain because so many people function with foot drop and don’t recognize the mobility challenge. Certain diseases, however, make it a clearly disabling symptom. Toe-Off makes that disability somewhat less disabling for young and old challenged walkers.

Foot drop can be associated with a variety of conditions such as flexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Basically, Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion during movement as you walk and stand. You drag your foot while walking. Some compensate when approached by hills and steps by elevating the hip. The result is a Frankenstein-monster like foot drop that results in imbalance and consequences like frequent falls. On level ground, the feet drag on the surface. Carpets and walkway cracks can often be threatening as a foot fails to lift.

Allard ToeOFF is a leader among several manufacturers making devices known as Ankle Foot Orthoses for children and adults to help cope with chronic foot drop. These are braces that fit into shoes and create a rocking motion at the base of the foot. It helps the foot simulate a smooth walking gait by lifting the toes off the ground, as evident in foot drop cases.

Foot drop may also be evident in young babies who have difficulties toddling at toddling ages. They have difficulty standing and walking. Pediatricians may recommend a Supra Malleolar Orthosis (SMO) if the child is 18 months or older.

Up to age 3, the diagnosis is usually hypotonia. Hypotonia is the medical term for decreased muscle tone. Healthy muscles are never fully relaxed. They retain a certain amount of tension and stiffness (muscle tone) that can be felt as resistance to movement. When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years. There may be several reasons for hypotonia in babies, including nerve, muscle, and metabolic syndromes.

An SMO is shorter than an AFO and usually has a baby-friendly decoration. It will help babies stand. Walking may require physical therapies. Sometimes a pediatric physiatrist (medical specialist in rehabilitation medicine) may organize a team of multifaceted supporters. Small studies indicate that the SMO with phased rehabilitation may help children overcome foot drop and walking issues within a couple years. After that, genetic testing may be required to determine whether hypotonia is more of a symptom of another disease than a condition itself.

Hypotonia is not the same as muscle weakness, although it can still be difficult to use the affected muscles. Depending on the cause, weakness may sometimes develop in association with hypotonia. As people age, muscle weaknesses may develop along with normall loss of lean tissues. Hypotonia influences the movement, condition, and action of muscles.

Foot drop is very evident in diseases like Muscular Dystrophy, Cerebral Palsy, CMT, Stroke, and Multiple Sclerosis patients. An Ankle Foot Orthosis (AFO) helps relieve foot drop. It resembles a brace but it fits in most of your shoes. Worn beneath long pants or skirts, an AFO is practically invisible.

While an AFO may not directly repair dorsiflexor problems or neuro-muscular conditions, it helps deliver a near-normal gait when walking. The key is near-normal but that is a vast improvement. You may experience difficulty ascending and descending stairs. Your speed may be slow, but significantly faster than dragging. Your maneuverability may be somewhat compromised. Compared to foot drop, an AFO is a very significant mobilizer for the somewhat immobilized.

The Dorsi-strap is the least invasive AFO and also relatively inexpensive in the $150 range. While users should first consult a sports medicine doctor about using it, purchase does not require a prescription. The manufacturer seems to promote its use as a cure-all, even supportive for obese and big people, but the Dorsi-strap is really only effective for very mild foot-drop conditions.

For moderate and severe foot drop, dynamic braces are often prescribed. These are light, generally made of carbon fiber, a foot-length foundation is placed in your shoe and covered with shoe’s (or your) orthotic. A vertical support goes up and the brace attaches to your leg by one or two Velcro straps. A dynamic response Orthosis helps support a stable, balanced gait for walking and enable better posture while doing so. These are expensive but when you’re immobilized, they help you become (somewhat) mobile. They are covered by Medicare and most insurance providers.

Some people might say that, if you’re immobile, why not get a wheelchair or scooter? It’s a good question from an outsider’s view. There are classes of stubborn immobilized adults who want the illusion of mobility as a biped (not including cane support) in a world designed for most healthy people that can walk normally. There are fewer doctors and people aware of dynamic AFO devices so few are seen. They are used, though a minority compared to wheelchair devices.

Among dynamic AFO manufacturers, Allard’s Toe-Off family recognizes this for adults with varying degrees of disability. They also remember children who can suffer at many levels when confined to wheelchairs when they have foot drop as a main concern. Allard’s KiddieGAIT offers innovative options that have never been available for AFO management of these challenges. Functional environments can be created that supplement gait function instead of immobilizing and inhibiting that function.

Designed to provide dynamic toe-off assist with maximum control for the unstable ankle, Toe-Off is available in five sizes from X-Small to X-Large to fit children through adults. The unique, patented design features a lateral strut which “wraps” over the instep to provide maximum medial-lateral and rotational control of the foot and ankle complex, when none or little normally exist. Approximate weight variations are Size 01 (XS) weighs 3.6 oz., Size 02 (S) weighs 4 oz., Size 03 (M) weighs 4.9 oz., Size 04 (L) weighs 6.4 oz. & Size 05 (XL) weighs 6.7 oz. This permits an almost invisible sense of added weight. There is, however, a training period to get accustomed to the rocking support of these braces. Significantly advantageous, the Toe-off AFO fits into the shoe like an insole and accommodates most shoes without having to increase shoe size. New Balance sneakers are recommended for daily use.

Beyond the KiddieGAIT and the regular Toe-Off AFO, Allard has introduced the Toe-Off BlueRocker to their AFO family. BlueRocker is identical in shape and design as Toe-Off but offers more orthotic control. It is developed primarily for bilateral patients and those with more involved pathology. The extra stability will improve both balance and posture and give the wearer greater security, especially individuals with weak quadricep muscles.

It is also the most preferred orthosis to be used in conjunction with a socket and toe filler for management of partial foot amputations. Every BlueRocker should be padded on the inside towards the tibia crest. The SoftKIT padding system is designed specifically for use with BlueRocker for optimum patient comfort and product performance.

There are several other dynamic response AFO brands available for all degrees of foot drop. Helios (Helical Energy Loading Integrated Orthotic System) focuses on the category that the Toe-off BlueRocker targets. Helios is quite different as it does not use Velcro straps but requires a custom wrap-around shell for additional support. The double-helical construction is designed to correct skeletal structural deformities and provide an increase in walking function. This unique energy loading design offers the potential of normal walking. Because of its energy return in walking, the manufacturer claims there is less fatigue. Like the Toe-Off, it targets muscular dystrophy, peripheral neuropathy, CMT, Stroke, Cerebral Palsy, Polio, and many other neurological and muscular diseases that compromise function of the dorsiflexor.

If you find walking painful and your feet are consistently dragging, find a physiatrist or sports medicine doctor. These doctors study and serve patients with movement disorders. Orthopedists primarily deal with bones. A thorough exam will help form a diagnosis. Physical therapy may help most people. If it doesn’t, an AFO may be prescribed. Use a recommended practitioner.

I was advised to go to Prothotic Laboratory for my AFO orthosis. While there are hospitals and other providers, this place was highly recommended by my physiatrist. David Zwicker is their certified orthotist and was a pleasure to work with. He suggested the Toe-Off and considered the basic model as satisfactory. I must admit that, once I put the Toe-Off on, it seemed a radical improvement. As with a cane, I’d advise moving up to the Toe-Off BlueRocker for maximum strength and support, though it does require a suitable get-comfortable period. Zwicker offers seasoned experience and provides an intuitive, independent approach to help maximize comfort. When using an AFO device, your relationship with the orthotist is very important. Do not get an AFO unless you are certain that your orthotist is right for you. If you are in the New York City area, David Zwicker of Prothotics offers excellent service, although many pediatricians and physiatrists offer AFO and SMO devices.

There are varying degrees of foot drop and many reasons behind it. There’s no assurance that a dynamic AFO will get you running or even fast-walking. In cases of muscular dystrophy (and my Myotonic dystrophy), happiness comes from the ability to walk without foot drop, or the use of a wheeled scooter. The myotonia is still there and instability and weakness may dominate. Using the Toe-off offers significant help in walking from point-A to Point-B. Without the Toe-off AFO, trying to walk is a monstrous challenge. Be thankful that world technology is designing products to help the significant few sample the illusion of normalcy again.

Ultimately, an AFO or SMO is an aid to enhance mobility against foot drop due to weak muscles and nerves. Seeking medical or rehabilitation help may be advised to avoid accidents or falls is advisable.