If the brace and shoe fit then wear it with AFO

Whether the origin of “If the shoe fits, wear it” comes from Cinderella, the saying can be traced over two centuries. At those times, shoes were exclusively for feet. Today, thanks to certain medical technologies, people with mobile impairments can choose shoes that fit. Unfortunately, if you are wearing a brace for leg and ankle support, many shoes intended for feet alone do not fit. If they do initially, they wear out rapidly. There are new support braces for children and adults that benefit many incurable conditions. Finding a standard shoe to fit a foot with a brace is often very complicated. You don’t have to wait for a fairy. Knowledge, research, experience and a medical professional motion support team can help.

When the cobbler cobbled his first shoe, it was intended for one foot in each shoe. They may not have been comfortable but they were sturdy and protective from rough terrain. For years, any form of brace, prosthetic or orthotic placed in the shoe with a foot would stretch the leather and the shoe-last would not last.

Shoes and sneakers do not adapt or wear well with braces also inserted with your foot. In addition, many brace users can’t jump over puddles or maneuver easily around them. Walking on smooth surfaces is almost or more challenging than hiking in the woods. A recent class of more supportive hiking boots may help people who rely on braces for degrees of mobility. Low-cut models with flexible midsoles are excellent for day hiking. Materials impact a boot’s weight, breathability, durability and water resistance. These may offer stiffer but comfortable ankle support. They may be the comfort match for brace wearers or those seeking more support than ordinary shoes provide. Low-cut hiking shoes are available virtually everywhere shoes are sold. If the shoes fit, they will wear well with or without a brace.

Wearing a shoe with an AFO or Ankle Foot Orthosis, a new term for a supportive brace, means you’re using the shoe beyond its expected intent. Most shoes will not withstand this use.

An AFO is a form of brace that supports and aids a common joint action called dorsiflexion. Dorsiflexion of the foot is sometimes referred to as dorsiflexion of the ankle. Flexing the ankle joint so that the underside of the foot rotates upwards. That is, the upper surfaces of the toes (including the toe nails) move towards the shin bones at the front of the lower-leg. Many are born with diseases that disallow those muscles (or associated nerves) to function normally. An AFO is added to the foot and lower leg. Both are inserted in a shoe.

Can you necessarily go to any shoe store or order online for a pair of shoes to fit a brace or AFO? Many will find it a stupefying task. You might have to opt for orthopedic or custom shoes that, for many, are not insured and beyond affordability. Furthermore, these custom shoe designers are usually podiatrists or orthopedists. They are often ignorant of what AFO is and how it works.

Many AFO manufacturers recommend and warranty each AFO foot brace for use with sneakers. Most sneakers are soft and these can stretch rapidly to the point of instability. Yet there is more to this dynamic. Weight and foot-size are two significant variables that can quickly damage ordinary shoes. Few AFO manufacturers are aware or recommend low-cut hiking shoes.

Among the best patients for an AFO are children that are low in weight. Children want to be mobile and AFO is a form of brace that helps support ankle and lower leg muscles that are necessary.

The ToeOFF KiddieGAIT is among the more popular AFO braces that many pediatric therapists prescribe. This brace offers dynamic technologies that help children rise and move from wheelchairs and walk.

The Allard KiddieGATE is a dynamic AFO and is very different than the brace you might have seen, such as the ones Forest Gump wore in the movie. Those are static braces. Static AFOs are devices that hold joints in constant position and are made of rigid materials.

Dynamic AFOs have varying types including hinged, articulating, static progressive or inhibitory. The dynamic components may be based on materials, mechanical joints, exertion of forces on joints, freedom of joint motion, or inhibitory influences to properly guide foot motion to simulate a normal gait.

David Zwicker, New York orthotist with Prothotics labs, indicates that dynamic AFO devices are helping children find mobility in varying degrees, based on their conditions. There are many more to choose from. Zwicker, among many other caring orthotists, understand that mobility is very precious to people at any age. Orthotists strive to use and explore technologies that help find the best and most comfortable fit to deliver the best mobility possible. In some cases, physical therapy aids in using the AFO devices more effectively.

Lighter body weights do allow a brace and foot to fit more sturdily in shoes and sneakers. Low-cut hiking shoes may add a little more stability while allowing other muscles to stretch and perform properly.

Adults with an AFO, on the other hand, over 175 pounds, bear more pressure that compromises the fit and durability of most shoes and sneakers. As adults age, calf to ankle muscles become more limited across genders and more complaints rise of walking issues. Over the course of ages 40 through 80, compromised dorsiflexion increases although sometimes related to other joint muscular problems.

Then there are adult-onset nerve and muscle diseases that wear nerves and/or muscles more rapidly, such as multiple sclerosis and muscular dystrophy.

Passive adults over 60 experience normal muscle wear and require additional support from shoes. You find New Balance sneakers more prevalent on normal aging feet, without braces. Some wear over-the-counter orthotics for

There’s a drop-off of how aging people might treat drop-foot dorsiflexion. They use canes, walkers, and power scooters. Many are unaware of what an AFO brace is, Very few are stubborn enough to want to stand and walk. That may be why fewer elect a brace and fewer than that choose an AFO.

Heavier bodies, larger feet, heavier feet, and an AFO can stretch almost any ordinary shoe, including leather or synthetic New Balance sneakers.

Hiking shoes are more rigid but an AFO foot brace doesn’t comfortably fit in a boot. It can fit in hiking shoes just at the ankle, and not tied to the top.

Brands like Oboz Footwear, The North Face, and Merrell make low-cut hiking shoes that are more likely to properly support an adult foot with a dynamic AFO brace in a shoe, while allowing dynamic natural foot movement in accordance with the brace.

AFO users have very case specific support needs. Avoid shoes that offer special supports for normal people. Some offer 3–5mm thick inserts are sandwiched between a boot’s midsole and outsole to add load-bearing stiffness to the midsole. They vary in length; some cover the entire length of the midsole, while others only cover half. There are also Plate supports –
thin, semiflexible inserts are positioned between the midsole and the outsole, and below the shank (if included). They protect ordinary feet from getting bruised by roots or uneven rocks. Most AFO wearers are more likely to be concerned about walking smooth hills or slightly bumpy surfaces. This is why use of a cane is helpful to avoid accidents.

Hiking shoe brands are not on many AFO brace manufacturer recommended lists and, in some cases, may nullify a replacement warranty. Consult with your prescribing health practitioner.

If you are an adult who wants to retain upright mobility and a choose a brace for support, then a low-cut hiking shoe is a lightweight alternative to flimsy sneakers. Remember that NO SHOE was designed for a foot and a brace and, as an adult, using a brace places you in a minority. Do not use a shoe for more than 3 consecutive days and switch to another. None of these shoes will last long under daily use. All will be more dependable than sneakers.

Nothing is better than stable, healthy muscles. An AFO helps people who can’t move as a helping aid. Ask a physiatrist for a recommendation. Ask you user to customize it for your comfort, Competent, professional orthotists like David Zwicker, can help you adapt and optimize a new pseudo-active lifestyle.

If the brace and shoe fit then wear it with AFO but make sure your shoe provides the support you need. A foot, an AFO device and a shoe must work in concordance. People with neuromuscular mobility problems need the assurance that fit and support must coexist for better mobility degrees, when nerves, muscles, or both can’t do the job.

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.

Paralyzed Patients Move with Spinal Stimulation

The early 19th-century was fascinated with electricity. Dr. Frankenstein used electricity to restore life to a lifeless body. Many people suffer from paralysis, the inability to move limbs or bend the torso. Research into Neuro-electric impulses and spinal stimulation seem to help some patients regain movement.

Being paralyzed is among the biggest and most disabling nightmares. For many years, if paralyzed, you were bed-ridden or immobilized in wheelchairs. Of ambulatory disorders, the inability to control legs, arms, feet, neck, and other things, paralysis was among the worst. Whether it was due from disease, traumas, or bullets, being paralyzed was often perceived as death. For decades, it was near hopeless.

In an article in Brain (April 8), a study was published that show how 4 men, paralyzed for over two years, regained movement with the aid of implanted electro-stimulators in the spine. Patients could move by use of a remote control device. The research was covered by the National Institutes of Health. Subjects were paraplegic patients who lost sensation and movement in arms and legs.

The bioengineering institute at United States’ National Institutes of Health is funding research to develop noninvasive stimulators. That way, the electrical pulses can be delivered through the skin rather than requiring surgery to implant a device.

The unique clinical research approach was developed by V. Reggie Edgerton, Ph.D., a professor at the UCLA Department of Integrative Biology and Physiology. Edgerton is notably connected with the Christopher Reeve Foundation and the Michael J. Fox foundation.

Few people realize that in virtually most ways our body is an electric powerhouse. A normal, functioning body uses transduction to convert what we eat and think about into a complex living network. All living organisms are made of individual and identifiable cells, whose number, together with their size and type, ultimately defines the structure and functions of an organism. Cells are involved in helping to preserve and create energy in our bodies. Nerves and neurons behave like cells as well. When a disease or injury forms, the normal flow of energy is blocked.

In small cases, like burning your finger when touching hot cookware, the perceived pain sets off a response through releasing a set of chemicals called endorphins that reduce perceived pain.

People who suffer major injuries that sever nerve and cellular connections block the smooth flow of transductive actions. Many things can happen when this occurs. One of these may be paralysis of a region, large or small. The electrical energy flow is blocked.

In Asia, that electrical body energy is called Chi. Chi is the internal energy that circulates through the body, according to many eastern martial arts and medical traditions. These practitioners believe when chi is blocked, either through natural causes or more nefarious means, it can stop us from being able to function physically, mentally and emotionally for a small amount of time or permanently. Through various methods, the goal is to free the flow of natural chi.

A paralyzed limb may be blocked by various means. Through an understanding of the electrical impulses the body uses, a paralyzed limb may be activated by implanting an electrical pulse generator at the core of the blocked location. In many cases, based on our limited knowledge, it is somewhat speculative. In the NIH study, it worked with those 4 paralyzed men.

Of course the unblocking and reactivation of those neuromuscular areas are only the beginning. Physical therapy and/or prosthetics may be required to possibly help restore more full functioning.

What makes this study so interesting is how those pulses work to help mobilize what was thought to be immobile, virtually lifeless. Sometimes what is not known may just require the restimulation of the blocked chi.

It takes innovative approaches to help combat and treat disorders. Some of those are seen as ancient alternative methods.

Current medical education is pushing vast numbers of doctors and medical professionals that are paralyzed when it comes to what is perceived as new approaches to medical problems. Sometimes modern and accepted traditional methods do not work for those rare cases that are beyond average.

Fortunately, there are some thinkers that explore through the dark, curvy tunnels and come up with novel approaches. Long term results may be speculative. Having a light at the tunnel’s end is a remarkable thing at the very least.

One can’t surmise that all paralyzed people may one day move again, walk and dance. This research means there is hope. The fictional Dr. Frankenstein wasn’t all that wrong. He just wasn’t ready to understand that electricity can be therapeutic to those that have life. Seeming lifeless paralyzed patients may one day move with spinal stimulation. You are the body electric.