Halt equinus contractures with the 654SKG DDA Orthosis
What is an Equinus Contracture?
Contractures resulting in an equinus deformity are commonly seen in many patients in critical care, neurological, spinal cord injury and the vascular wards. Muscle tension imbalance across the structures of the foot and ankle can result in a deformity quickly becoming fixed. The foot is a complex dynamic structure that adapts to the loads placed on it; shaped by the nature of the muscles, ligamentous and bony structures. The natural history of these situations and how to deal with them clinically will vary a great deal depending on the underlying condition. We must understand the particular risks presented by the features of each condition when thinking of a remedy. It should be obvious, for example, that tissue viability must be considered in each case alongside the biomechanics of deformity correction.
Whilst there are several treatments available to prevent, or even reverse, this condition - some surgical and some conservative - the effectiveness of those treatments can vary and often formal research is lacking.
The aim should always be to prevent these contractures developing because once established they seriously compromise prospects for ambulation later. For example, the stroke patient with an acquired equinovarus foot will prove difficult to mobilise even though this might be imperative for reasons of continuity of care. Once established, the patient must compensate for the deformity via altered foot, knee and hip positioning during gait. Knee hyperextension and hip adduction can develop, further adding to the person’s disability.
In an earlier article, we focused on the specific situation with spinal cord injury. This was motivated by a person I saw at home whose equinus contracture had developed to the point where she could no longer keep her foot on the wheelchair footplate. She had been provided with an orthosis with an adjustable, but passive positioning, ankle joint. The problem for her was that at best, this orthosis could only prevent the bad situation becoming even worse.
What is the DDA Orthosis?
The 654SKG Dynamic Dual Action Orthosis (DDA Orthosis) is becoming increasingly popular due to its effectiveness in preventing and even reversing heel contracture.
This orthosis confronts the vital issues of tissue viability and correction biomechanics and makes the device suitable for application across important clinical areas.
The adjacent image of the DDA (Dynamic Dorsi Assist) has 3 clickable icons that explain some of the key featres.
How Does the DDA Orthosis Work to Halt Equinus Contracture?
As standard the DDA is offered with a Kodel liner that is washable and replaceable. From the tissue viability point of view it can be used with the full spectrum of clinical presentations. In situations where the foot requires wound dressings making it difficult to use Kodel, a “Pad and Strap” kit is available that allows any dressings to be accomodated.
The dynamic stretch, or dorsiflexion assist, is provided by two elastic straps positioned medially and laterally. These can be individually tensioned to counter any (commonly seen) tendancy to equinovarus or valgus. The short video shows the basic movments of the product.
Basic movements of the DDA Orthosis
Tips for the Correct Use of the DDA Orthosis
These elastic straps positioned medially and laterally can only work because the heel section is hinged. This allows the foot section to move and remain in intimate contact with the sole of the foot. This is important because it ensures that pressures are not elevated on the metatarsal heads whilst making sure that there is absolutely no pressure on the vulnerable heel area.
Like all the products in the PRAFO range, the heel protection provided by the design ensures there is zero pressure on the heel area. The liner is opened up the orthosis postioned to get the heel into the back of the device. The forefoot vecro straps can then be secures and trimmed to size, followed by the tibial pad and strap. At this point the elastic strap tension can be set.
These elastic straps have an important role in dynamic management. If the patient has clonus, resulting in repetitive high pressures between the foot and the device - something needs to give!!. The elastic straps of the DDA allow these pressures to occur without risking overall tissue viability. The DDA can respond to this situation safely and maintain the possibility of a corective force.
One commonly seen problem with other heel protection products is that they deform too easily into a plantarflexed position but do not keep appropriate contact with the foot as a whole. The metatarsals are then at risk of ulceration.
With patient’s that can be mobilised, the DDA has an intrinsic walking base that allows this to take place.
In summary
Heel contracture is a condition that can cause significant disability in patients with many clinical presentations. Prevention is the key but requires attention in a timely manner to both tissue viability and foot and ankle biomechanics.
The 654 DDA Orthosis is a simple to use dynamic orthosis that has been proven to be an effective solution to halt and even reverse this condition. It provides the necessary heel protection and support to help patients achieve a more comfortable and healthy lifestyle.
Oh and before I forget, the 554SKG is available for the paediatric user.
If you or someone you know suffers from heel contracture, research the DDA Orthosis and the benefits it can bring. Be sure to check with an orthotist, physiotherapist or other healthcare professional before beginning use of the device.
Finally, an orthotist wrote to us this morning as follows
Hi Carolyn, Just wanted to let you know I have a stock of the DDAs which I'm now replacing as I go for ward cases.
Excellent feedback from physios and vascular surgeons on critical care, neuro spinal cord injury and the vascular wards.
Used today for SCI with clonus now losing range and potential heel DTIs. The elastic allows the patient to still have clonus without increasing pressure on met heads. He's also tight in inverters so physio tightening lateral strap more to correct. .this patient would have had no other option in the past as serial casts would have definitely resulted in forefoot sores as would (name of other product)