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Lower Limb Orthoses

Align Clinic is concerned with the design, function, and fitting of custom and pre-fabricated orthoses, which are devices that help support or correct musculoskeletal deformities. Here at Align Clinic, we strive to provide the highest quality products and services to all of our patients, based on our combined 60 years of experience. We treat each patient as an individual and not as a number. Below are a few of the many services and products we offer.

When you make an appointment at Align Clinic, our practitioners will provide a thorough evaluation of your individual needs including muscle testing, range of motion, sensation and gait assessment. Working with you and your physician or physical therapist, we will arrive at a treatment plan designed to assist you in meeting your goals.

During the fitting of your orthotic, you will be instructed on a break-in and wearing schedule along with precautions associated with the use of your orthotic. Instructions on use, function, skin inspection, and care and cleaning of your brace will also be provided to you. If any adjustments or repairs are required in time, our office will provide these services free of charge during our 90-day warranty period.

Foot Orthotics (FO)

Foot Orthotics are prescribed for a variety of conditions related to the feet and ankles. The most common of these are plantar fasciitis, flat feet (pes planus), high arches (pes cavus), and derangement of the ankle, sometimes due to healing of a severe fracture. The feet are the foundation of the human skeletal system and therefore many other ailments can be caused secondary to problems with the feet and ankles, such as lower back pain and knee pain. If you are experiencing any sort of lingering pain in your feet, it is imperative that you treat them before the damage spreads.

Foot Orthotics are inserts made to slip into your shoe which support and/or correct the condition from which you are suffering. In recent years, there have been many over-the-counter varieties of these inserts that have come onto the market. However, the foot orthotics provided by Align Clinic are custom-made to the shape of each individual’s foot contours. No two patients have the same shape of feet and this is how we approach each patient.

Ankle Foot Orthotics (AFO)

Ankle Foot Orthoses, commonly referred to as AFOs, are made for a wide range of reasons, such as drop foot caused by stroke, varus/valgus deformities, muscle weakness, and severe ankle injuries. An AFO extends from just below the knee to the foot.

They can be custom fabricated to the individual shape of the patient or can be pre-fabricated and designed to fit a range of individuals. They also come in both solid ankle and articulated ankle varieties, depending on what is needed.

Knee Ankle Foot Orthotics (KAFO)

Knee Ankle Foot Orthoses, commonly referred to as KAFOs, are made in a variety of designs based on the required function. They generally extend from the upper thigh down the length of the leg to the foot. They can have knee and/or ankle joints but depending on the condition could possibly be completely without motion. KAFOs are used to treat a variety of musculoskeletal conditions, such as post-polio, which can include preventing hyperextension of the knee, leg muscle weakness, and preventing pain and deformity.

The brace can be made from measurements, taking a cast of the leg or by scanning. KAFOs are made from a variety of materials depending on what needs to be accomplished. This can include materials such as Carbon Fiber, Titanium, aluminum and polypropylene.

Pediatric Lower Extremity Braces

Please note that there are many brace options and that the following is a very small sample of the lower extremity bracing available at Align Clinic.

At Align Clinic, we understand that pediatric patients are different from adults, and our practitioners are committed to treating them as such. We take great care in handling the orthotic needs of our youngest patients, treating not only their conditions but also providing them and their parents with emotional support. Parents and caregivers can feel confident with the level of experience we have in treating many neuromuscular and developmental conditions, such as scoliosis, cerebral palsy, muscular dystrophy, Down’s syndrome, and spina bifida. Our objective when treating children is always to correct the issue as quickly as possible while also providing the child with the most mobility possible. We design our braces to match the functional level of each pediatric patient in order to allow them to fulfill their full potential.

Align Clinic offers a wide spectrum of pediatric orthotic services. Our practitioners are trained and experienced in orthotic services ranging from prefabricated orthoses for infants with clubfoot or developmental dysplasia of the hip to custom fabricated orthoses for musculoskeletal conditions such as cerebral palsy or scoliosis.  These can include Pavlik harnesses, DAFOs, UCBLs, scoliosis braces, and cranial remolding orthoses (CRO), among others.

Steve Baum casting a patient at one of his clinics

Steve delivering the patient’s completed AFOs

Each child in need of orthotic care is managed on an individual basis, with a treatment plan based on their needs and goals. We are committed to a team approach, working in constant communication with patients, parents, physicians, and therapists, to give each child the best possible outcome. As part of this team, we strive to support our pediatric patients as they grow and mature, always ensuring that the devices they are using have the optimal function for their stage of growth and development and quickly adjusting or replacing the devices as needed.

If you are interested in a free evaluation for your child, please call our office at 650-375-2231.

Articles:

Journal of Prosthetics and Orthotics Online Library-
Initial Standing of the Osteogenesis Imperfecta Patient Steve Baum, C.O. Patricia Hazard, C.O.

Cascade DAFO #4 / SMO

The SMO design is usually reserved for issues that reside below the ankle. Only the mildest of dropfoot can be addressed with a brace this low in height. This style is best served by the population w/ moderate to severe medial / lateral midfoot and/ or hindfoot issues such as over-pronation, valgus and/ or eversion that cannot be adequately addressed by a plantar insert.

Cascade DAFO 3.5

This example is the Cascade DAFO 3.5 design that consists of a flexible shaft that can be ordered from very flexible to semi-rigid. This portion of the brace controls excess posterior motion while allowing dorsiflexion. The flexible wrap around design of the hindfoot and midfoot portion helps control the medial/ lateral deviations similar to the SMO design. Some of the problems this brace will address are lack of active dorsiflexion during swing, controlling mild to moderate plantarflexion. This brace may also contribute to reducing inconsistent foot placement during gait. Other designs that could be considered when looking at this brace may be articulated ankle joint type braces that can enhance motion that may be lacking or contain extraneous motion detrimental to gait.

Cascade DAFO, Turbo design

The Turbo design is a two piece design. It is usually fabricated to be used together, but under certain conditions it can be constructed so that the inner shell can be used separately during physical therapy and or supervised practice.

The design incorporates a strong posterior shell that that originates form under the forefoot and terminates below the knee. It helps the client w/ a strong stabilizing anterior / posterior presence. The interior piece fits intimately into the posterior piece and is very similar to the shape of an SMO but is thin and more flexible. It secures the medial / lateral alignment of the foot securely into the brace. This type of brace works well for the person that may either crouch or has strong excess plantarflexion. 

KAFO

The KAFO (Knee/Ankle/Foot/ Orthosis) is usually specified for the client with weak or uncontrolled knee issues. It is a tall leg brace, with the knee joint that can allow certain motion or be locked with variously types of hardware depending on the size of the client & their particular needs. This brace has the option to have ankle treatments ranging from rigid to free motion. Typical applications for a KAFO range from significant knee hyperextension, knee contracture, or the inability to actively keep the knee extended while walking.