John walks in the gait lab with his new carbon fibre ankle foot orthosis
08 March 2024
Way back in 1969, John had a horrific motorbike accident which resulted in brain damage and a fractured leg immediately above the ankle. He was in a coma for nine days. Though the ankle was operated on John surmises that not a lot of care was taken with getting it correctly re-aligned: he had not been expected to live the night after all. When John was 50, his cartilage just gave up and it was time for surgical intervention.
By the time John came to the London Orthotic Consultancy, he had really been through the mill. His latest surgery, a 3D printed internal ‘tower’ had unfortunately caused an infection in his heel and he had spent five weeks in hospital.
The consultant he was seeing said he had two options: amputation or an 18-month treatment plan to try and grow his tibia followed by ankle fusion. In the meantime, John was placed in an external fixature frame until he had made a decision. However, he was determined to find an alternative solution and did a lot of research. As he has said: “All I am missing is an ankle!”
Ankle Foot Orthoses (AFOs) made from carbon fibre are incredibly strong yet lightweight, making them easier and more comfortable to wear as it helps patients reduce their energy expenditure when walking. The reduced bulk also means it can fit within a wider range of shoes.
Eventually John’s research led him to LOC. He was first assessed in August 2023, he was seen by Connor Mumford who heads up LOC’s Cambridge clinic and Sam Walmsley, Director and one of the founders of LOC. He told them he had around 60mm of his tibia missing and not much if any talus present. He needed crutches to support him to walk.
Despite this, John says, “They were 99% sure that they could do something for me’. In the short term, John was prescribed a patella tendon bearing orthosis (PTB) socket style walker boot. More commonly used in below-knee amputees, it is used to off-load the foot by transmitting the weight-bearing loads via lateral uprights up the leg. The long-term solution was a carbon fibre Neuro Swing Ankle Foot Orthosis (AFO).
The design, much like a regular AFO, supports the ankle and foot while walking. The Neuro Swing system, from Fior & Gentz, is a modular unit added to the orthosis in order to help a patient control their motion and therefore have a more controlled gait.
The Neuro Swing AFO in this design has a bilateral ankle joint that is designed to be held within a carbon fibre construction. The Neuro Swing ankle joint dynamically brings the patient into an upright position and improves the patient's stability while walking and standing.
The joint has two springs, posterior and anterior that can be altered in three ways. Resistance in the springs can be reduced or increased and the range of movement can be altered as can the alignment of the ankle.
John's bespoke, carbon-fibre Ankle Foot Orthosis with the Fior & Gentz Neuro Swing system
John has been using his Neuro Swing since November: “I can walk pretty well, averaging 3,500 steps a day, I can now actually carry things because I am not having to use crutches, I can do a spot of gardening. In short, I am really pleased that I did bother to find an alternative. I am eager to share the videos of my walking in the Gait Lab with the consultant who gave me the rather bleak options; there is another way!”
If you would like to explore your orthotic treatment options, or feel you would benefit from an assessment in our gait lab, use our contact form to book an appointment today.
