Rivenditori

The Right Orthosis in case of a Combined Weakness of the Foot Lifting Muscles and the Calf Muscles

Patients with a combined weakness or paralysis of the foot lifting muscles (dorsiflexors) and calf muscles (plantar flexors) should be treated with an orthosis in the following category:

Custom-made ankle-foot orthosis (AFO) with an adjustable dynamic system ankle joint using precompressed spring units in the dorsiflexion and plantar stop’

Recommended system joint: NEURO SWING
Alternatives: NEURO SWING 2, NEURO SWING Carbon, NEURO HiSWING, NEURO HiSWING R+

We recommend that you first take the time to familiarise yourself with our online tutorial General Physical Examination. Use our Orthosis Configurator for a suitable joint recommendation.

What Should Be Considered in the Case of a Combined Weakness of the Foot Lifting Muscles and the Calf Muscles?

Many clinical pictures with neurological indications such as stroke, multiple sclerosis, paraplegia, cerebral palsy and others, lead to a combined weakness or paralysis of the muscle groups of the dorsiflexors and plantar flexors. A weakness of the foot lifting muscles, also known as peroneal paresis, peroneal palsy or foot drop, leads to stumbling, while a weakness of the calf muscles leads to insecurity when standing and walking, affecting stability and balance.

You will find an overview of all types of paralyses on the homepage.
 

Videos on the Orthotic Treatment in Case of Weak Dorsiflexors and Plantar Flexors

Below we present a series of videos. These provide a clear overview of the problems that a combined weakness or paralysis of the two muscle groups can cause both when walking and standing, the advantages of a modern orthotic treatment with the right orthosis and the deficits of previous treatments.

Video 1: Compensating for Weak Dorsiflexors and Plantar Flexors When Walking

In this video, you will find out what functions the dorsiflexors and plantar flexors perform when walking and which visible effects a weakness or paralysis of both muscle groups has on walking. The physiological and pathological gaits are analysed and compared. Subsequently, walking with the right orthosis is compared with the pathological gait.

Video 2: Compensating for Weak Plantar Flexors When Standing

In this video, you will find out how healthy plantar flexors ensure safe standing and why weak plantar flexors lead to insecure standing. Afterwards, safe standing due to the right orthosis is examined.

Video 3: Treatment with an AFO with a System Joint from the NEURO SWING Product Range

In this video, you will find out why precompressed spring units in an orthotic joint are state of the art. Subsequently, the function of an ankle-foot orthosis (AFO) with a NEURO SWING system ankle joint is explained.

Video 4: Problems of Traditional Treatments

In this video, you will find out why conventional types of orthoses, which are not state of the art, are not suitable for treating a combined weakness of the dorsiflexors and plantar flexors. Then, the disadvantages of conventional devices such as crutches and walkers are described. Such walking aids should no longer be the first choice.


Video Summary

As mentioned at the beginning, a weakness or paralysis of the foot lifting and calf muscles can make it very difficult for those affected to stand and walk safely. Therefore, it is essential to choose the right orthosis to treat this combined weakness of both muscle groups. The video sequences above examine this from different perspectives. Below, the contents of the video sequences are described in more detail and a conclusion is drawn as to why a lower leg orthosis (AFO) with a system ankle joint from the NEURO SWING product range should be used.

Video 1 – Compensating for Weak Dorsiflexors and Plantar Flexors When Walking

To understand the effects of a combined weakness of the two muscle groups, the physiological gait must first be considered – from the lifting of the heel in terminal stance, to the lifting of the forefoot in swing phase, to the controlled lowering of the foot during loading response. In a pathological gait, weak plantar flexors cannot activate the forefoot lever from terminal stance. To compensate this and a lack of stability in the ankle joint, the knee is hyperextended. In addition, the heel stays on the ground. During swing phase, weak dorsiflexors cannot maintain a physiological ankle joint dorsiflexion assist. The forefoot lowers, resulting in a drop foot and the knee joint angle increases to more than 60°. This leads to an unphysiological posture and circumduction. After the initial contact, the loading response cannot be controlled, which leads to the heel being lowered and not the forefoot, as it touches the ground first.

A custom-made AFO with an adjustable dynamic system ankle joint with precompressed spring units in the dorsiflexion and plantar flexion stop activates the forefoot lever and enables safe standing and the restoration of a physiological knee joint angle. Furthermore, the spring units are strong enough to lift the heel. The supportive level can be adjusted using interchangeable precompressed spring units with different spring forces.

Video 2 – Compensating for Weak Plantar Flexors When Standing

As the plantar flexors play the most important part when standing, only their function is considered in this sequence. For this purpose, the terms body's centre of gravity, ground reaction force, forefoot lever and supportive area are illustrated and explained. Strong, healthy plantar flexors activate the forefoot lever and are therefore essential in forming the supportive area on the ground. The stronger the muscle strength, the larger the supportive area. As long as the body’s centre of gravity is above this surface, the plantar flexors keep the body in a stable balance. If this muscle group is weak or paralysed, the forefoot lever is less or not activated at all and the supportive area is reduced. The lower the strength of the plantar flexors, the less balanced the body becomes. A forward shift of the body weight would lead to a fall. To counteract this, a custom-made orthosis with a foot piece should be produced, which is rigid between the heel and the metatarsophalangeal joints. The orthosis should have a rigid anterior (ventral) shell and be produced with a mechanical system ankle joint with two precompressed spring units, such as a system ankle joint from the NEURO SWING product range.

Video 3  Why the NEURO SWING is State of the Art in Neuro Orthotics

This video explains in detail why an efficient lower leg orthosis (AFO) should always include two interchangeable precompressed spring units in addition to the functional elements mentioned in video 2. The inadequate effect of conventional springs, compressed springs and posterior leaf springs (PLSAFOs) and spiral orthoses in terms of resistance force (basic resistance), minimum spring force, inclination angle (basic alignment of the orthosis) and restricted range of motion is illustrated. None of these options improve stability, which is why these treatments are not state of the art. The effect of a joint with precompressed spring units is then explained and a direct comparison with the other options is drawn. Finally, the functionality of the interchangeable precompressed spring units of the NEURO SWING system ankle joint and their effect is discussed.

Video 4 – Problems of Conventional Treatments that are not State of the Art

The different types of orthoses with their terminology and functions have already been explained in detail in the Types of Orthoses section. In this video, the conventional treatments are considered in detail with regard to their effect on a combined weakness of the dorsiflexors and plantar flexors. With a conventional AFO, no supportive area is created due to the lack of a dorsiflexion stop, which can result in a fall. A posterior (dorsal) shell and a plantar flexion stop can lead to a hyperextension of the knee and a lack of stability when standing. Although a SAFO activates the forefoot lever due to its rigid design, it blocks the dynamics in the ankle joint and causes the heel to lift when the body weight is shifted forward, which also leads to an insecure stance. Although PLSAFOs and spiral orthoses allow for a tilt, they are either too flexible and lead to insecure standing or too rigid and prevent movement in the direction of plantar flexion, which affects the natural gait. In addition to orthoses, the use of conventional devices such as crutches and walkers is also considered. Although they compensate for the effect of the forefoot lever and thus improve stability, they require the use of the arms and upper body, which can lead to problems in the arms, shoulders and back.


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