Can A New Orthotic Provide Better Stability For Patients?

By Robi Garthwait, Contributing Editor

   For some patients, the traditional foot orthosis is simply not enough to reduce the pain and symptoms associated with a variety of podiatric disorders. However, the Dynamic Control Orthosis (DCO) may provide the additional stability that podiatrists are seeking for their patients.    The DCO features a custom-molded polypropylene, metatarsal length foot orthosis with a 35-mm heel cup and free motion ankle joint attached to a polypropylene calf section, according to the device’s manufacturer, Langer, Inc. The one-piece calf design and footplate allows for maximum leverage, preventing abnormal motion in the transverse and frontal planes.    Generally, when patients have conditions that require control of the tibiofibular segment and the ankle/subtalar complex beyond what a foot orthosis can provide, they are good candidates for the DCO, according to Russell G. Volpe, DPM.    Practitioners might consider using the DCO for a variety of conditions, says Dr. Volpe, a Professor in the Department of Pediatrics and Orthopedics, and the Chairman of the Department of Pediatrics at the New York College of Podiatric Medicine. These conditions include posterior tibial dysfunction, degenerative arthritis or medial instability of the subtalar and/or ankle joints, severe pronation problems and sinus tarsi syndrome.    Dr. Volpe notes the device can also be useful as part of a rehabilitation program for traumatic injuries including ankle sprains.     “The DCO allows for sagittal plane motions which is essential for your more active, dynamic patients,” says Dr. Volpe.

How The DCO Controls Unwanted Motion

   The product offers several features, including the integrated calf section, which make the DCO an attractive treatment option, explains Dr. Volpe. He notes that the DCO “facilitates an effective closed chain three-point pressure system to control undesirable motions in the leg and foot.”    Chris Sacco, DPM, who utilizes the DCO to treat conditions ranging from tendonitis to plantar fasciitis, concurs.     “The rigid connection between the medial and lateral uprights helps eliminate unwanted motion,” says Dr. Sacco, who is board-certified by the American Board of Podiatric Surgery. He also praises the fiberglass casting sock that comes with each order as “an easy method for obtaining a quality mold.”    The DCO’s features also include a removable medial and lateral soft interface pad system, and a compressible post to the sulcus. Additional options available include PPT Gel Cold Therapy inserts and a temporary 90-degree ankle lock.

Addressing Patient Acceptance

    “Patient satisfaction is around 90 percent,” says Dr. Sacco, a Fellow of the American College of Foot and Ankle Surgeons. He adds that in worker compensation cases, patients “are able to continue working.”    Despite the success rate, patients need to be prepared to accept the DCO.     “As with all the articulated AFOs, patients need to be both physically and psychologically prepared for the bulk and design of these types of devices, and the appropriate shoe gear to maximize their effectiveness,” points out Dr. Volpe. “Patients must be willing to support these devices with appropriate shoes and accept the necessary limitations that their use implies.”     “Some people will not use a brace because of cosmetic concerns,” adds Dr. Sacco.    However, tolerance of the calf section can also pose a problem with all AFOs, reveals Dr. Volpe. He notes that Langer trains practitioners in casting and the design process to reduce the chance of complications.    Drs. Volpe and Sacco are familiar with other AFOs on the market, including Paris Orthotics’ Richie Brace, with which Dr. Sacco has positive experiences. However, both doctors would recommend the DCO to other practitioners.     “The Langer DCO, with the one-piece integrated calf design and carefully designed foot orthoses, represents an attractive alternative to other products,” says Dr. Volpe.

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