Orthosis for children with congenital tibia pseudarthrosis I

Abstract 

Congenital pseudarthrosis of the tibia is a bone disease being difficult to treat.Many methods of treatment have little effect. Patient's pelvis and torso canmaintain the balance after wearing orthosis.It will avoid a lot of complications, and help the patient standing and walking.

Key words 

Congenital pseudarthrosis of the tibia;orthosis

Congenital pseudarthrosis of the tibia is one of rarest deformity and difficult to treat, and its incidence is about 1: 19000. [1] few children appear pseudarthrosis of the tibia at birth, but most children born without obvious deformity or with only the lower tibia bending forward.The diagnosis is usually determined along with the pain caused by fracture. Fracture is unhealed for a long time, partial pseudarthrosisoccurs in angulation deformity. [2]

No ideal treatment is for congenital pseudarthrosis of the tibia.Repeated surgery stillcan not be cured in the progress of treatment, that may result in lower limb being shortened or disabled , and even in amputation. [2] Surgery is based on yearly treatment.The younger the patient is ,the higher failure rate is. Once the patients wear orthosis, and regular follow-up is necessary. [3].

First,Case Analysis

Children with Surname of An, female, was born August 11, 1995, has the deformity of proximal leg during walking.In 2002 she was diagnosed with congenital proximalpseudarthrosis of the tibia and fibula, her lower limb was shortened after surgery(Fig. 1). In 2004, she came to MEDI-REHATEK Rehab Center to check.Bilateral lower limb was measured with unequal length, the length difference is 5cm.knee is normal where pseudoarthrosis is located below 3cm.Spine are normal. 

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Flatfoot and Orthopedic shoes

Today MEDI-REHATEK will introdue you the symptom and cause of flatfoot.

A symptom

1, symptoms: 

There are two types of flatfoot,that is renewable and stiff.The medial longitudinal arch can be observed in normal foot when sitting and standing.If the arch is disappeared when sitting,saying renewable flatfoot. If we can not see longitudinal arch of the foot, that is stiff flatfoot. It can be separated into postural and spastic type.

1.1 Postural flatfoot: 

The onset of the arch is no abnormal appearance. But it feels tired and pain after walking and foot fatigue.The outside ankle of shank has a sense of pain, sole center and instep may have swelling.The navicular tuberosity hasswelling and tenderness, local skin with redness as well as mild foot varus limitsstanding. Symptoms and signs of flatfoot and foot valgus may disappear after rest.

1.2 Spastic flatfoot: 

It occurs most in young adults, some evolve due to be mishandled from postural flatfoot.It feels severe pain when standing or walking and the footstep is like Chinese character “八”. Peroneus longus has tonic spasm, footvarus and valgus, abduction movement is limited. Heel is widened, sole turnsoutwards, the achilles tendon deflects outwards. Navicular tuberosity of forefoot abduction completely collapses and projects outwards. Much worse,the footbecomes stiffness. The movement of foot varus and valgus, abduction and dorsiflexion is limited.It is difficult to improve symptoms even after a long time of resting, it, partial patients may has secondary  low back pain and hip-knee pain.

According to the clinical severity of the disease,it can also be separated into three types. But the change needs to be observed when the longitudinal foot arch bearsweight:

① Light: longitudinal foot arch reduces;

② Medium: longitudinal foot arch disappears;

③ Heavy: longitudinal foot arch disappears with the projection of medial edge. The head of the talus is shifted to plantar side that is below the front of malleolus. Sometimes patients presents with shortened achilles tendon and heel turns outwards.

2 Complications: 

Early symptoms have the anteromedial ankle pain. Long time of standing or walking exacerbates the pain.Rest relieves pain. The pain joint has swelling around,much wore like scaphoid tubercle causes staggering step, achilles tendon splays like the Chinese character “八” .

Through footprints inspection, the vacancies of longitudinal arch disappear.The middle of foot becomes wider, and sometimes as well as heel does.The arch disappears after X-ray examination. The angle increases between the longitudinal axis of the calcaneus and talus.Bone bridge forms after 12 years old.

B  Cause of Disease

It has not been elucidated, but epidemiological studies have found that the disease has a significant genetic predisposition. Pathological inspection shows that tarsal has no developmental abnormalities, but the ligaments connection with joint capsule of articulationes subtalaris,articulationes talonavicularis,boat wedge joint is more flabby than normal people.Calcaneus beneath talus turns inwards when foot bears load,its front moves to back and outer side.The talus moves to plantar and interior side. It will cause with more slack ligament that can’t support the head of talus.Longitudinal foot arch is lowered.The slack calcaneal ligament makes the calcaneus turn inwards and exacerbates the decline of longitudinal foot arch.

Clinically the cause of disease is separated into four factors:

① genetic factors;

② congenital deformities of foot bone ;

③ foot trauma or chronic fatigue;

④ Intrinsic or extrinsic muscles of foot is weak or spastic or paralyzed.

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Orthopedic insoles for diabetic foot ulcers

Diabetic foot ulcers is one of the common chronic diabetic complications, that is the main reason of amputation on diabetics. The feet of diabetics are particularly vulnerable to vascular and neurological diseases. 

Diabetic vascularity and nerve diseases affect each other and cause a series of clinical foot disease, including toe disease, callus formation, foot ulcers and skin lesions, musculoskeletal lesions causing deformities of the feet. The neuropathy of diabetics often causes loss or reduction of foot that is vulnerable to injury.Minor trauma can quickly cause ulcers, infections and gangrene, and eventually to be amputated.

MEDI-REHATEK Orthopedic insoles have treatment and prevention of diabetic foot ulcers.It redistributes plantar pressure,absorbs shock,stabilizes the foot and limits joint activities. 

At the same time patient can wear with the orthopedic shoes that are fit for their own feet ,have inner depth and can decrease foot pressure andaccommodate foot deformities. 

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Arm sling for three common injuries

Arm sling,also known as upper extremity sling,that is used in rehabilitation phase after with injury of upper limb.

Three major symptoms of MEDI-REHATEK arm sling as below:

First, to limit the joint after with fracture and injury of upper limb;

Second, to limit the joint with stroke, paralysis;

Third, to limit the joint with paralysis of deltoid muscle

Arm sling is mainly used for joint limit and protection when sitting and standing. 

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Rigid elbow orthosis

MEDI-REHATEK Rigid elbow orthosis, also known as fixed shoulder-elbow-wrist brace ,which is widely used in limit protection for elbow injury of upper extremity.

First, rigid elbow orthotics has functional fixation of elbow fracture;

Second,rigid elbow orthosis offers functional fixation of muscle injury on elbow;

Third,rigid elbow brace provides functional fixation of tendon injury on elbow;

Fourth,rigid elbow immobilizing orthosis is for functional fixation of nerve injury on elbow.

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Orthosis designed for finger flexion contracture

Fingers with flexion contracture (ape hand deformity) can’t extend straight normallydue to flexion constracture of finger extensors caused by radial nerve palsy.

MEDI-REHATEK Dynamic hand function orthosis can fix fingers and wrists in their functional positions according to the ergonomic requirements,which is the main aids ofrehabilitation training for patients.

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Rigid Elbow Immobilizing Orthosis

MEDI-REHATEK Rigid elbow immobilizing orthosis,being made of thermoplastic material or avacuum-forming resin sheet with high intensity, has a good adaptation as the mold taken from patient directly. This type of orthosis has an excellent immobilization effect for elbow fractures, muscle, tendon and nerve injuries. 

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Precautions of using below-knee prosthesis

Below-knee amputees should strengthen the muscle force of the knee flexion and extension, especially the extensor (quadriceps) in the progress of installing and wearing prosthesis.This will facilitate a more powerful swing while wearing the prosthesis by below-knee amputees.

Amputees with prosthesis should carry out some trains like standing balance ,swaying, walking climbing up and down stairs, ramps, then do other adaptive training.

MEDI-REHATEK professional advisors has the following recommendations for the amputees with prosthesis:

1, To early prevent muscle of residual limb from atrophy, the training for muscle strength of residual limb should be based on the guidance of the rehabilitationtrainer;

2, Patients must maintain a stable weight level. Weight changes over a certain rangethat will inevitably affect the shape of the residual limb.That will easily lead the prosthetic socket to be  too tight or loose;

3, To prevent below-knee prostheses from being subject to greater external compression, impact and high temperature, humidity and so on (except waterproof prosthetic);

4, If patients find out any unusual circumstances in wearing, who should immediately stop using prosthesis, contact and assembly units in time, and not give anyindividual to repair or repair by themselves, in order to avoid accidents or adverse factors impacting on the warranty even and damage identification.

5, Regularly clean the stump, kept dry and clean. Keep skin of stump and prosthetic socket clean, prevent the skin of residual limb from irritation, folliculitis, boils, swelling, ulcers, dermatitis, allergies and so on.

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The responsibilities for doctor to act in orthosis assembly

MEDI-REHATEK has learned the responsibilities for doctor to act in orthosis assembly.

The doctor has the opportunity to issue an orthotics prescription,who should not only be master of basic knowledge of orthosis,but also understand the principles and the structure of various orthosis,orthotic prescription is issued with in-depth understanding of the disease.Doctors should consider solutions for limb defects from the biomechanical point, meanwhile pay attention to the general condition and current state of mind of patient. After the possession of various cases,doctors choose the most suitable orthosis for patients, The prescription is clear, unambiguous, but also practical. It must clearly specify the purpose,requirements,range of fixation of orthosis,physical position and force distribution etc.In case of complex and difficult cases or special requirements,doctor and orthotist should  prescribe together.

 The correct orthosis prescription is very important after master of use of orthosis indication, As orthosis involves in many diseases,Orthotist can not analyze the patient’s condition and have ability to adapt orthosis without physician’s prescription.It is impossible to ask them observe correction effect and changes in the disease after installing orthosis. On the other hand, if a surgeon, orthopedic or rehabilitation doctor can’t prescribe a right and proper order without basic knowledge of orthosis.Of course.It is impossible to guide  orthotist, specify requirements and note the problems of orthosis.Meanwhile it is unqualified to finish functional evaluation after the completion of the product.

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