Remodeling
Remodeling means to reshape or
reconstruct. An orthodontist remodels ones mouth when braces
are used to realign teeth. The Greek prefix "Ortho" means to
straighten. Braces or orthoses by definition should correct
any existing deformity. Remodeling orthotic support systems
for CMT are available. DynamicBracingSolutions™ has created a systematic approach that will address the
fixed or rigid foot and ankle in addition to knee
deformities. This process can be used as a conservative
treatment plan in place of surgery. In cases where surgery
has been performed and problems persist, remodeling can
still be effective.
Remodeling of what was once considered
"fixed" deformities of the foot and ankle complex, is now
possible. The primary medical treatment plan has been
surgical intervention for foot deformities, the use of
accommodative orthoses or both. A typical surgical procedure
that has been performed for many years is the triple
arthrodesis. This consists of altering the structure and
fusing the three major bones of the ankle complex. The
intended purpose is to restore the normal anatomy of the
foot and to prevent further deformity. Studies have shown
that fusions have not been successful in CMT. One study
recommended the procedure be used only as a salvage
procedure. The mechanical stresses of ambulation are too
great on the fusions. In time, nearly all fusions break
down, which can compromise future medical treatment plans.
Other joints and the body as a whole are also affected by
such procedures. Balance and security issues arise as a
result. The original intent to prevent deformity can
actually increase deformity!
Remodeling has been utilized in certain orthotic applications for decades and
is still in practice today. Fracture braces realign certain
fractures and hold bones in position until the fracture is
healed. In fact, even the healing process of the bone is
called remodeling. Scoliosis bracing of the spine applies triplanar corrective forces for extended
periods of time for the purpose of remodeling the curve. The
term triplanar refers to the three major planes of motion
that comprise human movement. Ironically, this concept has
not been applied to all orthotic systems. Most
orthoses for the lower extremity are one-dimensional
devices. They control forces in one plane
only. Over time this type of orthosis becomes the cause of deformities in the remaining planes
of motion. Human motion is three-dimensional. The doctor,
the Physical Therapist or the Orthotist, cannot ignore this
fact; the complex solutions for efficient and secure
mobility must be solved three-dimensionally.
Surgery in itself presents complications.
Any surgical procedure is serious and there is the potential
for complications. In addition to the extended recovery time
and rehabilitation, there are psychological issues involving
inactivity, anxiety and family pressures. If orthotic
intervention is to be used in place of surgery, the support
system must address present and future
deformities. Although the time frame varies,
deformities in most pathologies are predictable. The use of a conventional or
one-dimensional orthoses will only accommodate existing
deformity; in addition, they are static rather than dynamic.
The use of such devices may ultimately lead to surgery or
the termination of ambulation.
While many deformities are predictable,
they are also preventable. In the case of fixed or rigid deformities, the use of our Remodeling orthotic support systems is
designed to decrease deformity over an extended period of
time. This allows the individual to remain active during the
treatment. In the case of surgery, the best alignment is
obtained within the timeframe of the procedure without the
possibility of improvement. Since the remodeling process is
ongoing, the alignment potential is more favorable. As in
any situation, prevention is better than correction after
the fact. Remodeling is most effective when the joint
structures and tissues are supple and not fixed or rigid;
however, remodeling also works in these cases as well.
The process requires very skilled
practitioners along with committed clients to be successful.
As in the case of the orthodontist, follow-up visits would
be required to maintain constant corrective pressures as the
fixed deformities slowly give way. As alignment improves, so
does balance, weight distribution on the foot and reduction
of the deforming forces. Each degree of improvement makes a
difference. Remodeling is a corrective process that
takes time. In some cases, only a few months are
required while other cases take longer depending on
complexities. Very positive outcomes have been obtained
utilizing this technique.
The Remodeling process requires advanced skills and techniques that maintain
consistent triplanar corrective forces in both stance phase
and swing phase of the gait cycle. The corrective forces are
applied at all times while the remodeling device is worn.
The remodeling process works continuously while sitting,
walking or lying down. The Remodeling device is functionally
utilized like any other AFO for walking. As the deformities
decrease, there will be a corresponding increase in balance,
security and function.
Orthotic support systems that incorporate
remodeling techniques are temporary. The objective is to
maximize potential. As the foot and ankle become more
supple, increased corrective forces can be applied. The
first orthosis can be adjusted as long as the triplanar
control is maintained. It would be counterproductive to
continue beyond this point as it would limit further
improvements and possibly cause regression. Eventually, a
new orthosis would have to be fabricated reflecting the
positive changes and allow for the continuation of
corrective forces and continued progress.
Remodeling outcomes have been very
encouraging. It is a positive approach with improvement as a
goal rather than the accommodation of an existing problem.
The remodeling orthosis is dynamic as opposed to static.
Users have experienced many benefits. For some it has
prevented unwanted surgeries and fusions. For others it has
restored the ability to walk more efficiently and enjoy past
activities, such as golf and dancing. It has improved
everyone's balance and security. There are fewer problems
reported than with conventional orthoses such as reduced
pressures on bony prominences. The potential to enjoy a more
active lifestyle is possible through determination and the
dedication to finding DynamicBracingSolutions™.