Re: More questions...DAFO, AFO, DBB

[Guest guest]

,

Here is a link to a lot of prior messages about AFO's

http://health.groups.yahoo.com/group/nosurgery4clubfoot/message/26101

Apparently, the initial DAFO (Dynamic Ankle Foot Orthotic) was a

brand name by a company called Cascade DAFO around 1982 for a better

fitting AFO that is made out of a thinner and more flexible plastic

material. DAFO may be a patented concept and is a trademarked name

for their type of AFO. To some degree it is like Kleenex is a

trademarked name for a better tissue.

From looking at their web site (DAFO, the Original Dynamic Foot

Orthotic), they show photos of about 20 variations of their DAFO

concept. All of them are below knee AFO type applications which

would not address the need for maintaining external rotation of the

foot. They appear to be a better AFO that fits and bends easier than

regular AFO's. But they are still AFO's.

KAFO's at least go above the knee and so could maintain some external

rotation to the foot like the casting does. But KAFO's have their

own problems (as stated in the Global HELP booklet) and should not be

used for maintaining correction in the Ponseti method.

Also at their site, I did not see them state that their product is

used for clubfoot. http://www.dafo.com/default.asp

At their web site they state concerning the difference between DAFO's

and AFO's: DAFOs Compared to AFOs "

" The plastic Ankle Foot Orthosis (AFO) is an orthotic design that has

been in use for many years. AFOs are rigid plastic shells that

partially wrap around the posterior of the lower leg, the heel and

under the foot (the Cascade " R " brace is a Regular AFO). Alignment

corrections are dependent on straps that pull the patient's heel and

leg back against the rigid shape of the brace. The patient's lower

leg is locked into this rigid position. The muscles that were causing

control or gait problems are supported by the brace, so stance and

gait may be improved. Those muscles that were functioning well,

however, may be over supported by the brace. Once use of the brace

becomes routine, these functioning muscles become weaker over time

through lack of use. "

" The Dynamic Ankle Foot Orthosis (DAFO) is a newer design concept

using similar technology. The shell of each DAFO brace is formed on a

plaster model of the patient's foot that has been reshaped to a

corrected foot alignment. The shell wraps very closely around the

patient's entire foot and ankle. The intimate fit of the shell allows

for use of a thinner plastic to precisely correct and control foot

position to a degree not possible in a standard AFO. The thinner

plastic allows the shell to flex, making the brace more comfortable

for the patient. The different DAFO styles offer a range of support

and control posibilities that allow a brace to be tuned to the

patient's needs. Those muscles that are well controlled by the

patient can remain active while the brace gives an appropriate level

of control or support to the muscles that require assistance. " page 3

of 13 at http://www.dafo.com/imageuploads/file114.pdf

It is possible that over the past 22 years, that other orthotic

manuafacturing groups have been able to somewhat get around any

patent issues for the original DAFO and are making something similar

that is generically referred to as a DAFO.

My guess is that your doctors problems with the DBB has been because

something was not done in the method exactly as designed. Then, not

understanding that whatever was changed might affect the ability for

the DBB to work, the DBB was blamed as the problem. There are a

number of things that can be modified that we have seen on the

internet to affect the ability of children to wear the FAB/DBB.

Dr. Ponseti has stated in their studies that for those who

discontinue the FAB/DBB early, the risk of relapsing is about 80%.

You have indicated that with the use of a very good quality AFO

(DAFO) that your doctor indicates that he still gets 50% relapsing.

Dr. Ponseti has shown that will the proper use of his method with the

FAB/DBB as designed, and compliance by the parents, that relapsing

drops to about 10%.

I hope that this helps.

and (3-17-99)

>

> Hi. First just my thoughts to the mom who's baby is having

> seizures...I'm no doc but febrile seizures are fairly common, and

> generally harmless (IF that's what your baby is having). Some

babies

> get them when they have a fever. My cousin's baby had them and it

> was scary & they had to undergo all this testing & in the end they

> just said it's febrile seizures & anytime he starts to get a temp

> they have to give him Baby Tylenol RIGHT AWAY to keep his temp

down.

> Anyway, that may not be what's happening to your baby, but that's

my

> 2 cents!! I hope everything turns out okay!

> Anyway, my daughter got her last cast off last Tuesday, and her

foot

> is BEAUTIFUL!!! Here's the thing...my doc uses Ponsetti's casting

> method, but not the DBB. He's prescribed a DAFO for my daughter. I

> tried doing some research because I had asked here before about the

> AFO & KAFO, but I never heard of a DAFO (Dynamic Ankle-Foot

> Orthodic). I can't completely understand it's function from what I

> read online, but from the pic I found, it looks VERY different from

> the AFOs & KAFOs. I'm EXTREMELY confused and VERY NERVOUS...I very

> much trust my doc, and I've questioned him before about the

Ponsetti

> method, because he does certain things differently. He is actually

> in close contact with Dr. Ponsetti & is going to Iowa next week to

> meet with him. The reason he prescribed the DAFO is because he said

> he can't get the DBB to work, he's had alot of trouble with it,

blah

> blah blah & that's why he's going to Iowa next week. But he also

> said their relapse rate is around 50%, as opposed to Dr. P's 10% or

> so. I was hoping someone knew something about the DAFO & could help

> me understand it before I meet with the orthodist or whatever

> they're called to get her fitted. Please help! I can't exactly

> express my confusion in words, but I'm sure everyone understands. I

> feel like I've been strong about the whole process so far...but now

> I see her kicking her little legs & wiggling her toes and I'm

> feeling resentful. I don't want her to have to wear a brace or bar

> or shoes or whatever! I just want to put cute little shoes on her

> like I did my other two and watch her learn to pull her feet up &

> suck on her toes....not go back to the stiff little leg that's hard

> to hold. I don't know what I'm saying, but like I said I'm sure you

> all understand the feelings I'm having. I absolutely know that

> bracing is essential, so don't lecture me!! I'm just letting off

> steam!! :-)

> Thanks,

>

> mommy of:

> Guinevere 5/28/00 (no CF)

> on 4/12/02 (no CF)

> Ava Ireland 8/4/04 (right CF)