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The latest newsletter from ProLab:
Preventing Malleolar Irritation with AFOs

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I am not aware of the extent of training that Pod's get in AFO's and their casting/use/.... etc.

However, this advice in this newsletter is dangerous. Poly AFO's are contrindicated for fluctuating oedema.

If you cast in the AM then the fit in the PM is constrictive leading to pressure on the leg.

If you cast in the PM then the AFO in the AM is loose leading to fiction/pressure sores as the leg 'moves' in the AFO.

These are not problems you want in a patient with fluctuating oedema.

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''The bottom line is too many people prescribe devices who haven't got the faintest idea of what they are doing. There are certain unscrupulous labs supporting this. There are too many people in it for the money.'' paraphrasing Simon Spooner

After reading your post, the question I ask is how many non-Pods get training in treating fluctuating oedema???

I disagree with your statement that fluct oedema is a "contraindication". It is a precaution. This must be taken on a case-by-case basis. The mere fact that the oedema "fluctuates" suggests that it most likely can be managed with compression therapy.

There are many advantages to a MAFO compared to a double upright AFO- better hindfoot control, less heavy, less O2 consumption, concealable, less expensive, can be used with a variety of shoes, less stigma, better compliance, etc. Patients HATE double uprights.

Why not TREAT the oedema and order the MAFO in patients with low risk limbs. It will serve as a barometer and reinforcement for the oedema treatment. I do this quite often and have much success.

Nick

Heah Nick

I agree. Treat the oedema first and when its stabilised then use the AFO (???MAFO....not one ive come across before).

My point is that the advice here is that the two can be done together.....which is misleading.

Also, are they recommending that the cast is taken with the compression hoisery on? There are too many variables for this newsletter to be correct.

Dave

PS There are loads of professions that treat oedema....apart from pod's.

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''The bottom line is too many people prescribe devices who haven't got the faintest idea of what they are doing. There are certain unscrupulous labs supporting this. There are too many people in it for the money.'' paraphrasing Simon Spooner

As an Orthotist Prosthetist (Foot and Ankle Centre) I can assure everyone that there are many many many types of AFO's. When the AFO is custom made, adequate relief in the positive cast can be inbuilt so that the malleoli can not abrade.
The prescription principles always relate to what (mechanically) the AFO needs to achieve - treat the oedema as oedema.
My lab does some ex fab work for remote podiatrists - I think it worthwhile that in circumstances such as an absence of a P&O that a professional with mechanical device fitting experience helps out.
Regards Paul R